The Physician Shortage and You
A shortage of doctors in the coming years
may mean you’re better paid,
but busier than you would like.
but busier than you would like.
In May of this year, the Association of American Medical Colleges (AAMC) sponsored a national conference on
the physician work force in Washington, DC. Many of the leading
experts in the world of physician supply and demand studies
were there.
With the notable
exception of Richard “Buz” Cooper, most of these
experts had, in previous years, predicted that the U.S. would
have far too many physicians.
They have since
changed their minds. Edward Salsberg, the head of the
AAMC’s Center for Workforce Studies, made a startling
admission during the conference. He indicated that the
AAMC’s goal is to increase the number of U.S. medical
school graduates by 3,000 per year by 2015. However, even if
this difficult mission can be accomplished, the U.S. still
could have a deficit of 200,000 physicians by the year 2020.
Why are we running short of
doctors and what does it mean to physicians new to the work
force? Executives with my firm, Merritt, Hawkins &
Associates, tackle the first question in a new book entitled Will the Last Physician in America Please Turn
Off the Lights? A Look at America’s Looming Doctor
Shortage (available at www.practicesupport.com). But here’s
the short answer: Demand for physician services is
increasing while the supply of physicians is decreasing.
Growing demand is in
part a function of demographics. The U.S. Census Bureau
projects that the U.S. population will grow from 285 million in
2000 to 335 million by 2020. That is roughly equivalent to
adding the population of England over a period of 20 years.
In addition,
we’re not getting any younger. In fact, we are getting a
lot older. Florida currently is the oldest state in the union
on average, due to its disproportionate population of senior
citizen retirees (it is followed by West Virginia,
Pennsylvania, Rhode Island and Maine in the geriatric
department.) Well, Florida is our future. The Census Bureau
predicts that by 2030 the entire country will, on average, be
as old as the population of Florida is now.
This matters because older
people visit a doctor at a much higher rate than younger
people. The National Ambulatory Medical Care Survey reports that people between the ages of 25
and 34 visit a physician 2.2 times per year, while people 65-74
visit a physician 6 times a year. Those 75 and over visit a
physician 7.22 times a year. Setting the question of aging
aside for a moment, population growth alone will account for
150 million additional physician visits by the year 2020. That
is if you multiply an increase of 50 million people between
2000 and 2020 by three, which is the number of times, on
average, Americans visit a physician per year. However, that
rate is set to increase significantly, as it has for the last
10 years. Add population aging to the mix and the number of
physician visits we will soon generate gets into Carl Sagan
territory (“billions and billions.”)
Other factors also are
driving demand. We’re fat and we want to live forever (or
at least look young forever). Obesity-related conditions and
the growing appetite for elective procedures that enhance
appearance or lifestyle are contributing to rising surgery
rates. We’re also getting much better at prolonging life.
People who used to die of heart disease and cancer are
surviving into advanced old age, and they require regular
medical attention and a growing variety of prescription drugs.
On the supply side, we will
soon be reaching a point of decline in the physician
population. The consulting firm MGT of America projects that in about 15 years the number
of physicians retiring or passing away each year will exceed
the number entering the work force. But that is only part of
the supply story. The significantly higher number of women
entering medicine is having a dramatic impact on the physician
work force. Female physicians work fewer hours per week than
male physicians. This is not strictly a gender-based issue,
however, as many younger physicians, male and female, put a
premium on a “controllable lifestyle” and seek set
hours. Paperwork takes up an increasing amount of physician
time, and thanks to immigration policy changes, the supply of
international medical graduates is in flux. Congress has capped
both the number of residency programs it will fund through CMS
and the number of weekly hours residents can work.
Absent a major effort
to significantly increase physician supply, the net number of
physicians in the U.S. will continue to decline just as demand
for medical services is spiking.
First, the good news
The good news for physicians? The shortage
will bring job security, job choice, professional clout, and
rising incomes.
Unlike many professionals,
physicians will be able to select from a wide range of job
opportunities. In Merritt, Hawkins & Associates’ most
recent survey of final-year medical residents, 89 percent of residents reported they had
received 26 or more job solicitations over the course of their
residencies, while 43 percent said they had received over 100
job solicitations. The challenge will not be to find a job, but
to find one that most closely matches your professional and
personal parameters.
