SHORTAGE OF DOCTORS AND ITS CONSEQUENCES FOR PRIMARY CARE

The AAMC, Association of American Medical Colleges, predicted back in 2017 that physician shortage was on track to reach 104,900 by 2030. I remember seeing these numbers back then and totally freaking out. Then, the shortage of doctors in primary care stood at a possible 43,100 by 2030. I did the only thing I could – I hoped the situation gets better. Spoiler alert, it did not. It got worse.

Fast forward to 2020, and the estimated shortage of doctors, according to the AAMC, could be as high as 139,000 in 2032. For primary care, we could be looking at a shortage of 55,200 doctors. And you want to know the weird thing – I did not freak out as much. It’s as if I have become numb to these horrible numbers and statistics. This is the story of our healthcare system. 

Over the years, there have been lots of flaws in the American healthcare system, but this, doctor shortage in primary care, is not one we can afford to live with. The overall health and wellbeing of the nation are largely dependent on the quality of primary health care services. When the primary healthcare sector fails, there isn’t much hope on the medical front. The shortage of doctors is never a palatable situation, but even more so in primary care. I don’t quite think you understand how important primary care physicians are. According to research, raising the number of physicians in the primary care sector by one per ten thousand people is linked with a reduction in mortality by 5.3%. 

With this, you’d expect that primary care fields should constantly be increasing in the number of doctors, but that’s not the case. In fact, the opposite is the case. And you know what is even more saddening, it is not only that the number of doctors is reducing, but the number of medical students that choose to go into primary care is also plummeting, reaching all-time lows. Am I disappointed? Yes, a little. Am I surprised? Not a single bit. Because can you blame the students for not wanting to go into a field where the pay is ridiculous compared to other medical fields, big thanks to insurance companies, and where the chances of burnout are ridiculously high?

Then there’s also the fact that the doctors in the field are aging. The U.S. Census Bureau estimates that the total population of the country is going to increase by over ten percent in 2032, with people over the age of 65 increasing by 48%. One in three doctors in the U.S. today is over 65 years of age and is close to retirement. So, get this – the number of people willing to go into primary care is reducing, the number of people in the U.S. is increasing, and the number of doctors close to retirement is also increasing. This is bad news. If you are looking for a silver lining in all of this, don’t bother, there’s none. 

What frightens me the most amidst all of this is what the implication of this shortage will be. I already mentioned that increasing primary care physicians are associated with lower mortality rates, right? Now guess what will happen when you reduce the number of primary care physicians. Go on, take a wild guess.

Not to mention that this shortage will further lower the time available for doctors to spend with their patients. The queues in doctors’ offices are getting longer every year. Getting an appointment is getting more and more difficult. Some doctors attend to 40 patients a day. 40! To make it work, these doctors cut down on the time they spend with each patient, reducing the quality of care, which increases the mortality rate in the long run. Many doctors resort to charging exorbitantly to compensate for the effort they’re putting in, and what does this cause – low-earning people are deprived of the healthcare services they need. This will further increase the disparity between high/medium earners and low earners. 

The increased workload is not only going to affect patients but also doctors. Imagine asking a doctor to attend to thirty to forty doctors a day and then acting surprised when they get burnt-out and break down. I mean, how can anybody survive in such grueling conditions? How? There isn’t any upside to a shortage of doctors. None whatsoever.

I am going to do what I did three years ago, the only thing I can do – I am going to hope for the best. It’s not looking particularly promising, but when has it ever?

