A 30-percent increase would require more than 4,900 additional medical students per year. But will this solve the problem?

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The Plateau

During the 1980s and mid-1990s a workforce oversupply (145,000) of physicians was predicted by the year 2000. The year 2000 came and went and with that the AAMC concluded “that there’s no good model for projecting the future need of physicians in relationship to the demands of the population.” By that time the federal government had taken the recommendation of various advisory bodies (Graduate Medical Education National Advisory Committee, Council on Graduate Medical Education and the Institute of Medicine) and capped the amount of money it spends on physician residency training; that cap has been in place for the past ten years. In the meantime, the U.S. population has grown by about 71million.

What is driving the reconsideration of physician shortage? Clearly aging baby boomers will require more medical care, and this same population is also opting for the “gray out” of (early) retirement. Dr. Richard A. Cooper, an authority who has predicted this shortage for quite some time, estimates that if current patterns continue, the U.S. will be short 200,000 physicians by 2020.

Maldistribution

In October 2006, the Government Accountability Office (GAO) released a report on the status of officially designated Health Professional Shortage Areas (HPSAs). HPSAs are geographic areas (inner city, rural communities), population groups, e.g., migrant workers, or a particular health-care facility such as a rural health clinic. Apparently there is an expected shortage of primary-care physicians for more than 5,500 HPSA designations.

While a glut was anticipated in the previous decade, there was also anecdotal evidence of increasing physician shortages in many rural and inner-city communities. The reasons for the shortages are varied, e.g., “professional isolation in a non-collegial setting, income reduction due to increased number of uninsured in area, lack of physical and cultural amenities, and the difficulty family members face in finding employment in the underserved community” (Physician’s News Digest, June 2004).

At the same time there is an increased need for health care services in the suburbs, which are fast growing areas. Population growth in the 1990s was faster in unincorporated areas and in new suburbs than in existing suburbs.

Resolution

Now that there seems to be agreement that a shortage of physicians is imminent (and don’t even get me started on the nursing shortage), it’s worth watching to see if the historic pattern of maldistribution of the physician workforce in serving underserved populations persists; or will HPSAs be victims of “leapfrog” in spite of genuine attempts at solving the problem.

References

Bureau of Health Professions - HPSA information

Physician employment trends - Physician’s News Digest, June 2004

GAO report on Professional Shortage - October 2006 report from the GAO on shortages in the health professions

AAMC report and recommendations for dealing with anticipated physician shortage

About the Author

Dr. Flippin brings a wealth of experience, starting with her long tenure as an attending physician at the Cook County Hospital Emergency Department. She is currently Corporate Compliance and HIPAA Privacy Officer at major Chicago hospital.

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