The pendulum has swung in the great doctor-supply debate. After years of warning about an overabundance of tens of thousands of physicians in the new millennium, the typically conservative medical community is now listening to experts who, for years, have been predicting a looming undersupply of doctors.
The Association of American Medical Colleges, which represents the nation's 125 accredited medical schools, issued a report three months ago calling for a 15% increase in medical students, or about 2,500 per year, by 2015. The Council on Graduate Medical Education recently came to the same conclusion. Even, the American Medical Association, which argued for years against an increase in the ranks of the nation's doctors, is set to debate a hike in supply when it gathers in Chicago late this week for its annual meeting.
The big question is: Will educators, the medical community and public policymakers come to a consensus and address this issue in time to make any real difference?
"This is an urgent concern right now," says Edward Salsberg, director of the 14-month-old Center for Workforce Studies at the AAMC, which hosted the first national conference on this topic last month in Washington. "And why it's urgent is because of how long it takes to create new medical schools, change supply and distribution and train new doctors. We need to be concerned about the year 2015 because we can't wait for 2015 to say, `Who's going to care for the baby boom generation?' "
He noted that the number of Americans age 65 and over will swell by 35 million by 2030, increasing utilization for the kinds of expensive medical treatment most often associated with the elderly, including heart disease, cancer, pulmonary disorders and diabetes. Meanwhile, doctors appear to be working less and retiring earlier, while the U.S. population has grown.
"We can't rely solely on waiting for signals from the marketplace that we need more," Salsberg says. "If somebody could definitively say today that we need X number of physicians, it would take us 10 years to produce them."
Richard Cooper, a physician who is the director of the Health Policy Institute at the Medical College of Wisconsin in Milwaukee and another national expert on physician-workforce issues, says the conference helped reinforce the "broad consensus that we're in the middle of a deepening shortage of physicians and we need to do something about it." He suggests, however, that the shortage will be far more acute than predicted by the AAMC.
Cooper criticized Salsberg, a longtime colleague, and the AAMC in general, for what he calls a tendency toward understating the urgency of the future shortage -- and thus minimizing the national reaction to the problem. He is certain the shortage will be much worse than Salsberg estimates and says he believes it takes a worst-case scenario to generate an adequate response from policymakers.
"The problem with (the AAMC and Salsberg's estimates) is that they've undershot (the real shortage) to such a degree it will mislead the nation -- it's deplorable. They've come up with a figure that leads to complacency. You don't energize a response by minimizing a problem."
The AAMC's two-day physician-supply conference, which attracted dozens of researchers, educators and doctors, was the first step in underscoring the importance of sharing information and working toward a common goal, Salsberg says. For too long, he adds, researchers from many different arenas -- including the federal government and the medical community -- have worked "in their own silos," rarely sharing data.
"We've had lots of bits and pieces," he says. "But there's never been a real focus on this kind of research by a group like the National Institutes of Health or the Centers for Disease Control. There is no systematic national funding for physician-workforce planning."
While there are plenty of projections of what the supply might look like a decade from now, Salsberg says it's increasingly important for overall planning and strategy to determine, for example, if doctors are retiring earlier than usual or working less than their counterparts in the past. That kind of information is a key piece of the puzzle when policymakers begin to sort through future needs.
Amid the growing acceptance of a future physician shortage, Salsberg says he expects to see the number of medical students increase by 15% through a combination of a slight enrollment boost in existing schools and the addition of "six or seven" new medical schools over the next five years.
Yet, even those increases might not be enough to meet demand, Salsberg says. In his presentation at the AAMC meeting, he pointed out that the 15% hike would add about 30,000 new doctors to the supply by 2020, bringing the total to just more than 1 million. That, he says, is far less than the "likely demand" of as many as 1.24 million physicians "if services in 2020 are delivered as they were in 2002."