America’s million-doctor shortage is right around the corner

The doctor is disappearing in America.

And by most projections, it’s only going to get worse — the U.S. could lose as many as 1 million doctors by 2025, according to a Association of American Medical Colleges report.

Primary-care physicians will account for as much as one-third of that shortage, meaning the doctor you likely interact with most often is also becoming much more difficult to see.

Tasked with checkups and referring more complicated health problems to specialists, these doctors have the most consistent contact with a patient. But 65 million people live in what’s “essentially a primary-care Desert,” said Phil Miller of the physician search firm Merritt Hawkins.

Without those doctors, our medical system is “putting out Forest Fires — just treating the patients when they get really sick,” said Dr. Richard Olds, the chief executive officer of the Caribbean medical school St. George’s University, who is attempting to use his institution’s resources to help alleviate the shortage.

Dr. Ramanathan Raju, CEO of public hospital system NYC Health + Hospitals, goes even further, saying the U.S. lacks a basic primary-care system. “I think we really killed primary care in this country,” said Raju. “It needs to be addressed yesterday.”

The primary-care gap is particularly acute in about one-third of states, which have only half or less of their primary-care needs being met. Connecticut is a standout among the group, at about 15%, with Missouri, at 30%; Rhode Island, at 33%; Alaska, with 35%; and North Dakota, at 37%, next on the list, according to government statistics.

 

“The real problem is we don’t have enough doctors In the Right places and In the Right specialties,” Olds said, noting that doctors tend to cluster in big cities, and are Far more scarce in rural areas and in other small communities as well as certain parts of some big cities.

But how did this shortage come about, and how has the problem gotten so acute?

Here’s what’s involved:

How doctors get paid: Choosing to go into primary care is also a choice of lesser pay.

Starting salaries in high-paying specialties can range from $354,000 (general surgery) to $488,000 (orthopedic surgery), while primary-care fields tend to bring a sub-$200,000 starting salary, from$188,000 (pediatrics) to $199,000 (family medicine), according to a Merritt Hawkins report.

The pay disparities reflect America’s “fee for service” health-care model, which compensates providers based on the number and type of services they complete, and which inherently favors specialists.

Reform-minded critics say compensation should instead be based on the period of time a patient is cared for. They argue that this structure would incentivize preventative care and prevent unnecessary (and often costly) medical procedures. The Centers for Medicare and Medicaid Services is in the very early stages of considering this global payment model.

Experts say it’s not just that primary-care doctors are paid less; they also typically work longer hours and have to be well-versed in a wide array of medical issues, to refer patients to the appropriate specialists.

Our culture is also part of the problem, Raju said, since “it’s not very glamorous to [say] that I went to some primary-care doctor. It’s glamorous to say, ‘I went to a cardiologist.’ ”

Paired with hundreds of thousands of dollars of debt, it’s a recipe for a shortage, Olds said.

“From the patient standpoint, the most important doctor you have is the primary-care doctor, who’s paid the least,” Olds said. “We pay for procedures, drugs and expensive tests, but we don’t pay doctors to think and care and manage patients’ health-care problems.”

More Demand: People are living longer and thus need more medical care, accelerating doctor Demand; AAMC’s 2015 report calculates an 11% to 17% growth in total Demand, of which a growing and aging population is a significant component.

The shortage is one that’s been stewing for decades but of late was exacerbated by passage of the Affordable Care Act, which increased the number of insured people and along with that the Demand for doctor access, experts say.

• Medical schools themselves: Few medical schools consider a community-service background or an expressed interest in primary care when admitting applicants, though these are factors that would be easy to screen for. Past service in programs such as the Peace Corps and Teach for America are good predictors of students taking an interest in primary care, Olds said.

Diversity also plays a role. Olds said he’s found that students from a range of socioeconomic backgrounds tend to go into a diversity of medical fields, too.

Then there’s the structure of the programs themselves. A majority of med-school faculty members tends to be composed of specialists (a more research-oriented bunch, aiding the school’s federal funding), which influences their students’ choices, and use of university hospitals as teaching sites doesn’t immerse students as much in the outside community, inhibiting growth of community Roots.

Osteopathic schools — which have the same educational requirements as an M.D. degree institution but with a focus on holistic medicine and a more hands-on approach — tend to have more luck sending students into primary care, with over half of graduates going into nonspecialized fields, said Dr. Barbara Ross-Lee, dean of the New York Institute of Technology’s new osteopathic medical campus at Arkansas State University.

The NYIT ASU campus was founded to alleviate Arkansas’s physician shortage and will enroll its first class of 115 students in August.

Like other osteopathic schools, the NYIT ASU degree program will focus on patients’ overall wellness, an approach that dovetails with the philosophy and role of a primary-care doctor.

But osteopathic programs are also designed to expose students to general medicine, with generalists making up much of the teaching faculty and clinical training opportunities in settings where primary care is Delivered. The school also asks students in entrance interviews about their interest in primary care, Ross-Lee said.

