A Word From the President: Facing the Facts About the Physician Shortage
AAMC Reporter: December 2013
For many of us, the time when we most need a doctor’s care potentially means we have experienced a profound personal moment of truth in our lives. We, as a nation, need compassionate, well-trained doctors to guide us through those difficult times. But as our aging population grows and the number of doctors who are available to treat individuals who need care is threatened by physician shortages, we are looking at a future crisis in medical care delivery. That is why it surprised me to read recent media articles that question whether the coming doctor shortage is real.
Over the past few years, the AAMC’s Center for Workforce Studies has released data strengthening the case for addressing an impending doctor shortage, even as a number of academics and analysts studying the workforce issue elsewhere have refuted our research or have put forward a different perspective on the data. For example, a November Modern Health Care magazine article titled “What Doctor Shortage?” directly questioned whether our nation is, in fact, facing a physician workforce challenge at all.
This troubling contention comes just as that shortage is worsening rather than abating. In fact, by 2020, we will need 91,500 new doctors, and by 2025, we will need 130,600 doctors, according to AAMC estimates. Contrary to what many believe, the coming shortage is divided nearly evenly between the need for more primary care physicians and the need for surgeons, oncologists, cardiologists, and other specialists.
Yet, in early December, an opinion editorial titled “No, There Won’t Be a Doctor Shortage” appeared in the New York Times, also questioning AAMC projections on the impending physician shortfall. In a letter to the editor published the following week, I took issue with the op-ed, noting that we are not facing an “either-or” proposition between new care delivery methods and adding more doctors to the workforce. The reality is that we need both. Improvements in technology certainly are making a difference for patients. And medical schools across the country are training tomorrow’s physicians to work in teams with other health professionals, including nurse practitioners and physician assistants, to make health care delivery more efficient and effective. But these efforts alone will not compensate for the need to increase the overall number of doctors providing care because of some undeniable demographics.
Our country is aging fast. The population of older Americans will double between 2000 and 2030. In fact, baby boomers will turn 65 at a rate of 10,000 per day for the next 19 years, according to the Pew Research Center. This translates to a new Medicare beneficiary every eight seconds.
With this longer life expectancy comes increasing consumption of health care services. Adults reaching age 65, for example, can expect to live almost 20 additional years, according to statistics from the Administration on Aging. And for many individuals with chronic diseases, the extent and complexity of their care only will increase, calling upon an ever-growing number of health care providers and interventions to bring relief. That fact alone will place added pressure on overall demand for physician services, as well as for other health providers.
And what of the physician workforce itself? As the general population ages, so do our physicians. Right now, 16 percent of doctors are age 65 or older. AAMC physician specialty data show that one in three practicing physicians expects to retire in the next 15 years. So even if we expand the health team, provide care more efficiently, and use technology better, the aging of our population and the expansion of access to health care through the Affordable Care Act points to one conclusion: we still will need more physicians to provide the care our nation will need.
Yet, in the face of these facts, some continue to debate how to analyze workforce numbers or how technical or medical innovations will eliminate the need for more physicians. While medical schools and teaching hospitals are working hard to revamp health care delivery models and pioneer new medical innovations, we also believe that our nation needs a modest increase of 4,000 doctors a year. Given the time it takes to educate and train a new physician (a minimum of seven years from the start of medical school), we need to begin this modest increase now; time spent on debate about idealized scenarios that may or may not prove true could be critical time wasted. Medical schools have been increasing their enrollments since 2006, but our nation cannot increase our overall supply of physicians unless Congress lifts the cap on residency training slots that has been in place since the 1997 Balanced Budget Act.
I am heartened by recent movement in Washington on reaching a possible bipartisan budget deal. For the first time in what seems like years, there are signs clearer heads may prevail, leading to restored funding for medical research and health professions training. But while this represents an important step, it remains only a first step on a long road. I believe all of us who advance the mission of medical schools and teaching hospitals have a responsibility to help the public and our nation’s leaders understand the urgent need for expanding the physician workforce to provide the care we all will need in the future. It is time to stop the debate and acknowledge the physician shortage for what it is—a risk to everyone’s health and well-being. This is the moment of truth for the physician workforce. How our nation responds—or does not respond—could affect our health and health system for decades to come.
Darrell G. Kirch, M.D.
AAMC President and CEO