References

  1.  https://www.news-medical.net/amp/health/Strategies-to-Improve-Shortage-of-Primary-Health-Care.aspx
  2. https://patientengagementhit.com/news/amp/understanding-physician-shortage-issues-patient-care-access
  3. https://www.washingtonpost.com/health/america-to-face-a-shortage-of-primary-care-physicians-within-a-decade-or-so/2019/07/12/0cf144d0-a27d-11e9-bd56-eac6bb02d01d_story.html
  4. https://www.news-medical.net/amp/health/Physician-Shortage.aspx
  5. https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage
  6. https://www.aamc.org/news-insights/press-releases/new-aamc-report-confirms-growing-physician-shortage

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10 Responses

  1. Kurt Savegnago says:

    Bottom line is primary care/FP sucks. I will never forgive Obama ramming EHR down our throats. May he roast in Hades or at least purgatory for that. Oh purgatory is out. I forgot he’s not Catholic. Well, I guess hell it is.
    I was perfectly happy up until 2007 when EHR was instituted.
    Saw 20 to 30 patients a day. Dictated good records and a few page flips and one could find what they wanted. Re-dictated the medication list about every other visit and would call the pharmacist for any discrepancy. Oh the nurse would call in med refills and the pharmacist would point out the “specialist” changed the dose on such and such drug so many months ago. Now with EHR, med errors are at a phenomenally higher rate than with paper! Especially if a rural doc is expected to refill the specialty docs meds out of courtesy. Now well, when a script comes in electronically, the pharmacy assumes it’s an med or dose change. Viola’ medication error!!
    Oh and then there was time for hospital practice and taking call. No prior auths back then and if patients followed our advice then great, if they didn’t, we’d graciously do our best to pull them out of the hole. Now we have to bicker with the insurance bastids right and left trying to get workups, tests and drugs for patients. You call that fun?
    Oh and there is the known fact that most patients DON’T listen to us. Just look at how the obesity rates and diabetes rates keep climbing, climbing and climbing. Who is being held responsible? Well the primary care docs not the patients. Most don’t give a s#!t. Oh and next it will be the FPA NP’s who will get to enjoy this too unless they are smart enough to go into specialty practice. Oh and there are the endless faxes from the payers saying your patient hasn’t had “this” or haven’t had “that”. I look at the records and 99% of the time the patient has vehemently declined the mammogram, the colonoscopy or covered blood tests for health maintanence. That’s a time waster!
    DPC? Setup a DPC practice in the wrong geographic area with too many poor people (or the politically correct wrong payer mix) and you’ll go bankrupt.
    No. Classical office, hospital and on call primary care practice is a dinosaur of the past. In its day it was stimulating and gratifying but after EHR and the other crap that befell physicians it sucks. May God condemn to Hades anyone who dupes a student to go into it.
    Sure, setup more FP residencies for those who unfortunately don’t match. When one is desperate, they’ll do what they have to do to be able to make a living. They will get disillusioned in a very short time once they get out.
    Unless they get lucky and are able to confine themselves to an office only DPC practice. Like I said, DPC will NOT work everywhere simply due to the economics. Ask any non-DPC doc if they would retire if they could and the percentage rate I believe approaches 80%. My advice, don’t have a lot of kids because college costs. Don’t take a lot of pricey vacations as that is money that can go to retirement funding. Don’t have a large difference in spousal ages like greater than 5 years as I know some FP/IM docs who are continuing to work so their spouses can still get medical insurance even though they are at a retirement age themselves. There is no turning back as the Genie is out of the bottle. Better to bust ones buns and try to get into a specialty or fellowship.

    • Stewart says:

      Appreciate your frustration, but there’s still no requirement forcing docs to use EMRs.

      They weren’t rammed down our throats; docs opened their mouths wide and cried “Deeper, deeper!” If we blame others for our bad decisions . . .

      We decided to stay with paper, and are more thankful that we did every day.

      • Kurt says:

        You’re right but…………….
        Work in a hospital owned multi-specialty practice and the docs are stuck using whatever the administration rams down their throats. Our practice had to sell out to the local hospital as it was the only choice other than bankruptcy due to a lousy payor mix. A lot of bad debt.
        There is a financial penalty for those who don’t use EHR and I’ve seen posted here that some small groups get by with the financial hit by sticking with paper.
        I’m out of it now as I retired after 32 years of working at the same entity in July.

  2. arf says:

    Some hospital system with million-dollar-a-year administrative salaries can’t find a family doc they can screw over, unwilling to be overworked, underpaid, made responsible for nurse practitioners who are supposed to be equal to the doctors, unwilling to accept a noncompete where the doctor is chained to the system or they have to uproot spouse and kids to leave county when there are other jobs nearby.

