Will there be enough doctors in America's future?
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • Biden to reopen 'Obamacare' markets for COVID-19 relief
      Hospitals push CMS to pause 'most favored nation' drug-pricing rule
      Prime Healthcare settles with union workers, agrees to $458,000 in backpay
      Biden administration warns fully meeting vaccine demand could take 'months'
    • Biden to reopen 'Obamacare' markets for COVID-19 relief
      Biden administration warns fully meeting vaccine demand could take 'months'
      Hospital system rebuked after offering vaccine to donors
      Thousands of Portland's healthcare workers not vaccinated
    • Thousands of Portland's healthcare workers not vaccinated
      Ascension’s St. Mary’s Hospital Surgery Center at Towne Centre and Allegheny Health Network’s Bethel Park surgery center
      Hospitals see opportunity, risk in ambulatory surgery centers
      Health suffers as rural hospitals close
      Medicare ACO participants fell in 2021
    • Billing, antitrust exemption changes upend negotiations between insurers and providers
      MAIN-Health Bill_iStock_i.jpg
      Insurance-tech firm MultiPlan makes $155M buy after blank-check deal
      Last-minute COVID costs cut into UnitedHealthcare's $396 million operating income
      CMS approves rule forcing insurers to ease prior authorization
    • Biden to reopen 'Obamacare' markets for COVID-19 relief
      Hospitals push CMS to pause 'most favored nation' drug-pricing rule
      Regulation Tracker: Biden reviews Trump's final rules
      Hospital system rebuked after offering vaccine to donors
    • Anthem's Q4 profits drop 41% with added COVID costs, patient care
      jesse ford salud revenue partners headshot
      Sponsored Content Provided By Salud Revenue Partners
      How to succeed on self-pay: think ‘balance integrity’
      KPMG says deal activity will stay high in '21: 10 takeaways
      By the Numbers: 20 largest healthcare investment banks in 2020
    • Studies extend hopes for antibody drugs against COVID-19
      Google to convert office space for COVID-19 vax clinics
      Dr. Karen DeSalvo
      Next Up Podcast: What to expect with telehealth and healthcare technology in the next four years
      Next Up Podcast: What to expect with telehealth and healthcare technology in the next 4 years - Transcript
    • Amid COVID health worker shortage, foreign-trained professionals sit on sidelines
      China pushes conspiracy theories on COVID origin, vaccines
      50% of Americans make resolutions. Fewer than 27% keep them over time.
      Data Points: Sticking with your resolutions
      An older man wearing a mask receiving a vaccine.
      Want more diversity in clinical trials? Start with the researchers
    • Humana names first chief equity officer
      WEb_i.jpg
      Q&A: Dr. Cliff Megerian, University Hospitals' soon-to-be CEO
      ZentyWeb_i.jpg
      Tom Zenty is leaving a legacy of transformational growth at University Hospitals
      Cerner names Erceg as new CFO
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • InDepth Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • New care model helps primary-care practices treat obesity
      doctor with patient
      COVID-19 treatment protocol developed in the field helps patients recover
      Rachel Wyatt
      Project to curb pressure injuries in hospitals shows promise
      Yale New Haven's COVID-19 nurse-staffing model has long-term benefits
    • Michellene Davis
      Healthcare leadership lacks the racial diversity needed to reduce health disparities
      Dr. James Hildreth
      How medical education can help fight racism
      Modern Healthcare InDepth: Breaking the bias that impedes better healthcare
      Videos: Healthcare industry executives describe their encounters with racism
      Quotes from rebadged employees
      Outsourcing IT, revenue cycle takes toll on internal culture
    • A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
      A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      self service station
      COVID-19 pushes patient expectations toward self-service
      Targeting high-risk cancer patients with genetics
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Highmark Health inks six-year cloud, tech deal with Google
      Study: 1 in 5 patients report discrimination when getting healthcare
      HHS proposes changing HIPAA privacy rules
      Android health records app launches at 230 health systems
    • California hospitals prepare ethical protocol to prioritize lifesaving care
      Amazon, JPMorgan Chase, Berkshire Hathaway disband Haven
      Digital pathways poised to reshape healthcare continuum in 2021
      Healthcare was the hardest hit by supply shortages across all U.S. industries
    • A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
      A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      New care model helps primary-care practices treat obesity
      How hospitals are building on COVID-19 telehealth momentum
    • Regional insurers bet big on virtual-first plans
      MedPAC votes to boost hospital payments, freeze or cut other providers
      Most Next Gen ACOs achieved bonuses in 2019
      Congress recalibrates Medicare Physician Fee Schedule after lobbying
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
      Dr. Bruce Siegel
      Why taking a hospital not-for-profit was Dr. Bruce Siegel’s boldest move
    • Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
      Laura Lee Hall and Gary Puckrein
      Increased flu vaccination has never been more important for communities of color
      John Daniels Jr.
      Health equity: Making the journey from buzzword to reality
      Mark C. Clement and David Cook
      We all need to 'do something' to fight inequities and get healthcare right, for every patient, every time
    • The missing piece in our fight against COVID-19: primary care
      Ambulatory surgery centers offer extraordinary value in a high-cost healthcare system
       Alan B. Miller
      Looking ahead with optimism as we continue to transform healthcare
      Dr. Bruce Siegel
      By protecting the healthcare safety net, Biden can put us on the path to a stronger country
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Best Places to Work in Healthcare Logo for Navigation
      Nominations Open - Best Places to Work in Healthcare
      Nominations Closed - Health Care Hall of Fame
      Nominations Open - 50 Most Influential Clinical Executives
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Top 25 Minority Leaders
    • Top 25 Women Leaders
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • ntt data logo lockup webinar
      Sponsored Content Provided By NTT DATA
      Webinar: Mistakes I’ve Made — Confessions of a Healthcare Cybersecurity Expert
      bright.md logo lockup webinar
      Sponsored Content Provided By Bright.md
      Webinar: Enabling a hybrid care model — Streamlining the patient path to both telehealth and in-person care
    • Leadership Symposium
    • Healthcare Transformation Summit
    • Women Leaders in Healthcare Conference
    • Workplace of the Future Conference
    • Strategic Marketing Conference
    • Social Determinants of Health Symposium
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala (2022)
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Dr. Karen DeSalvo
      Next Up Podcast: What to expect with telehealth and healthcare technology in the next four years
      Carter Dredge
      Next Up Podcast: Ready, set, innovate! Innovation and disruption in healthcare
      Next Up Podcast: COVID-19, social determinants highlight health inequities — what next?
      Next Up Podcast: Saving Rural Health
    • Beyond the Byline: Regulators aim to boost value push with fraud and abuse law updates
      An older man wearing a mask receiving a vaccine.
      Beyond the Byline: Verifying information on the chaotic COVID-19 vaccine rollout
      doctor burnout
      Beyond the Byline: How healthcare supply chain struggles contribute to employee burnout
      Beyond the Byline: Covering race and diversity in the healthcare industry
    • Leading intention promote diversity and inclusion
      Introducing Healthcare Insider Podcast
    • The Check Up: Dr. Joseph Kerschner
      The Check Up: Dr. Joseph Kerschner of the Medical College of Wisconsin
      The Check Up: Chip Kahn
      The Check Up: Chip Kahn of the Federation of American Hospitals
      The Check Up: Trenda Ray
      The Check Up: Trenda Ray of the University of Arkansas for Medical Sciences
      The Check Up: Dr. Kenneth Davis
      The Check Up: Dr. Kenneth Davis of Mount Sinai Health System
    • Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Physicians
December 15, 2004 12:00 AM

