The number of physicians in the U.S. is growing, but not quickly enough to meet the needs of an aging population, according to a new Association of American Medical Colleges study (PDF) which projects a shortage of 46,000 to 90,000 doctors by 2025.
The number of people older than 65 is expected to increase 46% by 2025, noted Dr. Janis Orlowski, AAMC chief healthcare officer. Also adding to care needs, individuals are living longer with chronic conditions and diseases such as cancer, requiring more healthcare services.
The report used 2013 as its baseline. There were 767,100 active physicians in the U.S. that year under age 75. Ten percent of those doctors were between 65 and 75 years old and 26% were between 55 and 64. A third or more of doctors practicing today could retire in 10 years, the report noted. Younger doctors replacing them typically do not work as many hours as the older doctors they are replacing, another cause for concern.
Some major cities appear to have an oversupply of physicians, leading some to argue that the problem is an uneven distribution of doctors, not a shortage. But Orlowski said it's not an either/or proposition.
“It is a nationwide shortage,” she said. “It's exacerbated by maldistribution.”
A report released in January 2014 by the Merritt Hawkins physician recruitment firm found that cities perceived as having an abundance of doctors had some of the longer wait times among the 15 markets surveyed. In Boston, for example, the average wait time to see a family practice doctor was 66 days and it took 72 days to see a dermatologist. Waits were nowhere that high anywhere else, but patients still waited 26 days to see a family physician and 24 days to see a dermatologist in New York, another city with a high physician concentration.
“This is truly urgent,” said AAMC CEO Dr. Darrell Kirch.
The AAMC recommendations for addressing the problem include having physicians make better use of information technology, adopting innovations for more efficient delivery of care, and adding 3,000 more federally funded graduate medical education positions, Kirch said.
There are roughly 118,000 GME positions for new doctors to undergo their residency training. Medicare is the biggest source of funding for physician training, providing $9.7 billion in 2012.
Adding 3,000 new GME slots would cost about $1 billion annually, Orlowski estimated. Kirch noted that there were three different bills introduced in Congress last year to increase the number of federally supported medical residency positions but none made it out of committee.
The AAMC was not issuing any recommendation on how these new positions would be distributed, Kirch emphasized.
An Institute of Medicine GME report issued last summer was highly critical of the way residency positions are allocated.
The IOM report noted how, despite the reliance on federal funding to pay for GME, new physicians “have no obligation to practice in specialties and geographic areas where they are needed or to accept Medicare or Medicaid patients once they enter practice.”
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