"Doctor Dearth" Opportunities and Exposures
Worth Magazine, Published November 2005.
By Leana S. Wen, 2005-2006 National President, American Medical Student Association
Who's going to treat you when you get older? Access to healthcare is a problem that plagues the 45 million people in America who lack health insurance. The U.S. is still the only industrialized country that still does not guarantee healthcare to every one of its citizens. But will access to doctors-that is qualified, competent doctors-be a barrier for even wealthy patients who can afford health insurance?
If current trends continue, the answer is likely to be yes. The population in the US has been steadily increasing, and its most quickly growing portion is the elderly. Beginning in 2011, baby boomers will begin to turn 65 years of age. The number of Americans per day turning 65 will rise from 6,000 to 10,000. The aging baby boomers will place enormous pressures on the healthcare system, and will create demand for tens of thousands of new doctors.
However, the medical community had developed a consensus that there were likely to be too many, rather than too few, doctors. Some groups in organized medicine wanted to restrict the supply of doctors to drive up salary, and the data available on workforce composition was too scant to contradict their assertions. Consequently, while several new osteopathic medical schools have opened, the number of graduates from allopathic medical schools (schools granting the "MD" degree) has remained steady since the 1980s. This occurred despite the many qualified students applying to medical schools; each school turns away 2 applicants for every accepted student.
Over the last few years, multiple studies have confirmed that a physician workforce shortage rather than an oversupply will likely develop, with mid-range estimates of a shortage around 90,000 doctors by 2020. Shortages are predicted to be more dramatic in primary care than in specialty fields. Distribution and access-to-care issues will likely be exacerbated as well, with even fewer physicians willing to work in underserved inner-city and rural areas.
The Looming Physician Shortage
The U.S. is facing a looming physician shortage that could potentially impact health care delivery. In retrospect, simple laws of macroeconomics would have predicted the shortage years earlier: the supply of physicians remained steady while the demand was expected to increase exponentially. Yet it was not until earlier this year that the government-appointed Council on Graduate Medical Education finally reversed its policy and admitted that if trends continue, demand for physicians will far outstrip supply. Both it and the Association of American Medical Colleges finally took up the call to propose solutions to the looming shortage.
The solution is simple enough: train enough physicians to meet the needs of our society. By 2020 our society needs more doctors, up to 90,000 more, than our medical schools are training now. We must get more doctors from somewhere. The most ethical method and the best investment is to expand our physician workforce by training more medical students within our own country. Currently, we rely on graduates of international schools to fill our training positions-25 percent of residency positions are filled by international graduates, who subsequently become practicing physicians in the U.S. Reliance on international graduates creates an unfair burden on the developing world, draining them of intellectual talent and healthcare providers. It is also a far better investment for our country to expand medical school capacity, particularly because we have the resources and the human capital to fill the schools.
We also need to ensure that our new doctors are well-trained to reflect the changing needs of society. A 2003 survey found that one-third of graduating students did not find their training in the care of the elderly to be adequate. Less than 10 percent of medical schools require students to complete even one course in geriatrics. Yet it is estimated that doctors spend more than 50 percent of their time with elderly patients. In the era of aging baby boomers, each school should train students in areas like geriatrics that are becoming far more important in medicine.
So will you have access to a qualified and competent doctor in your old age? The answer is likely to be no unless action is taken now. After many years of self-denial, the medical profession is finally beginning to acknowledge the shortage, but it must do more: it must act swiftly and start opening medical schools and implementing curricular changes now. And ultimately, it must acknowledge that the problem of access runs deeper than just whether one person can find a single physician at a single point in time. Our country needs fundamental reform of the healthcare system so that everyone can have access to physicians and healthcare services.