Geography: It doesn’t take more than a quick scan of a map of medical schools in the U.S to note that they’re heavily concentrated in the northeastern U.S. Graduates tend to stay in the areas where they went to school, so this contributes to a geographic skew among doctors.

Prospective doctors must complete a residency in order to practice medicine, but those programs — funded in part by federal dollars — aren’t located in areas with great need nor do they geographically calibrate with that factor in mind.

Pay figures in, too. Suburban areas typically offer a perceived higher quality of life to doctors and their families, along with, often, better compensation than a public, urban system, said Raju, resulting in shortages even in places such as his own hospital system in New York City.

The government’s role (or lack thereof): In the U.S., though government dollars sponsor aspects of medical education, especially residencies, there’s no oversight in how doctors are sorted into various specialties.

But fingers aren’t just pointing at medical schools. Fear of a doctor surplus prompted a 1997 payment cap on Medicare funding for residencies, which has served as a “stumbling block” for doctor training ever since, John Iglehart wrote in the New England Journal of Medicine in 2013.

So as medical-school enrollment has swelled — medical schools planned to increase their enrollment classes by almost 30% between 2002 and 2016, according to Iglehart — residency-slot expansion has slumped.

A numbers game: Only about one in four medical-school graduates is heading into a primary-care career, according to Olds, a ratio that’s half what it should be.

But doctors also want to practice differently today than their predecessors did, placing a higher premium on regular, 9-to-5 hours, Miller said. So “we find it takes more than one doctor coming out today to replace an old-style, baby boomer doctor [of 25 years ago],” he said.

Then there’s the seven years it takes to train a doctor — a lag time that’s built into any program or effort to address the shortage.

That means there’s little wiggle room. “The Time is Now,” said Ross-Lee.

Forbes and AAMC: The U.S. Primary Care Physician Shortage Worsens

In this article, Forbes reporter Bruce Japsen reports on the American Academy of Medical Colleges annual physician workplace report, which notes the growing decline of primary care physicians in the United States year-over-year.

Forbes: Doctor Shortage Worsens, Particularly In Southern States

There are 91 active primary care physicians per 100,000 population in the United States, but there needs to be more if Americans are going to get the right care, In the Right place and at the right time, a group representing the nation’s medical schools and teaching hospitals says in a new report.

The Association of American Medical Colleges (AAMC) this week released its annual physician workforce report, which looks at the Supply and makeup of U.S. physicians, as well as the general expanding state of graduate medical education in the U.S. The report drew on data that includes information from AAMC researchers as well as the American Medical Association’s “Masterfile.”

While it’s been well documented that the U.S. needs more doctors, the report shows much of the country is in need of primary care physicians and their numbers aren’t on the Rise despite increasing emphasis on outpatient care and wellness. The flat to falling number of primary care doctors comes as more Americans can pay for treatment and are flocking to healthcare providers thanks to the Affordable Care Act.

Primary care doctors, which include internists, family physicians and pediatricians, are critical to managing chronic conditions to ensure Americans are getting the care they need to avoid bad health outcomes and higher costs that go when patients get sick and end up in the hospital. The median number of “active primary care physicians” has steadily fallen to 90.4 per 100,000 from 91 in 2010.

“We do have concerns when the numbers get below 100 primary care physicians per 100,000 people,” Dr. Atul Grover, AAMC’s chief public policy officer, said in an interview. “I’m worried people aren’t going to have access to primary care.”

Medicare and private health insurers like Aetna AET -1.85%, Anthem ANTM -0.71% and UnitedHealth Group UNH -0.85% are pushing value-based care models that emphasize primary care, wellness and outreach to populations.

But across the country, there is one primary care doctor for every 1,100 people and Grover said anything below a doctor per 1,000 Americans isn’t good. Most U.S. states except those in the northeast and certain states in the upper Midwest like Minnesota and Michigan have fewer than 100 primary care doctors per 100,000 people.

By comparison, southern states are severely lacking and tend to have a greater need. Texas, Oklahoma, Georgia, Arkansas, Alabama and Mississippi not only have low numbers of primary care doctors, but analysts say these areas tend to have high rates of obesity and chronic conditions like hypertension and other risk factors for heart disease.

There were 11 states with 64 to 78 primary care physicians per 100,000 people with Mississippi scoring the worst with just 64.5 physicians per 100,000 Americans. By comparison, Massachusetts was at the top, with 133.9 primary care physicians per 100,000 people.

The Wall Street Journal Sits Down With Our President & Founder, Dr. Leonard Glass

In this piece, The Wall Street Journal interviews our President & Founder, Dr. Leonard Glass, about the Physician Retraining & Reentry program and his efforts to positively impact the growing physician shortage.

Wall Street Journal: “A Retired Surgeon Takes on a New Medical Mission”

Former surgeon forms an organization that retrains retired specialists to be generalists

The U.S. is facing a looming doctor shortage. With a surge of baby boomers enrolling in Medicare and millions of newly insured citizens seeking physicians under the Affordable Care Act, there simply aren’t enough general practitioners to go around. The Association of American Medical Colleges estimates the U.S. will be short by as many as 31,000 primary-care doctors by 2025.

