Specialists, Not Just PCPs, Are in Short Supply: Report

Ken Terry

December 14, 2017

A new white paper from Merritt Hawkins Associates, a leading physician recruiting firm, argues that specialists such as pulmonologists, psychiatrists, and dermatologists are in just as short supply as primary care physicians (PCPs) are, and that the situation is getting worse.

One reason frequently offered for the high cost of healthcare in the United States — contrary to the paper's results — is that the physician workforce here includes far more specialists than PCPs; in contrast, the numbers of PCPs and specialists are roughly equal in other advanced countries that spend less on healthcare than the US does.

Some experts have suggested that if the style of care delivery in this country were changed so that it focused more on primary and preventive care, providers could reduce waste and lower health costs significantly. In this view, the United States needs more PCPs and can make do with fewer specialists than what it has today.

Such may not actually be the case, according to the new paper's researchers.

"The notion that we should be training more primary care physicians while maintaining or reducing the supply of specialists is a grave miscalculation," said Mark Smith, president of Merritt Hawkins, in a news release about the report. "We should be training more of both types of physicians."

In terms of demand within specialty and the number of job openings, pulmonologists are by far the most in-demand specialists whom Merritt Hawkins is hired to recruit, the report shows. The growing need for pulmonologists is driven by two factors: the aging of the population and the continuing rise in chronic obstructive pulmonary disease, the report said.

Another area of particular need is vascular surgery. There are only several thousand vascular surgeons in the United States, while about 100 million people are at risk for vascular disease, according to the report. It cited a journal article predicting that there will be an 11.6% deficit of vascular surgeons by 2030.

As noted, the aging of the US population is the strongest argument for training more specialists, the researchers write. People age 65 years or older make up 14% of the population but account for 34% of inpatient procedures and 37.4% of diagnostic treatments and tests.

"It is primarily specialists such as cardiologists, orthopedic surgeons, neurologists, rheumatologists, pulmonologists, vascular surgeons and many others who care for the declining health and organ systems of elderly patients, and a growing number will be needed as the population ages," the report shows.   

But the problem is due not only to aging patients. The physician workforce is aging as well, and many doctors are nearing retirement, according to the paper. Forty-three percent of US physicians are 55 years or older, and specialists are older, on average, than PCPs. For example, 73% of pulmonologists are age 55 or older. The same is true for 60% of psychiatrists, 54% of noninvasive cardiologists, 52% of orthopedic surgeons, and 48% of urologists.

Supply and Demand

Merritt Hawkins' data on the types of search assignments it conducts for hospitals and other healthcare facilities demonstrate the growing demand for medical specialists, according to the paper. The recruiting firm's research shows that  80% of specialists are overextended or at capacity, while 20% have time to see more patients or take on new duties. These percentages mirror those for PCPs.

Citing a 2017 Merritt Hawkins survey, the paper noted that the time it takes to schedule appointments with specialists, such as cardiologists, dermatologists, orthopedic surgeons, and obstetricians/gynecologists — as well as family physicians — has increased 30% since 2014. While that finding applies only to 15 large metropolitan areas, the wait times are even greater in medium-sized markets, the report noted.

Another indicator of growing demand for specialists, the paper said, is the number of job offers received by PCPs and specialists during their training. Fifty-five percent of PCPs received 100 or more job offers while in residency. Although specialists fell short of that, 46% received 100 or more job offers, and 64% received 50 or more recruiting offers, according to the paper. The number of job solicitations medical residents (both primary care and specialists) received was higher in 2017 than in any other year since Merritt Hawkins first conducted the survey in 1991.

Twenty-seven percent of Merritt Hawkins' recruiting assignments in 2017 were for primary care positions, down from 33% in 2014, while 73% were for specialty physicians or advanced practitioners. "Job openings for medical specialists per capita can be greater than for primary care physicians," the researchers noted.

The team-based model of care, which involves the increased use of physician assistants (PAs), nurse practitioners (NPs), and other advanced practitioners, is likely to mitigate the shortages of physicians, the report acknowledged. This is largely why the Association of American Medical Colleges has reduced its projection of the physician shortage in 2030 from 130,000 to 104,900 physicians, the paper said.

However, the researchers pointed out, PAs and NPs are not a substitute for primary care and specialist physicians. For example, they are trained to assist in, not to perform, the bulk of procedures. Advances in medical technology and narrower areas of concentration will create an even greater need for specialists, the report shows.

The report also delved into the challenges facing some specialties in the future. For example, it cited a recent report by the National Council for Behavioral Health that also indicated there is a national demand for psychiatrists. Seventy-seven percent of US counties have a severe shortage of psychiatrists, and two thirds of PCPs have trouble getting psychiatric services for patients, according to that report.

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