U.S. Physician Shortage: How Bad Is It?

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​Last year, when the AAMC (Association of American Medical Colleges) released its latest report on the impending U.S. physician shortage, the picture looked particularly bleak.

It hasn’t improved.

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U.S. Physician Shortage: How Bad Is It?

Rural, Low-Income Areas
​Facing Crisis Levels

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Did you know…  

• In 2020, there was a shortage of 29,000 to 42,900 doctors in the U.S.
• By 2033, a shortage of up to 139,000 U.S. physicians is expected, at least half of which will be among primary care physicians.
• Rural and impoverished areas will be hardest hit by the increased doctor shortage.
• Two-thirds of Colorado’s 64 counties are designated as either “rural” or “frontier,” and are already medically underserved.

Last year, when the AAMC (Association of American Medical Colleges) released its latest report on the impending U.S. physician shortage, the picture looked particularly bleak. It hasn’t improved.

In fact, according to AMA President Patrice Harris, the COVID pandemic has exacerbated the workforce challenge. But even before COVID hit, the country was facing a potentially serious doctor shortage, particularly in rural and inner city areas. There are several explanations for the shortfall.

Growing Population

The U.S. population increased by 7.4% from 2010 to 2020. This is the slowest growth rate since the Great Depression, partly due to the pandemic. Yet it still represents an increase of almost 23 million people.

Aging Population

Today, there are more than 46 million U.S. residents who are age 65 and older; by 2030 that number is projected to increase by almost 18 million. By 2032, seniors will outnumber children and teens for the first time in U.S. history.
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With an aging population comes an increased demand for physician care. Older adults typically have multiple chronic health problems such as diabetes, heart disease, arthritis, depression, and hypertension. An estimated 90% of U.S. adults over age 65 experience at least one chronic condition requiring specific treatments and medical care.

​Aging Physicians

According to Dr. Janis Orlowski, AAMC's chief healthcare officer, one out of every five U.S. doctors is older than 65. And a third of practicing physicians are over 60. But physicians often delay retirement for a few years, compared to average American workers. “We get started later because we're in school for so long,” Orowski said. “People enjoy the work they're doing and find it fulfilling. So we see physicians tend to work a little longer.”

What Is an HPSA?

HPSAs (Health Professional Shortage Areas) are federally designated geographic areas, populations, or facilities with a shortage of health care providers, as identified by the Department of Health and Human Services (HHS).

Three criteria are used to identify HPSAs:

• Population-to-provider ratio
  
  
• Percentage of population below the Federal Poverty Level
  
  
• Travel time to the nearest source of care outside the HPSA.

Nevertheless, as their numbers begin to dwindle, the remaining doctors can easily become overworked and stressed, as they attempt to satisfy the demand for services.  A burned-out physician may choose to reduce his workload in the interest of self-preservation.

​Effect of COVID 

And then there’s the impact of COVID on the medical community.  In 2020, more than 3,600 medical personnel died from COVID. Seventeen percent of them – at least 613 – were doctors.

In addition to the death count, the daily battle with this pandemic has taken a physical and emotional toll on physicians, leaving them exhausted and vulnerable to infection. More than a year later, some hospitals are still routinely combatting the virus.

COVID-related economic uncertainties have also taken their toll on physicians. During the height of the pandemic, thousands of medical practices called it quits. With elective medical procedures suspended, hospitals and doctors’ offices lost billions in revenue. Almost half of U.S. physicians surveyed indicated that they were seriously reconsidering their career or practice.

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​Federal Cap on Residencies

Every year the Centers for Medicaid and Medicare Services (CMS) pay hospitals to hire their residents. The number of residencies ultimately determines the number of practicing physicians for any given year. But the 1997 Balanced Budget Act placed a cap on the number of annual residencies the CMS would support. As a result, the funding has been frozen at 1996 levels for almost 25 years.

In March of this year, the Resident Physician Shortage Reduction Act of 2021 (HR 2256) was reintroduced in Congress, after a similar bill two years earlier failed to pass. This bill increases by 2,000 the number of residency positions paid by Medicare to qualifying hospitals, including those in rural areas and HSAs. HR 2256 is currently under committee review.

​Is There a Fix?

Experts believe there are several steps public health officials can take to alleviate the physician shortage by equalizing the distribution of healthcare services. These include:

• Promoting telemedicine and other new technologies
• Expanding the scope of practice for nurse practitioners, clinical nurse specialists, and physician assistants
• Adjusting physician reimbursement policies so providers are induced to practice in shortage-prone areas.
• Encouraging retired doctors to reenter the workforce
• Enabling early graduation for medical students
• Encouraging medical school graduates to pursue primary care residencies (such as family medicine, internal medicine and pediatrics) in the most underserved areas.
• Promoting the passage of HR 2256 to increase the number of annual residencies paid by Centers for Medicaid and Medicare Services (CMS.)

Colorado’s Current Need

Within RFS's home state of Colorado, the Department of Health and Human Services (HHS) has designated 119 areas as primary care Health Professional Shortage Areas (HPSAs), meaning they lack the number of physicians needed to serve the population.

A little more than half of the state’s HPSAs are located in Denver County. The rest are spread out across predominantly rural areas. Two-thirds of Colorado counties are “rural” or “frontier,” and are served by less than 10 percent of the state’s physicians.

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Sources:
Images: Pixabay
AAMC
New York Times
Colorado Public Radio
MedPageToday
Adaptive Medical Partners