Leonard Glass, a retired surgeon, had an idea about who could help fill these much-needed shoes: older medical specialists. For example, many surgeons retire due to diminishing eyesight or fine-motor problems, while obstetricians often burn out in their 60s after decades of Sleepless Nights. Yet these doctors are still capable of providing general medical care. Dr. Glass himself retired from practicing surgery in 2005 when a neck injury began limiting his dexterity.

“I kept reading about this impending doctor shortage, and I looked around at many of my retired colleagues and thought, why not get some of these doctors back to work?” says Dr. Glass, now 80.

So in 2013, he Launched Physician Retraining & Reentry, or PRR, to help retrain medical specialists in adult outpatient primary care. He funded the startup with his own savings and investments from friends and family, and didn’t primarily set out to make a Profit. “I just had to do something to ensure my kids and grandkids would have access to good medical care,” Dr. Glass says. “It became my obsession to help fix the doctor shortage.”

PRR is essentially an online training program, helping medical specialists get up to speed on the latest primary-care techniques. Specialists are already licensed in general medicine, but most haven’t practiced it since their residencies, so they want a “refresher course,” says Dr. Glass.

The self-paced program includes interactive tests and live role-playing, with actors posing as patients. It takes four months to a year to complete. “We teach everything from the latest diagnostic techniques to medical record-keeping,” says Dr. Glass, who works about 30 hours a week at PRR.

Doctors who complete the program receive 180 hours of continuing-education credit and help finding jobs. PRR has only four full-time paid employees (Dr. Glass and his brother-in-law, who Serves as CFO, don’t receive salaries), and one works solely on job placement.

“Many doctors want to work part time, and some want to give back by working at public clinics, while others want full-time posts,” says Dr. Glass. Only 30 doctors out of the 130 who have entered the PRR program have completed it so Far, but Dr. Glass is hopeful hundreds more will. “We built the technology platform so up to 3,000 doctors could take it per year,” says Dr. Glass. If doctors can’t afford the $9,750 course fee, PRR offers no-interest financing.

“Being a primary-care doctor is medicine at its finest, but many doctors lose sight of that purpose after practicing a specialty for decades,” Dr. Glass says. “We help doctors get back to the root of why they went to medical school in the first place: to take care of people.”

Healthcare IT: “Are retirees the answer to the physician shortage?”

Leonard Glass, MD, a retired clinical professor at UC San Diego School of Medicine, believes that retired physicians can be part of the solution to the growing physician shortage in the US.

Glass founded an online program called Physician Retraining and Reentry, which retrains retired physicians to provide adult outpatient primary care.

At the end of the program’s first year, 13 physicians had successfully completed the program, 70 were still in training and 20 were getting ready to start.

Recruiting retired physicians to help solve a looming doctor shortage

An online program created in collaboration with the UC San Diego School of Medicine faculty aims to help address the nation’s shortage of primary care physicians, a critical health-care issue highlighted by the Association of American Medical Colleges on Tuesday.

Created by educators at the medical school and primary care physicians who are renowned experts in physician training and assessment, Physician Retraining and Reentry (PRR) provides physicians of all backgrounds, retired and otherwise, the tools needed to offer adult outpatient primary care in their current practices or at understaffed clinics across the country.

Read more at The Washington Post.

Supply won’t meet growing demand for primary care

Federally funded programs will add at least 2,300 new primary care practitioners by the end of 2015, but the funding for at least one of those programs is set to expire at the same time, contributing to a massive shortage of doctors available to treat patients — including those newly insured through the Affordable Care Act and Medicare.

The U.S. is expected to need 52,000 more primary care physicians by 2025, according to a study by the Robert Graham Center, which does family medicine policy research. But funding for teaching hospitals that could train thousands more of these doctors expires in late 2015.

Population growth will drive most of the need for family care doctors, accounting for 33,000 additional physicians, the study says. The aging population will require about 10,000 more. The Affordable Care Act is expected to increase the number of family doctors needed by more than 8,000, the study says.

Read more at USAToday.com.

Solving the physician shortage: Secrets to recruiting and retaining providers

Solving the physician shortage: Secrets to recruiting and retaining providers

The looming physician shortage, especially in primary care, was a topic of conversation in healthcare circles long before the Affordable Care Act (ACA) became law. Estimates as to the extent of the problem vary–from a predicted shortfall of 52,000 primary care physicians to more recent reports that the industry overestimated the crisis.

For the most part, healthcare organizations are able to accommodate increased patients, according to a report from Kaiser Health News. But because awareness of and enrollment in health exchanges continues to grow, some groups believe access difficulties lie ahead. “We have not felt the full impact of it yet,” David Fleming, president of the American College of Physicians, told KHN. “We are going to see a substantial increase in volume and it is going to be a problem because there are not enough primary care doctors.”

Read more at FiercePracticeManagement