Richard Cooper, M.D., won't say, "I told you so," but if academic medicine had heeded his warnings nearly a decade ago, the country might not be facing a protracted physician shortage today.
Cooper took a lot of criticism when he wrote in the Journal of the American Medical Association in 1994 that a short-term physician surplus in the 1990s would turn into a shortage by 2010. Back then, he warned that new medical schools needed to be built right away so residents could be turned out at the other end of a long educational pipeline to meet the shortage.
Actual signs of a shortage began in 1999, when physician-search firms began having trouble recruiting some specialties, says Cooper, now director of the Health Policy Institute at the Medical College of Wisconsin in Milwaukee.
Merritt, Hawkins Associates, a recruiter in Irving, Texas, now reports difficulties filling positions in radiology, orthopedics, anesthesiology, cardiology, rheumatology, dermatology and urology.
Cooper says the shortage is most pronounced in rural areas, but even in Milwaukee, it takes four months to get in to see a neurologist.
Since 1994, Cooper's warnings have grown dire, with his predictions ranging from 150,000 to 200,000 physicians needed by 2020. He says that would require 25 to 30 new medical schools, but only one new school and two new campuses are in the works. If plans started today for more new schools, Cooper says it would take 14 years for a resident to come out at the other end of the pipeline.
Cooper says policymakers basically ignored his warnings until September, when the federal Council on Graduate Medical Education reversed its predictions of a growing physician glut and predicted a shortage of 85,000 to 96,000 physicians by 2020. In December, the AMA will reconsider its own prediction of a glut.
Cooper says COGME's surplus failed to materialize because the council engaged in "social engineering." It tried to set the correct number of physicians per population at 145 to 185 physicians per 100,000 population, but by 2001 the figure had reached 214 physicians per 100,000, according the U.S. General Accounting Office.
Cooper sees a lesson here.
"When forecasters forecast the weather, they don't do it based on what they would like to see," he says. "As a forecaster, you have to step back."
Cooper says the ratio of physicians to population has shifted; physicians work fewer hours than before, meaning more of them are needed to do the same amount of work; and the amount of work has increased. He says demand for physician services has been booming due to an aging population and more clinical breakthroughs.
Even efforts to reduce costs and medical errors drive up demand, he says. For example, cutting physician reimbursements makes clinical care more affordable, and improved safety for procedures like corneal transplants means more people want them.
Cooper is calling for creation of no less than 25 new medical schools in the next decade to alleviate just one-third of the projected shortage.
He acknowledges that will be hard for allopathic schools, which tend to be financed through state universities, to do at a time when state budgets are being cut back. Osteopathic schools, on the other hand, use private funding and have been growing, but there are only 20 osteopathic schools, compared with 126 allopathic schools, he says.
With no immediate prospect of a surge in physician supply through the education pipeline, some think the only answer is to make physicians more efficient.
For example, Kansas City, Mo.-based Cerner Corp. recently said its information technology can fight the shortage by reducing paperwork and nonclinical work. In addition, ambulatory surgery centers say they can make surgeons more efficient by reducing turnaround times.
But Cooper thinks such changes will have a one-time, minimal effect on physician supply. He adds that efforts to improve physicians' clinical efficiency, such as limiting time with patients, can backfire by lowering patient satisfaction.
Cooper is also skeptical of suggestions that nonphysician providers can cover the physician shortage.
While nurse anesthetists and psychologists have been filling in for anesthesiologists and psychiatrists, Cooper says many of the shortage specialties do not have readily identifiable nonphysician counterparts.
Cooper still complains that his plea for more physicians in training is not heeded. Writing about the shortage in Academic Medicine in August 2002, Cooper asked, "Hello-o, is anyone listening?"