Why Doctors are America’s Most Wanted

We all know that access to and the quality of healthcare Americans receive is an ever-growing, increasingly important, and always polarizing topic, especially with a burgeoning aging population.

But there is another significant threat to quality healthcare that doesn’t get enough air time, one that could create a ripple effect through the healthcare system as we know it: the dwindling doctor supply.

According to the American Association of Osteopathic Colleges, “by 2020, the gap between our physician supply and demand will range from 50,000 to more than 100,000.” Medical schools are trying to fill this gap without the support of federal funding. Many new schools have opened, and major changes have been made to open up new rotations and residency programs.

Yet we’re not even close to adequately beefing up the doctor supply—and here’s why.

There Still Aren’t Enough Medical Schools

There are only 171 medical schools in the United States: 141 allopathic (MD) and 30 osteopathic (DO) (that’s in contrast to over 4,000 MBA programs at over 450 institutions). With so few schooling opportunities, even the creation and introduction of a few new schools each year fails to fill the void of the upcoming shortage.

Even if a Student Gets into Medical School, She Probably Can’t Afford It

The cost of medical school—in terms of time and money—is an obstacle of its own. Four years of medical at $40-$50K a year adds up to a whopping $160,000, which, given interest, could add up to an even more whopping $400,000. That’s a cost that cannot easily be paid off: school is followed by residency and possibly fellowship, which means doctors can still be in training anywhere between 2-7 years (and more) after medical school. These trainees have a set pay that can’t begin to cover the debt burden during this time, and certainly doesn’t compare to even a first year salary for someone straight out of an MBA or a law degree. In fact, students who go through such MBA or law programs graduate make, in some cases, over three times more than a first-year resident, with average pay ranges between $75-$130K. Add to this the fact that business school is 2 years and law school is 3, the educational cost of medical school looks fairly grim—impossible even—for most people contemplating a career in medicine.

Federal Funding Remains at 1997 Levels

Funding for a medical education is another significant problem. The Balanced Budget Act of 1997 was set up to reduce Medicare spending by 2002, and it cut payments to health service providers and practitioners. The Act has not been updated or altered since that time, despite the fact that in 2000 the Department of Health and Human Services determined that the act could actually negatively impact access to and quality of medical care. The effect of this dated act impacts a broad spectrum of healthcare—everything from medical education to medical care itself.

The Affordable Care Act provides significant improvements for many individuals in terms of their medical care options, but it too fails to address the medical shortage. And, as the New England Journal of Medicine reports, funding for medical education remains at 1997 levels. According to the NEJM, “efforts by the AAMC and its allies to persuade Congress to increase Medicare GME [graduate medical education] support—funding an additional 15,000 positions—were thwarted during the debate over the Affordable Care Act (ACA).” In fact, “the 2014 budget [called] for reducing Medicare GME support by $11 billion over the next decade.”

US Hospitals are Wasting Resources Needlessly

There are countless lost resources in healthcare. In her piece “Anatomy of a Hospital, Or Why Your ER Wait Time is So Long,” Laura Christianson dissects how the time, money, and misutilization of resources especially in the emergency room, further impacts patients’ opportunities to access quality care in a timely manner. What would happen if improved processes could better patient safety and care—and save the system resources it could then allocate to physician training?

A Drop in the Global Bucket

The US doctor shortage is almost minor compared to the shortage globally. According to the WHO, there is a worldwide physician shortage of 4.3 million. This growing gap leaves many, especially in some of the poorest parts of the world, without access to proper care and treatment. As long as this continues, many preventable illnesses will persist and diseases that remain mundane and treatable in the developed world can continue to cause havoc in developing parts of the world. Additionally, basic health education and simple resources that provide an easy way to provide health improvements to a large population easily and efficiently will suffer.

What’s Being Done?

In 2015, MD and DO residencies will merge in the US, creating a more unified, linear system with streamlined training. This step may also have the advantage of creating more training spots in the next few years. It should also improve the access to and quality of training for medical students.

But there is clearly still a long way to go, and simply increasing the supply can’t be the only answer. With so great a shortage and so great a demand, the answer is going to have to lie in the crossroads of increased training spots, public education, politics, and technology at a global level. Technology is always providing new ways to improve diagnosis and access to care, and while it will never replace the personal care of a physician, it may help mitigate inefficiencies and improve patient medical awareness for patients.

But what’s most needed is political will. Additional reform is crucial—the Budget Act needs to be updated to account for the medical, economic, and social changes of the past 18 years. And given the national and global crises, the time to act is now.

Further Reading

• The Doctor Shortage
• Laura Christianson, “Anatomy of a Hospital, Or Why Your ER Wait Time is So Long”
• John K. Iglehart, “The Residency Mismatch”

Image Credit: Good Eye Might from Flickr