Businessweek: The Looming Physician Shortage

With the health care debate seemingly at its last round, many Americans have overlooked the fact that whatever health-care bill is passed and signed into law, will likely add “some 30 million currently uninsured people,” according to an article in Businessweek. As a result, although these new patients may have access to doctors and health care providers, the real question is whether there will be enough.

Without being able to predict the likely success of health care reform today, lawmakers in 1997 “placed a cap on the number of medical residencies—hospital training required for all doctors—in order to contain costs under Medicare, which pays for most of these training slots.”  

The caps on residency slots were also supported by an Institute of Medicine report and recommendation which predicted a surplus of physicians and called for cuts in cut residency funding, freezing medical school slots to better match physician supply with requirements (healthcare provider supply change).

Consequently, medical schools have begun trying to even out the shortage by “announcing plans to add 3,000 new positions for first-time students by 2018.” The problem with such a proposal however, is that if “the residency cap is still in place, these efforts may not be sufficient.”

There is also another important factor to consider: if the new insurance and health care reform pass, millions of people will flood our health care system while new positions for first-time students will still be taking classes on anatomy. “It takes years to produce doctors,” says Steven H. Lipstein, president and CEO of 13-hospital BJC HealthCare in St. Louis, which trains residents from Washington University. In other words, to turn over new doctors to treat the new patients will leave a significant gap in time, especially considering there are significant predictions of doctors retiring, as well as taking early retirement and reduced hours based on lower reimbursement rates and increased use of government plans such as Medicare and Medicaid.

The article noted that last year alone, there were “nearly 17,000 fewer primary-care doctors than needed in inner-city and rural areas, according to the U.S. Health & Human Services Dept.” In addition, the Association of American Medical Colleges projected that by 2025 there will be a shortage of as many as 159,300 doctors.

Robert Feinstein, senior associate dean for education at the University of Colorado Denver School of Medicine, acknowledged that lawmakers need to raise the number of residencies available to students because it affects 90,000 of 110,000 residencies at U.S. hospitals. The article cited the fact that “Medicare pays about $100,000 a year per residency, at a total cost to the program of about $9 billion, according to a report filed in June by the Medicare Payment Advisory Commission. Consequently, the funding for residencies that were initially created in 1965 did not predict the growth of Medicare to more than 45 million, and the potential for adding 30 million more over the next few years.

A first attempt at reducing this gap was made in early December of last year when Senate Majority Leader Harry Reid (D-NV), along with Charles Schumer (D-NY), Bill Nelson (D-FL.), and other sponsors, submitted an amendment to the health-care reform “bill that would add 15,000 residencies at a cost to Medicare of about $1.5 billion, according to Atul Grover, a lobbyist with the medical college association.”

As the author correctly points out, “today the U.S. is in the grip of a nationwide doctor shortage, brought on by an aging population demanding access to specialists.” If Congress does not address this shortage within the health care reform bill, it should be interesting to see who lines up knocking on the Capitol door steps first: the millions of patients who cannot find doctors, or the thousands of doctors who cannot take any more patients.