The “pull”
that physicians have in medical politics also is likely to
increase. As physicians become harder to find, their individual
influence within their groups and vis-a-vis hospitals will
grow. This already is apparent as many hospitals are moving
toward adding physician executives to their administrations and
adding physicians to their boards. The current rift between
specialty hospitals and traditional acute care hospitals is
tied in part to physician supply trends. When physicians invest
in specialty hospitals or ambulatory surgery centers,
presenting a direct challenge to traditional hospitals, they
often cannot simply be replaced. In an era of shortages,
physician retention, even if it means political compromise,
will become more important to both hospitals and medical
groups.
Physicians’ incomes
also will generally trend upward. Because reimbursement is set
by third parties, physicians don’t have the same control
over their incomes that other professionals do. Nevertheless,
the shortage will have a positive effect on incomes as doctors
are able to select better paying patients if they so choose.
This trend already is well under way. Surveys show that an
increasing number of physicians are not accepting Medicaid. In
Merritt, Hawkins & Associates’ 2004 Survey of Physician Appointment Wait Times, only five percent
of ob/gyns in New York City indicated they accept Medicaid as a
form of payment, while Medicaid acceptance rates for physicians
in other cities also are low. In addition, fewer physicians are
available to cover hospital emergency departments and a growing
number of hospitals are paying doctors to do so. With numerous
patients available, some physicians do not feel obliged to
participate in discounted HMO or PPO insurance plans and are
experimenting with classic fee-for-service medicine.
Rising demand is certainly
affecting the financial incentives hospitals and medical groups
offer to recruit physicians. Income offers to the top 10
recruited specialties have increased by an average of 16
percent in the last three years, according to Merritt, Hawkins
& Associates‘ 2005 Review of Physician Recruiting Incentives. (See “Demand Draws Higher Pay” in the July/August issue of UO).
The time it takes to
become a physician (and the educational debt many physicians
incur) makes medicine a less lucrative profession than is
commonly perceived. Primary care physicians, in particular,
often do not enjoy incomes comparable to those of other
professionals when pro-rated out over the course of a career.
However, the shortage will help physicians to maintain their
incomes and to increase them in some cases.
There are negatives
Being busy and being wanted will be mixed
blessings for physicians practicing in the era of physician
shortages. Lifestyle-conscious or not, younger physicians will
find themselves pressured to see more patients and it will be
easy to become overextended. It also will be harder for
physicians to spend as much time with patients as they would
like. In some cases, assembly-line medicine will be
unavoidable.
Patients will have to
schedule appointments further ahead and the time they spend
waiting to see a physician once they are in the doctor’s
office is likely to get longer. This won’t help the
already fraying physician/patient relationship.
Indeed, general tension in
health care will heat up as uninsured or underinsured patients
have an increasingly hard time seeing a physician. Studies
already suggest that a growing number of non-emergent insured
patients are seeking treatment at hospital emergency rooms in
order to have quick access to a physician. Lack of specialists
covering the ED will be a growing problem. A survey conducted
by The Schumacher Group, an emergency medicine management firm,
indicates that 43 percent of hospital ED managers already
believe that lack of medical specialists available to cover the
ED poses a “significant risk” to patients at their
facilities.
Physicians will find
the shortage frustrating for a variety of reasons, particularly
when they have a hard time referring their patients to
specialists or when they themselves are seeking to add
physicians to help cope with a busy workload. The shortage also
means that physicians will need to cede a growing variety of
clinical duties to allied professionals.
Although these are sobering
negatives they hold the seed of a positive, which is that
medicine is an extremely challenging profession, open only to
the dedicated and the capable. That is why under the modern
system of medical training there has never been, and never will
be, “too many” physicians. The system is designed
to be exclusionary, and that is generally a good thing for
patients and a point of pride for physicians. Clearly, we need
to train more physicians, and the cost of a medical education
should not be prohibitive. At the same time, we should
acknowledge that, for our own benefit, physicians will always
be an exclusive group. g
Kurt
Mosley is the vice president of business development for Merritt,
Hawkins & Associates and Staff
Care, Inc., affiliated
companies specializing in permanent and locum tenens physician
staffing. He can be reached at kmosley@mhagroup.com.
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