Remedies for Looming Doctor Shortage
Prepare to spend some extra time in the waiting room—there’s a looming doctor shortage on the horizon.
The Association of American Medical Colleges (AAMC) estimates the country will come up short by 62,900 physicians in 2015, and by over 130,000 in 2025. As Minnesota 2020 has reported, the gap will be greatest among primary care docs. That means longer waits to see doctors, further drives to available doctors, and often skipped care when the hassle proves too great. It also means pricier care, as primary care physicians fall back on referrals to more expensive specialists to save time.
The main driver of the shortage is the United States’ aging population. With baby boomers retiring, the number of Medicare enrollees will double between 2000 and 2030. “Older Americans require significantly more health care,” says Dr. Darrell G. Kirch, AAMC President. Compounding the problem is the number of baby-boomer doctors approaching retirement—one in three current doctors is 55 or older.
A second factor adding to the shortage will be the 32 million Americans who begin receiving insurance coverage under the Affordable Care Act in 2014. These previously-uninsured individuals will suddenly have the financial means to seek out doctor’s visits on a regular basis.
The forces pushing medical students to become specialists rather than primary care doctors exacerbate the problem. That trend has been clear since the late 90s, no doubt driven by the wage differential—today, specialists often make twice as much as primary care physicians.
The shortage will do the most damage in low-income and rural areas, while leaving some parts of the country relatively untouched. Today, Minnesota ranks 13th among the states in physicians per capita. Furthermore, 51% of doctors who receive their undergraduate education in Minnesota practice here, beating the national average of 38.6%. The state also retains 44.2% of doctors who attend medical school here, near the nation’s 45.7% average.
This is not to say Minnesota will dodge the doctor shortage bullet. A 2008 study found nearly half of Minnesota doctors are over 50, and our state’s retirement-age population is growing even faster than the national average. Problems will be felt most acutely in rural Minnesota; 13% of Minnesotans live in rural areas, but only 5% of our doctors practice there.
What can be done to alleviate the looming doctor shortage? Here are a few suggestions:
Train more doctors. Medicare funds most medical residencies, but their number has been limited since the 1996 balanced budget act. Obamacare includes funding for new primary care residencies—172 slots in the first year—and has incentives for working in underserved areas. But these are baby steps. Right now, growth in medical school enrollment actually lags behind population growth, while medical schools only accept 8.9% of applicants. We need to open the floodgates to counteract the looming doctor drought by accepting more applicants and establishing more residency programs.
Expand the medical experts we consult. There are a number of medical professions that could help fill the looming gap in care. MN2020 has previously discussed the roles nurse practitioners and physician assistants can play moving forward. Studies demonstrate both professions are medically competent enough to relieve some of the burden on doctors, and could take on an expanded role with less required supervision from medical doctors.
Allow more immigrant doctors. With higher doctors’ earnings than anywhere else on the planet, the U.S. could easily attract more foreign doctors if we adjusted our very tight caps on their visas. The Conrad State 30 Program has proven successful in the past at bringing in foreign doctors and directing them to medically underserved areas. The program, however, has existed on a temporary basis since its inception. The Conrad State 30 Improvement Act is currently sitting in the Judiciary Committee of the U.S. Senate and would both expand the program and make it permanent. This act or other legislation that permits doctors to immigrate to the U.S. more easily could give an immediate shot in the arm toward reducing the doctor shortage, and provides the benefit of allowing for targeting medically underserved areas by requiring immigrant doctors serve there.
Better utilize technology. Modern technology can both better direct resources to underserved areas and expand the number of patients a doctor can treat. Better integrating technology can take the form of telemedicine, remote medical devices, and even simply e-mail with your doctor. Such methods can free up valuable time for physicians while saving patients a trip to the doctor’s office, all while providing quality care.
If we want to curtail the looming doctor shortage, we must act. Only smart public policy can address the problem while guaranteeing the access to quality care Minnesotans cherish.