Shortage of Physicians Overall, or Only in

¶ … shortage of physicians overall, or only in key areas? If the latter, what policies might encourage more physicians to enter important fields like primary care and geriatrics? The answer to both questions is 'yes.' While overall there is a shortage of physicians, there are clearly areas of greater need than others. In total, "at current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges" (Sataline & Wang 2010).

However, there are critical areas that are suffering much more acute deficits, such as primary care. "The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007" (Sataline & Wang 2010). Only about half of all physicians go into primary care, compared to what is necessary to meet the current level of demand (Halsey 2009).

"Evidence that demand already exceeds the supply of primary-care doctors ripples through the system as patients increasingly have trouble finding a new doctor, then wait weeks or months for an appointment, spend more time in the waiting room than in the examining room, encounter physicians who refuse to take any form of insurance, and discover emergency rooms packed with sick people who cannot find a doctor anywhere else" (Halsey 2009).

These anecdotes regarding poor quality of care are supported with cold, hard statistics: there is a national average of only 88 primary care doctors per 100,000 Americans (Halsey 2009). 63 days is the average time needed to get an appointment with a primary care physician in Boston (Halsey 2009). Because primary care physicians receive lower reimbursement rates for the treatments they offer, patients suffer as well. According to one patient: "many of the doctors I tried to see would not take my insurance because the payments were so low" (Pear 2009).

However, the situation is even more critical in rural areas, many of which do not have physicians at all within a reasonable distance. One county in Idaho, for example, "had no doctors, even though it is larger than the state of Rhode Island" (Pear 2009). Although 20% of the U.S. population lives in rural areas, only 9% of physicians practice in rural areas. Physicians cite a preference for living in an urban environment, lower reimbursement rates from insurance companies, and greater administrative hassles for their reluctance to practice in rural locations.

Even doctors with origins in these communities seldom return after medical school (Kavilanz 2009). Q2. What are the key barriers to increasing the number of primary care physicians? Certain problems affect demand in all areas of medicine. For example, residencies are scarce. "The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics. There are about 110,000 resident positions in the U.S., according to the AAMC" (Sataline & Wang 2010). Despite the proliferation of teaching hospitals, these hospitals rely upon funding from Medicare to pay for resident positions.

Funding for resident positions has been capped since 1997, thus there is a shortage of medical resident positions relative to the supply and hospitals do not have the money to expand the number of positions. Doctors from abroad cannot 'make up' for the discrepancies, given that by law they too must fulfill a residency in the U.S. The new health care bill did not offer funding to expand residencies, and there is little hope, given the current budgetary crisis, that expanded funding for residencies will be available in the future.

Inadequate reimbursement is frequently cited as a reason for low levels of primary care physicians specifically. Over 70% of doctors work in higher-paid specialties in America (Halsey 2009). This is despite the fact that more and more HMOs are requiring that patients see a primary care physician first, before obtaining a referral to a specialist. Patients must wait to first see the doctor who is the more, rather than the less over-burdened of their treatment team, to have the specialist appointment 'vetted' by their insurance. Q3.

What policies might be used to address these issues? Physicians can hardly be blamed for desiring to go into more lucrative specialties. Medical school debt can total over $200,000, providing the impetus for many physicians to 'take the money and run' to a specialty field. President Obama has said: "We need to rethink the cost of medical education and do more to reward medical students who choose a career as a primary-care physician" (Halsey 2009). However, this rhetoric must be backed up with real, concrete policies.

"The average annual income for family physicians is $173,000, while oncologists earn $335,000, radiologists $391,000 and cardiologists $419,000" and doctors do not wish to work longer hours for substantially less pay (Halsey 2009). As more people will have access to insurance, given the current healthcare bill, demand for primary care will likewise go up, and the shortage must be rectified sooner rather than later.

Two possible solutions exist for this problem -- one possible solution is to reduce the overall costs of medical education, by calling upon medical schools to make an effort to keep down tuition and offer more in-house grants and scholarships to doctors. However, the reasons that the cost of a medical education has gone up in price is not solely due to the mercenary attitude of medical schools.

As modern medicine grows increasingly technical and sophisticated in nature, it becomes all the more critical that doctors are well-versed in such technology before graduating. The demands of knowledge for doctors, spanning from medical ethics to new pharmaceuticals and forms of treatment, have expanded, and thus has the cost of medical education. Another solution is to create a system of incentives to encourage specialization in primary care through tuition reimbursement, provided both by institutions and by the federal government.

The incentive to specialize is often due to high levels of student loans, thus primary care physicians should have some assurance that they will have less pressure to pay off high levels of medical school debt. Expanding programs that offer tuition reimbursement to.