Reassessing the Data on Whether a Physician Shortage Exists

Abstract

Does the United States have enough physicians?-Yes.For decades, experts have bemoaned a lack of sufficient primary care physicians in the United States. These fears came to a head during debate over the Affordable Care Act (ACA), when critics suggested that the millions of US residents gaining coverage under the ACA would further exacerbate the existing physician shortage. A 2011 American College of Surgeons report asserted that "even before [this] health care reform, the nation was headed for serious physician shortages and reform has only made it worse." 1 According to the updated report of the Association of American Medical Colleges (AAMC), released March 14, 2017, the AAMC still predicts a shortage of between 40 800 to 104 900 physicians by 2030. 2 Some have questioned the accuracy of these projections. Yet the ominous forecast of a physician shortage has already motivated significant reforms. During the last 15 years, the number of medical schools in the United States-including those with provisional or preliminary accreditations-has increased from 125 to 145. Concomitantly,medicalschoolenrollmenthasincreasedfrom16 488 to 21 030 students, an increase of 28% since 2002, and is expected to increase even further by 2018. 3 Additionally, over the last 5 years, the number of Accreditation Council for Graduate Medical Education programs has increased from 9022 to 9977, an increase of 10.6%, and the number of active residents (currently enrolled in a program) has increased from 115 293 to 124 409, an increase of 7.9%. 4 Since passage of the ACA, 22 million US residents have gained health care coverage and thousands of newly trained physicians have begun practicing. 5 Given these changes, it is worth reassessing the data on whether a physician shortage really exists.

A Census of Actively Licensed Physicians in the United States, 2016

“…9 Because of increases in medical school numbers and enrollment, expanded health care roles and practice rights for non-physician clinicians and delayed retirement by older physicians, some assert a physician shortage does not exist. 10 Concerns about health care workforce shortages remain, however, due to a growing and aging U.S. population, as demands are predicted to exceed supply. 11 While earlier projections by workforce researchers anticipated physician shortages to reach upwards of 159,300 physicians by 2025, 12 more recent predictions suggest a still-alarming shortage between 40,800 and 104,900 physicians by 2030.…”

The effect of malpractice law on physician supply: Evidence from negligence-standard reforms

“…For recent policy discussions and empirical analyses surrounding physician supply, see, for example,Kirch and Petelle (2017),Gudbranson et al (2017),Strange (2014),Garthwaite (2012);Chernew et al (2009),Staiger et al (2009), and Institute ofMedicine (2008).…”

The Physician Workforce and Counting What Counts in Primary Care

“…This problem may contribute to conflicting assessments in several recent reports of the current and future workforce needs in primary care. [2][3][4] The Millis report offered additional specific requirements of the primary care physician, such as "understanding and treating the whole man [sic]"; "continuing and comprehensive responsibility"; and "see that the necessary arrangements are made" for hospital or specialist physician services. In a recent review, O'Malley et al reaffirmed the continuing relevance of the core elements invoked by the Millis Commission that collectively differentiate primary care from other clinician services.…”

“…Nonetheless some current workforce analyses continue to conflate training background with primary care practice. For example, some commentators arguing no shortage in primary care 3 cite the Kaiser Family Foundation (KFF) report of over 456,000 US "primary care physicians." 6 However KFF includes 188,000 internal medicine physicians-many of whom are in hospitalist or other specialized roles.…”

“…Some analyses estimate primary care physician workload based on current medical practice data. 3 Such calculations overlook the constraints of the mispriced, and visit-driven Medicare fee schedule known to discourage achievement of the core features of primary care. 7 Furthermore, these analyses do not take into account the longstanding evidence that generalist physicians have no time for primary care due to increasing patient complexity and growing diversity of relevant tests and treatments.…”