With some regularity, articles are published that predict an impending shortage of physicians in the U.S., often based on the number of them being trained. However, a recent piece in the NYT questioned this logic with a look at how our healthcare system will be staffed in the years to come (see: A Doctor Shortage? Let’s Take a Closer Look). Below is an excerpt from it:
In 2014, the Institute of Medicine released a thorough analysis on graduate medical education that argued there was no doctor shortage, and that we didn’t really need to invest more in new physicians.The system isn’t undermanned, it said: It’s inefficient. We rely too heavily on physicians and not enough on midlevel practitioners, like physician assistants and nurse practitioners, especially because evidence supports they are just as effective in primary care settings. We don’t account for advances in technology, like telehealth and new drugs and devices that lessen the burden on physician visits to maintain health. And we fail to recognize that what we really have is a distribution problem. Parts of this country have lots of doctors, perhaps too many....[M]any rural areas, and less popular cities, experience more of a doctor shortage than others.The other distribution issue is in specialization....When you compare the percentage of physicians who are generalists with those who are specialists, the United States beats only Greece among developed economies. Here, financial drivers play a role. Doctors who choose to specialize can make much more money, millions more dollars over a career, than primary care physicians. Money isn’t the only reason that medical graduates choose to specialize.... A specialty that might offer you a lot more money is enticing. None of this should be taken as a cry for sympathy for the financial plight of doctors in general. They are more likely to be in the top 1 percent of earners than any other profession.
Here's a partial list of the reasons why I think we will not be facing a physician shortage despite the fact that demand for services will surely be increasing:
- Increased use of physician extenders such as nurse practitioners to help manage the increasing patient load (see: Healthcare providers grow physician extender staffs to meet demand).
- Increased use of telemedicine for visits that should allow physicians and nurses to increase their operating efficiency (see: Introduction of the Term "Webside" to Refer to Telemedicine Interactions; Firm Offering "White Label" Service to Enable Virtual Hospital Physician Office Visits).
- More efficient use of physician time using other digital medicine technologies such as e-prescriptions (see: E-Prescriptions Linked to Higher Utilization by Patients But Why?).
- Increased use of smartphone apps and health monitoring with "wearables" to assist patients with chronic diseases and support wellness (see: Physicians Will Soon Be Prescribing Apps to Improve Their Patients' Health).
- New drugs and the pursuit of healthier lifestyles to avoid, reduce, or eliminate some health risks (see: The impact of a healthy lifestyle on Disability-Adjusted Life Years: a prospective cohort study).
Although I discuss physician extenders above, it's likely that this term is going out of style (see: Healthcare providers grow physician extender staffs to meet demand).
[W]hen a healthcare provider refers to physician extenders they have two primary job roles in mind – nurse practitioners and physician assistants. Nurse practitioners may actually take offense at the term,...since they may have broad authority in some states and be able to make care decisions without the need of physician sign-off. That is not the case for physician assistants, who must work with a physician in all cases. Certainly not everyone with the title of physician assistant or nurse practitioner is a physician extender, either.
Here is a quote from an article about the primary care workforce that puts some numbers behind some my staffing predictions (see: Rethinking the Primary Care Workforce — An Expanded Role for Nurses):
...[T]he number of NPs entering the workforce each year has mushroomed from 6600 in 2003 to 18,000 in 2014. The number of primary care NPs is projected to increase by 84% between 2010 and 2025....If these trends continue, the proportion of primary care practitioners who are physicians will drop from 71% in 2010 to 60% in 2025 and will continue to decline thereafter. The proportion of practitioners who are NPs will jump from 19% to 29% during those years and will continue to rise. In rural communities, this trend is even more pronounced, since NPs are considerably more likely than physicians to settle in rural America.