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There aren’t enough doctors to go around
Quite possibly, the most dire health-care crisis facing America these days is the one we hardly hear about. While lawmakers on both sides of the aisle quibble about the best way to offer Americans access to care, another, more fundamental problem is rapidly becoming acute: There aren't enough doctors to go around.
The United States will face a shortage of anywhere between 42,600 and 121,300 physicians by 2030, according to a study released earlier this summer by the Association of American Medical Colleges.
These aren't just disembodied statistics: They mean that, increasingly, even Americans who believe they have ready access to health care may not be able to see the specialist they require. And given that a doctor's training lasts about a decade, it's a crisis we're already late in addressing.
How did we get here? The issue certainly isn't a dip in medical school enrollment, which has increased by nearly 30 percent since 2002.
Instead, the answer is twofold. The first problem is a fast-changing demographic shift: With thousands of Baby Boomers turning 65 every day and entering Medicare, the number of older Americans will double in the next 20 years, a rapid rise that would place an immense burden on even the most functional health care delivery system.
And then, there's economics. In 1997, the Balanced Budget Act capped federal funding of medical residency programs; in 2016, for example, the government spent about $10 billion, the overwhelming majority of it coming from Medicare. Most experts predicted that the cap would soon be lifted; more than 20 years later, it's still in place.
As a result, what we have now is a classic bottleneck condition: More and more people want to practice medicine while less and less funding is available to help create residency programs that meet the demand.
In some fields, this shortage is already acutely felt. The U.S. currently needs 2,800 more psychiatrists just to meet the existing demand, according to a recent study by the US Department of Health and Human Services, a dearth that means that large swaths of the country have no adequate psychiatric coverage and aren't likely to get it anytime soon.
Add to that the fact that nearly half of physicians working today are 55 or older, and you've got the makings of a real, durable crisis.
Meeting it has been the focus of physicians and educators for at least a decade. Some solutions are promising, like relying on new technologies to facilitate processes previously administered by doctors and the emergence of telemedicine for virtual consults.
Other approaches attempt to maximize all available human resources, creating collaborative teams of care providers that work together to try and meet their overwhelming demands. But little of any real consequence is likely to change without legislative intervention.
Thankfully, a bipartisan bill was introduced in both the House and the Senate last year. Called the Resident Physician Shortage Reduction Act of 2017, it would provide some urgently needed relief by funding 15,000 Medicare-supported residencies over a five-year period. This would primarily benefit underserved communities.
While well-funded hospitals in large cities have a much easier time filling their residency programs based on need, rural and other underserved communities depend heavily on federally funded incentives to draw promising candidates.
As a medical school dean, I feel this problem deeply and personally. Every year, my colleagues and I witness our talented graduates deal with the anxiety of applying to more and more residency programs, knowing that fewer and fewer spots are available. That's a shame.
Training to become a doctor is one of the most intellectually, financially and emotionally demanding things a human being can do, and the added stress of career uncertainty is helping no one.
Let's hope, then, that Congress acts to address this problem before it gets worse. In the meantime, it's up to all of us to raise our voices and demand both the quantity and quality of physicians we deserve.
Lawrence G. Smith M.D. is the dean of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He is also Northwell Health's physician-in-chief, the senior physician on all clinical issues.