Will there be enough doctors in America's future?

Joseph Conn
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print

    The title is provocative enough: Will the Last Physician in America Please Turn Out the Lights? Subtitled A Look at America's Looming Doctor Shortage, the thin, 80-page paperback by the principals of the MHA Group, a physician recruiting and staffing firm, is also a brisk read with a grim conclusion.

    America is heading for a perverse version of a Canadian-style healthcare system -- with long waits to see physicians -- but without universal coverage, just higher costs, according to one of the book's three co-authors.

    The book lays out in 12 chapters what James Merritt, Joseph Hawkins and Phillip Miller call the "Dirty Dozen" reasons why there aren't enough doctors now and won't be nearly enough in the coming years, particularly specialists.

    They conclude there will be a physician shortage of an estimated 90,000 and 200,000 doctors in 15 years because:

    1. planners of medical education goofed
    2. managed care fizzled
    3. training shifted away from specialists
    4. the population is getting older and fatter
    5. docs are getting older, too
    6. the hours limits on residents and fellows has shifted the work load
    7. more women are becoming doctors
    8. the supply of international medical school graduates is shrinking post-9/11
    9. doctors' time is being consumed by increased paperwork
    10. many younger physicians won't work the long hours their older colleagues will
    11. medical technology is driving demand for care
    12. the existing supply of physicians is maldistributed
    Miller, the recruiter's vice president of corporate communications, said the target audience for the book includes physician leaders of medical education programs; government leaders who can fund needed increases in medical training, especially residency programs; hospital administrators puzzled at why it is so difficult to recruit physicians, particularly specialists; and physicians themselves, who need to know how their changing practice styles will help create the shortage.

    The authors conclude the prospects for alleviation of the shortage are bleak. "I can't really see it happening, because the pain threshold hasn't gotten high enough for most people," Miller said. "Doctors themselves have had a vested interest in keeping the supply limited, and the federal government's direction has been in the whole opposite direction, in decreasing GME funding."

    "The place where we see the most repercussions is in the emergency departments," he said. "We're seeing a lot of diversions. It's not from overcrowding; it's from a lack of specialists. That's a harbinger for what we see is coming."

