The Association of American Medical Colleges in a recent study has projected that there will be a doctor shortage between 42,000 and 120,300 by 2030. This is a stunning number when you break down the fact that the shortage will affect primary care doctors (14,800 – 49,300); specialists (33,800 – 72,700); and surgical sub specialists (20,700 – 30,500). The looming crisis is magnified by the fact that increasing demand from a both a growing and an aging population must be considered.
How did we get to this point? Perhaps it is because Congress passed The Balanced Budget Act of 1997 which limited the number of residency positions in the US. Because of this, there are doctors who graduate from medical school each year, who cannot be licensed to practice medicine because they cannot find a residency. Physicians must complete at least one year of residency to be eligible to practice medicine. Instead of taking care of patients in underserved communities, these doctors are unnecessarily sidelined.
The solution to the problem has been a movement towards changing the healthcare workforce. The delivery of healthcare has morphed into a team approach where nurses and physician assistants and now artificial intelligence have become the drivers in the belief that each member of the healthcare system is interchangeable. However, is this belief based on fact or convenience?
In the haste to control costs and expand access, basic questions have been virtually ignored: Are physicians really interchangeable? Will patient care be affected by the absence of the physician? Will moving towards virtual medicine (such as telemedicine) and precision medicine based in population, artificial intelligence and algorithms work for the individual patient? Will using allied health professionals with a different scope of training lead to better outcomes for a patient with a complicated medical problem?
People may not realize that a physician’s training is unique. Over the course of 4 years of undergraduate education, 4 years of medical school, depending on the specialty 2-10 years of post graduate training (residency), and the practice of medicine, thousands of hours of training create a fund of knowledge that is invaluable in teaching a physician to see the patient as more than a collection of symptoms. To think outside of the box and to individualize patient care.
Time will tell, but the answers are becoming clearer. In the attempt to ‘fix’ the problem there has been a doubling down on the very things that are at the heart of it. There continues to be a steady increase in healthcare costs, patients are waiting longer to seek healthcare, and access to healthcare has decreased especially in rural areas. Whether you want a single payer system or free market medicine it won’t fix the current system which is controlled and manipulated by forces that thrive on lack. In order to control resources monopolies run by Big Pharma, pharmacy benefit management (PBMs) companies (a third party that ‘negotiates’ drug prices for pharmacies, drug manufacturers and insurance companies which makes approximately 300 billion in revenues each year); corporate hospitals, which have on average a 16:1 ratio of administrators to physicians; and commercial insurance companies which have increasingly shifted healthcare costs to its members in out-of-pocket expenses have integrated themselves into the healthcare system.
Source: The Wall Street Journal
Their common denominator is the fact that they do not provide patient care. Do we really have to re-create the wheel? Or is the answer right in front of us in the thousands of physicians waiting for the opportunity to provide care for patients. A good start would be for Congress to reverse the moratorium on residency spots and for medical schools to continue to increase the number of seats for students.