From a young age, most of us are taken to the doctor’s office. Whether it be for a cold, cough, fever or the flu, we have all been treated by a physician. Unfortunately, it gets harder to seek the same level of treatment as the years pass by due to our existing physician shortage problem. Yet, the pathway to becoming a doctor has become harder than ever. While our appreciation for physicians and healthcare professionals has grown during the COVID-19 crisis, America is still not doing enough to keep the current healthcare system afloat.
The Association of American Medical Colleges (AAMC) estimates that the U.S. will see a shortage of up to 124,000 physicians by 2034. Many physicians are retiring or considering an early retirement after being overworked and facing stressful conditions during the recent pandemic.
The shortage of physicians is also more pronounced in primary care which is critical to the healthcare system. Primary care physicians are the doctors most of us are most familiar with – pediatricians, internists, OBGYNs, geriatricians, etc. Primary care physicians are the first line of contact of any sick patient, and a lack of primary care physicians would mean that more patients will be forced to use emergency rooms. This increases costs as emergency room visits are more expensive than a quick visit to your primary care physician. Going to an emergency room also increases the time of your visit, as the ER doctor must determine which doctor would be ideal to see, diagnose and possibly treat you – all without knowing your extensive history. This puts a huge strain on the healthcare system as the increased amount of time and effort being spent by both physicians and patients is inefficient and costly.
Additionally, every two in five physicians are expected to retire in the next decade as the average age of practicing physicians is increasing. Even with more medical students graduating to become doctors every year, they are still not enough to replace the huge gap caused by retiring physicians. On top of this, America is expected to see a growth in the aging population, which already accounts for a disproportionate amount of the healthcare system. Currently, there are only 1.07 geriatricians for every 10,000 geriatric patients, suggesting that we have a looming healthcare crisis.
There are proportionally fewer medical school students who enter primary care compared to more advanced medical specialists, such as ENTs (often called allergy doctors). This is often because primary care physicians tend to not perform research and on average, get paid less than specialists. As such, geriatricians, pediatricians, OBGYNS and internal medicine specialists are declining faster than higher-paying and research-driven specialties, such as neurology or oncology. This has led to primary care physicians often being overworked due to these shortages.
There are also shortages in physicians from rural, economically disadvantaged communities and underrepresented backgrounds. Patients in these communities often prefer to speak with physicians of their common language, race or religion, making it difficult for physicians who are not of the same background to communicate with them and understand their needs. As such, the physician shortage is shown to partly stem from failures within pipelines that aim to increase diversity in new doctors. Medical school pipeline programs have popped up across the nation to cultivate high school graduates from underrepresented backgrounds to become practicing physicians. However, as the average cost of medical school is around $150,000 for in-state students and around $250,000 for out-of-state students, medical school is often an unaffordable choice for students from these backgrounds, making it a less viable career option.
As the American physician labor force faces a crisis, one would expect it to be easier to get into medical schools. Unfortunately, the reality is that medical school admission rates are decreasing despite the increasing demand for physicians. This is because medical schools have not expanded the training facilities needed to support a larger number of aspiring physicians.
Even still, increasing the number of medical school seats would still not fully solve the problem due to the bottleneck effect created by residency programs. Medical school graduates often do a residency, where they train under the guidance of a physician to specialize in a specific field of medicine. Without a residency, medical school graduates are not allowed to diagnose/treat patients. Increasing the number of medical school seats increases the number of graduates that become applicants for residencies. However, residency placements have a fixed number of slots, causing many medical school graduates to not be placed into a residency program. This issue exacerbates the physician crisis as there are students who are fit to become doctors, but do not have the training needed to see patients.
Medicaid and Medicare (government-funded assistance programs for low-income patients’ and elderly patients’ healthcare expenses) provide funding for residency slots. However, this funding has been frozen since 1997. The government recently approved 1000 more residency spots due to the raging effects of the COVID-19 pandemic. While 1000 more residency spots sound like an apt solution to the problem, the plan actually adds only 200 of these spots every year for five years, which is not rapid enough of a growth. As a result, this does not fix the bottleneck situation and is not a long term solution to the problem.
COVID-19 has shown us how important physicians are and a long-term solution is needed to preemptively solve this shortage crisis. Perhaps, the most practical solution is to increase the number of physicians by increasing the number of residency slots and seats in medical schools. This decision is largely made by medical school and residency program admissions teams. However, students can also play a role themselves by choosing to go into much needed medical careers, especially primary care roles that serve underserved communities.
