Fifteen years ago, several federal agencies predicted that there would be an oversupply of physicians in the United States by 2010. They were wrong.
Current estimates now suggest that there will be a significant shortage of physicians, varying widely by geography and specialty.
The Council on Graduate Medical Education is predicting a shortfall of doctors anywhere from 65,000 to 150,000 nationwide by 2020. With Colorado’s and the nation’s growing population, the need for physicians is increasing with each passing year.
The Association of American Medical Colleges has recommended that medical schools increase their enrollment by 20 percent by 2015. (At the University of Colorado, we’re already increasing enrollment.) Currently, 16,000 students graduate from all U.S. medical schools each year. With this increase, there would be 18,400 graduates annually. Only time will tell if this will be enough.
There are many challenges facing the field of medicine that have contributed to the dwindling pool of physicians needed to keep pace with health care needs.
Physician demographics began to change dramatically with the introduction of managed care in the 1990s. By 2000, many practicing physicians had had enough of the new managed care realities of overwhelming paperwork and declining reimbursements. In the “pre-bubble” economy, many physicians cashed in their retirement plans and got out of medicine altogether.
At the same time, there has been an important change in the way physicians think about their work. Simply put, physicians want a life outside of work and are willing to accept lower salaries to ensure it.
Some might attribute this shift to the influx of women in medicine. It is true that number of female medical students in the United States grew from 20 percent in 1980 to 50 percent by 2005.
Yet that answer is too simple. Researchers have examined the causes for these new attitudes toward work hours in medicine. They are clearly linked to generational issues, not gender issues. Simply put, neither men nor women of this generation want to work the 100 hours a week considered acceptable a generation ago. This shift has had a very direct consequence; in the absence of those hours, we need more people.
The final challenge stems from the progressively decreasing number of medical students electing to go into “personal care medicine.” Personal care specialties, where continuity and lower payment for time spent are hallmarks, include family medicine, internal medicine, obstetrics, geriatrics and pediatrics.
(Alternatively, subspecialties are becoming increasingly popular. The Association of American Medical Colleges has recently released data that shows that the number of medical students choosing family medicine, general internal medicine and general pediatrics are all down. Specialties such as anesthesia, internal medicine specialties (such as cardiology) and pediatric specialties are on the rise.)
Confronted with increasing debt load on graduation, it is simply not in the a young physician’s interest to choose a training program in a specialty when the end result is long hours and low reimbursements.
As individuals age, they typically develop multiple problems that should require the treating physician to spend more time with each patient, something for which medicine today seems to have little room. Yet these specialties are the backbone for a healthy medical system. The progressively decreasing numbers of students entering them raises the question of who will be left to take care of the complex chronic disease patient in a decade.
The University of Colorado School of Medicine, the only medical school in a 500-mile radius, is working to address some of these challenges.
The school has increased its class size for the first time in 30 years. The incoming 2005 class increased by 12 students to a total of 144 students and will increase by another 12 students next year. Fortunately, the number of qualified applicants continues to grow each year. In addition, the school has revamped its curriculum and developed tracks to guide medical students and focus on drawing graduates into areas that are underserved.
For example, there is a rural track for a group of medical students accepted each year who are specifically interested in providing health care in rural communities. These students receive the same training as our other medical students, but the majority of their clinical experience occurs in a rural setting.
We recognized long ago that it was essential to develop a pipeline of future physicians. We work with K-12 students in rural and underserved communities to encourage medicine as a career possibility and work diligently to provide these students with every opportunity to succeed. We are now beginning to see these efforts pay off.
Since 1968, Colorado’s population has increased from 2.2 million to 4.5 million. Large and diverse populations have emerged in Colorado, including various Latino, Asian and former Soviet Union cultures. Each community has specific needs, and physicians must be adept at addressing the needs of each cultural group. The medical school has integrated cultural competency “threads” that weave throughout the medical students’ education.
What else can be done? One can look back to the 1960s, when the country last faced a physician shortage. At that time, the federal government provided special funds to train physicians in family medicine, general pediatrics and general internist areas. With finances dictating physician specialties, so too must financial incentives be developed to alleviate this crisis. Loan repayment options for service to the underserved and delay in repayment until after residency will help. Ideally, a scholarship program tied to community service on graduation should be developed.
Our health care system faces many challenges: a continuing nursing shortage, the Medicare system accommodating the flood of baby boomers as they turn 65, as well as an increasing need for physicians. These are complex problems that will require multiple answers.