    Miller said he does not foresee a crisis in which people will not get treatment. "It will be a matter of inconvenience, sort of what you see in Canada, with the lines getting incrementally longer," he said. "The time and the cost to see a specialist is going to increase dramatically in the coming years."

    The analogy to a Canadian system is only partly apt, according to veteran physician workforce watcher Richard Cooper, M.D., because in Canada, at least everyone is covered by government-sponsored insurance.

    In America, "It won't be exactly that, because the waiting times are going to be even longer for poor people," said Cooper, director of the Health Policy Institute at the Medical College of Wisconsin in Milwaukee. "Almost no one recognizes this as a national problem."

    Not a crisis, says COGME chair

    There are several schools of thought about the severity of the problem. On one end of the spectrum is Cooper, who gained notoriety in back 1994 for his controversial projections of an impending shortage. On the other end is Carl Getto, M.D., chairman of the federally funded Council on Graduate Medical Education. COGME tracks physician workforce trends, and Getto is less of an alarmist than the authors.

    "I think it is a problem; I don't see it in crisis proportions," Getto said. "They (the authors) have more alarm attached to it because that's their business, and they're hearing more alarm from their clients."

    In July, the council issued a report calling for a 15% expansion of the physician workforce in the coming decade, an increase in medical school output of about 3,000 more physicians a year, or fewer than three more graduates a year on average over 10 years from each of the nation's 125 medical schools. The easiest thing will be for the existing schools to expand, Getto said, but several new medical schools probably will come on line, too.

    "COGME doesn't think we're looking at a train wreck," said Getto. "We're in the range of where we want to be."

    There will be shortages in some areas, even with the recommended increases in medical school output, Getto conceded. "Rural primary care is going to be hurt a lot," he said. "That's the area where you're going to see the biggest shortage.

    "The biggest bottleneck is in residency programs," said Getto, who also serves as vice president of medical staff affairs at the University of Wisconsin Hospital & Clinics, Madison. "They aren't going to grow because there is no new money. I think it's the No. 1 question, and I don't have any bright ideas."

    Edward Salsberg, a physician-supply expert who authored the COGME report, said he is becoming increasingly troubled about the shortage and is edging toward the Cooper camp. His estimate that there would be a shortage of as many as 90,000 physicians by 2020 would only be mitigated, not alleviated, by the 30,000 additional graduates called for by the COGME increases. Salsberg is the director of the Center for Workforce Studies of the Association of American Medical Colleges, which was created last December and is studying the problem.

    "Adding 30,000 would not meet the projected demand," Salsberg said. "There are reasons to be concerned, for sure. I wouldn't classify it as grim yet."

    He said better technology and encouraging physicians not to retire could be part of a solution.

    "The medical-care field is going to have to evolve," he said, adding the new book is "raising important questions."

    Efficiency doesn't mean efficacy

    Cooper, however, is grim. He wrote about the problem last month in the article "Weighing the Evidence for Expanding Physician Supply," which appeared in the Annals of Internal Medicine.

    "We can get more mileage out of training more advance-practice nurses and physician assistants, but we can't get a lot of mileage. They can do well-baby exams, they can't do surgery. So even if you took away from physicians everything everyone else can do, it wouldn't make much difference." The danger with this tactic, Cooper said, is if it is carried too far, beyond the training and skill level of physician extenders, impacting quality of care and even patient safety. Similarly, efficiency gains through technology, such as electronic medical records, is all well and good, but "it is all counterbalanced by regulations, such as hours of work, HIPAA regulations, managed-care consents. As fast as you become efficient, there is an army of MBAs out there making us more inefficient, and they're winning."

    The country could lift the caps on foreign students to U.S. residency programs for a quick fix, he said. "You can get foreign residents in three or four years, but you've drawn these people from where there is a terrible shortage. Already it's a crisis in Africa. They're closing hospitals in the Philippines. That's a real problem.

    "So everywhere you turn, you've got the brain-drain problem, or the regulatory problem, or you can't ask PAs and nurses to do much more than they're already doing, and you add that all together and there is no clear solution. COGME created the problem and I wish they'd go away. They've done enough damage.

    "I don't have any real short-term solutions for what to do," Cooper said. "In the near term, there is just no way out."

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    The Check Up: Dr. Joseph Kerschner of the Medical College of Wisconsin
    The Check Up: Dr. Joseph Kerschner of the Medical College of Wisconsin
    Q&A: Addressing unconscious bias requires 'all hands on deck,' says Medical College of Wisconsin dean
    Q&A: Addressing unconscious bias requires 'all hands on deck,' says Medical College of Wisconsin dean
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • InDepth Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Top 25 Minority Leaders
        • Top 25 Women Leaders
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Leadership Symposium
        • Healthcare Transformation Summit
        • Women Leaders in Healthcare Conference
        • Workplace of the Future Conference
        • Strategic Marketing Conference
        • Social Determinants of Health Symposium
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala (2022)
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing