The number of medical residents pursuing careers in primary care and mental health has increased in recent years, but there still aren't enough specialists to meet the current demand.
Labor shortages throughout the healthcare industry have led to delays in care and strained hospital resources. Hospitals and health systems as well as federal and state governments have tried to attract more into the profession, but there is concern that the growing number of physicians entering the field still won't be enough to keep up with rising demand and a wave of retirees.
There were 14,193 residents—a 15% increase over the past three years—training in Accreditation Council for Graduate Medical Education-accredited family medicine programs in the 2021-22 school year, while the current shortage exceeds 17,000 primary-care physicians across U.S. healthcare professional service areas, according to the Association of American Medical Colleges and the Health Resources and Services Administration. As for the mental health workforce, there were 7,093 psychiatry residents—a 21% increase over the past three years—compared with a current shortage of nearly 8,000 practitioners.
The supply-demand mismatch is, in part, due to a wide variation in pay. The average starting salaries for primary-care physicians and psychiatrists last year were about half the average starting salaries for orthopedic surgeons and interventional cardiologists, according to data from physician search firm Merritt Hawkins.
“The way we pay physicians in this country is too disparate between primary care and other specialties,” said David Auerbach, a health economist and senior director for research and cost trends at the Massachusetts Health Policy Commission.
That disparity is felt acutely in rural areas, which have one-third the total physicians per capita as urban areas, he said.
As long as other specialty services are valued and reimbursed much higher, these distortions will remain, said Ryan McBain, a policy researcher at nonprofit think tank RAND Corp.
Still, Auerbach and other researchers cautioned that the shortage estimates do not factor in nurse practitioners and physician assistants, two of the fastest-growing job sectors in healthcare. The growth in those two professions, which often provide primary care and are taking on bigger roles in healthcare delivery, will partially offset the estimated 17,800 to 48,000 primary-care physician shortage projected by 2034, according to the Association of American Medical Colleges.
Even so, the shortages of physicians and nurses are creating massive backlogs. Many health systems, for instance, are treating mental health patients in their emergency departments for longer stretches because their post-acute referral partners don’t have capacity.
“We are already in a situation today where there is a waiting list for outpatient and residential mental health facilities,” said Vasanta Pundarika, co-head of healthcare investment banking at Matrix Capital Markets Group. “As there is a shortage of mental health practitioners and psychiatry residents, does that waiting list continue to grow?”
Hospitals and health systems as well as federal and state governments are offering incentives such as free or partially reimbursed tuition for doctors who pursue primary care and mental health in underserved areas. But those efforts have had a limited effect, industry observers said.
The Health Resources and Services Administration has funded a range of scholarships and career development programs aimed at boosting the healthcare workforce in rural areas. While those efforts have helped, the divide between the number of physicians per capita practicing in urban versus rural areas has grown over the past decade, Auerbach said.
“You can only do so much to get people to go where you want them to go,” he said.
Telehealth has filled some of the care gaps as academic medical center-based specialists guide procedures performed in rural hospitals. The $1.7 trillion omnibus bill passed at the end will likely help, as the legislation extended telehealth reimbursement waivers through 2024.
Expanding the number of slots for seats at U.S. medical schools could also help, said Rand's McBain, noting that the average acceptance rate is about 5%. "This means that the U.S. is turning away a lot of potential talent," he said.