    So the hospital big box flacks scream DOCTOR SHORTAGE.

    No, sorry, there is no doctor shortage.

    There is only a shortage of physicians willing to be screwed.

  3. Jesse Belville,PA-C says:

    Primary care,long hours low pay compared to Dermatology, Radiology,ER, Surgery subspecialities, Cardiology.. Hospitalist.
    More money better quality of life time off,with family,pursuing other interests..
    Why go into primary care?
    I am a PA-C. I work with a physician supervisor. I have since August 1976. 44 yesrs rural health primary care that involved clinic, hospital admits,discharges,daily rounds, With my supervising physician. I do not want to replace my supervising physician. I want to be part of his or Her team providing good care to the patients in His/Her practice. I want to see the routine cases,school physicals,renew meds for hpertension,Diabetes, thyroid, cardac conditions. Make sure the patient or family is up to date on immunizatons. Routine health checks for kids adults,seniors. Evrything in family practice / primary care. Minor laceraions, removal of lesions,knowing when to refer to a specialist. Knowing what resources are available in the community to meet health care needs,pay for meds/care. Psych/social work needs.
    Long hours, in underserved areas. I loved and still love every moment. I consider that I have had a wonderful life so far because I had the honor to help many folks 1 person at a time.
    If you primary care Physicians want things to change its called politics and you must lead the way..
    Also a physician championed PA-C’s at Duke University in 1965 using Medics from the Vietnam war. A way to meet physician shortage in primary care then. Started with 4 guys and grew from there. I was a medic in Vietnam for 19 months April 69 to end October 1970. Accepted to PA school George Washington University,Washington,D.C. 1974. Created by physicians to Help Physicians. Then NP’s followed cause RN ‘s want to run Medicine and always have. Since they become Admin people they have gotten what they wanted. They are still Not Happy. Cause they are not Doctors. Funny sad ain’t it…
    I am not a Physician,I am a PA-C. I choose to become a PA-C. I still love it. I usually like my supervising physician. Not always,but I do, so far ,respect them as Physicians.

  4. Frank Savoretti, JD, MD says:

    Let’s repeat the Serenity Prayer to ourselves: “…grant me the serenity
    to accept the things I cannot change, the courage to change the things I can,and the wisdom to know the difference.”
    Since we have no influence or control over the number of Primary Care Doctors being “created” let’s look at the positive aspect: The Law of Supply and Demand: “Generally, low supply and high demand increase price and vice versa.” Would have put Primary Care Doctors in control BUT the Administrators created the new class of Primary Care IMITATIONS! NP’s and PA’s practicing independently to drive down reimbursements. Nonetheless I suspect the general population will sooner or later understand the difference and prefer a real MD or DO to the counterfeit brands.

    • Jeff A. says:

      Just to clarify, it’s the Prayer of Saint Francis: “Lord grant me the serenity to accept the things I cannot change, the courage to change the things I can change, and the wisdom to know the difference.”

      And there’s the updated prayer of the U.S. citizen: “Lord grant me the serenity to accept the things I cannot change, the courage to change the things I can change, and the weapons to make the difference!”

    • Kurt Savegnago says:

      As Dr. Natalie Newman so pointed out, God bless her. Your JD suffixed colleagues will have a plethora of cases with poor outcomes to litigate for a long time once FPA/NP’s get established and find out the hard way the “real” practice of medicine is not so simple as it seems.

  5. ML says:

    We need more residency spots, and we need to have the midlevel encroachment stopped. The non medical legislation and public feel that an NP/PA is equal to a highly trained primary care physician and it is terrifyingly incorrect. Midlevels are being looked to as the solution and are being minted at an alarming rate, and with an ever lowering bar for admission to school and graduation.

  6. Emms says:

    There’s plenty of doctors without residency spots. The problem isn’t in how many graduate pass their USMLEs the problem is they graduate and are forced to languish on the vine in thousands of dollars in debt because no one is interested in actually fixing the problem!

    Best,

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