Fixing the Doctor Deficit
Improving efficiencies can help, but cutbacks at state medical schools don't.
While everybody talks about the rising cost of health care, there's one number that's expected to drop. The country could end up with a doctor shortage--124,000 fewer physicians by 2025 to be exact, according to the Association of American Medical Colleges (AAMC). Some of the reasons have to do with population growth and aging, but the doctor deficit will be exacerbated by the new health-care reform law providing coverage to an additional 32 million patients by 2019.
Edward Salsberg, co-author of the AAMC's The Complexities of Physician Supply and Demand: Projections Through 2025¸ says the legislation likely will have a significant impact on demand, though pinpointing by how much is difficult. Nonetheless, "it's going to be a challenge for the supply side to keep up," he says.
Simply educating and training more physicians won't be enough to address these shortages, and Salsberg, director of the AAMC's Center for Workforce Studies, says improving efficiencies is a key factor. "When we surveyed physicians, time spent on paperwork and administration of health insurance is always listed as a very significant factor," he says. "If addressed, practicing physicians think it would free them up to provide more services."
Salsberg also mentions making better use of physician assistants and nurse practitioners by utilizing the team approach. "It may be that a physician working with a nurse practitioner and a physician assistant can comfortably serve a panel of 2,500 or 3,000 patients," he says, "but if they were by themselves, they might only be able to serve 1,500 patients."
In this vein, 28 states are considering expanding nurse practitioners' authority, allowing them to prescribe narcotics and practice without a doctor's watchful eye. And in upstate New York, a new project developed by the Workforce Investment Board will train 2,450 students in supportive health-care roles, such as nurse educators, certified nursing assistants and licensed practical nurses, to name a few, according to Alice Savino, executive director of the Workforce Investment Board. The program was made possible by a three-year, $2.7 million U.S. Department of Labor grant.
Still, the country needs more physicians, and one university is making it even easier to educate and train them: The Texas Tech University Health Sciences Center School of Medicine started a Family Medicine Accelerated Track program, which allows primary-care students to complete their degree in three years at half the cost of the standard four-year program.
Overall, however, educating and training more doctors is difficult in this economic climate. The University of Utah School of Medicine, for example, lost nearly 40 percent of its budget from both the feds and the state for the 2009-2010 school year. The result? The school had to shrink the size of its fall 2009 entering class from 102 to 82 and raise tuition by 15 percent, says David Bjorkman, the school's dean, calling what happened to cause this magnitude of cuts a "perfect storm" and disastrous for the current and worsening doctor shortage.
"Many medical schools were poised to increase their class size to meet the demand for more physicians--we were one of those," he says. "The year before this, we offered to increase our class size by 30 percent if the state could provide the marginal additional funding. They couldn't, so we didn't. So instead of having a class of 130, we have a class of 82."
And the University of Utah School of Medicine isn't alone: Indiana University's School of Medicine was handed a $7 million reduction in state funds, and plans to reduce the number of first-year medical students it admits in August 2010 to 308--14 fewer than in 2009.
The hope, Bjorkman says, is that these cuts are temporary. But additional funding will be necessary to increase class sizes.
And ultimately, Salsberg says, educating more physicians is critical. "I think it's going to be a tremendous challenge just to meet the rising demand. We really do believe it's a combination of adding supply and improving efficiency, and we wouldn't recommend either one of those alone."