Guest Author - A. Maria Hester, M.D.
National surveys confirm an impending physician shortage of potentially catastrophic proportions. The Council on Graduate Medical Education conducted a study which projects a deficit of 85,000 doctors by the year 2020, while a report by Dr. Richard Cooper, director of the Medical College of Wisconsin's Health Policy Institute estimates the impending physician shortage to be 200,000.
The Assn of American Medical Colleges' Center for Workforce Studies has determined that this impending shortage will result from the growth of the population, aging baby boomers, older doctors retiring and younger ones limiting their hours.
The average age of practicing physicians is 50. 18% of them are over 65, while only 12.6% of the overall population is over 65 years of age. (3) As older physicians retire there will not be enough new physicians entering the field to replace them, even when one accounts for new foreign medical graduates.
In addition, many physicians are striking a new balance between work and family. A survey by Cejka Search and the American Medical Group Assn found that both men and women appear to be more interested in working part-time than before. Between 2005 and 2006, the proportion of physicians who worked part-time increased from 13% to 20%. As a matter of fact, flexible work hours or part-time options ranked among the top 3 retention strategies noted by medical group leaders.
Medical school enrollment is another key factor in the impending physician shortage. According to the AAMC center, medical school enrollment was fairly constant at approximately 16,000 each year from 1980 through 2002. However, during the same period, the U.S. population increased by 71,000,000. From 1980 to 2005, medical school enrollees per 100,000 population dropped from 7.3 to 5.6, and if the current trend persists, the ratio is expected to drop down to 5 by 2020. 1
In an attempt to address the anticipated shortfall of physicians, the AAMC called for America’s allopathic medical schools to boost enrollment by 30% during the next decade1, but with high malpractice costs, dwindling reimbursements, long hours, and tremendous personal and family sacrifices, can America continue to attract the best and brightest students to this field when they could easily enter other professions that are potentially more lucrative and less demanding? Even if the answer is yes, how smoothly will they transition from medical school to medical practice?
AMA News recently reported that the training budgets for teaching hospitals may be cut between 15 to 30% if a recent CMS proposal goes into effect. The issue is the desire of the Dept. of Health & Human Services to end federal matching of state Medicaid graduate medical reimbursements. According to the government, this move would have the potential to cost teaching hospitals $1.78 billion over the next five years. However, GME leaders think the blow could be several times that much.
The impact could be felt in large and small training programs around the country. New York trains the most residents of any state. Kenneth Raske is president and CEO of the Greater New York Hospital Assn, whose hospitals train 16% of medical residents in America. Since most of New York's hospitals are simply break-even operations, such a tremendous cut would force them to revamp their services and training programs in the midst of anticipated physician shortages. Utah trains a mere fraction of the residents trained in New York hospitals, but the proposed cut would cost Utah an amount equivalent to salaries of 84% of the residents and fellows. For some programs which operate at the minimum number of residents allowed by the Accreditation Council for GME, losing just one resident would force them to close down their entire program!