Physician Shortage Grows in Latest Projections

Marcia Frellick

June 26, 2020

Fifteen-year projections for the shortage of primary care and specialty physicians in the United States grew to between 54,000 and 139,000 in the latest annual report by the Association of American Medical Colleges (AAMC).

Those estimates are up from last year's projections of a shortfall of 46,900 to 121,900 by 2032.

The Complexities of Physician Supply and Demand: Projections from 2018-2033, was the sixth annual study conducted for the AAMC by the Life Science division of global analytics firm IHS Markit.

This analysis, conducted in 2019, includes supply and demand scenarios but predates the COVID-19 pandemic.

In a telephone press briefing this morning, David J. Skorton, MD, AAMC's president and CEO, told reporters that the pandemic has highlighted the acute effects of physician shortages.

"We've seen in stark detail how fragile and quickly overwhelmed America's healthcare system truly is, and we're nowhere near out of the woods with this public health emergency yet," he said.

The persistent shortages mean people "will have ongoing difficulty accessing the care that they need, especially as we all age."

Some of the biggest shortages will be seen in nonprimary care specialists. Skorton notes that during the pandemic, shortages of specialists in hospital settings, including critical care, emergency medicine, pulmonology, and infectious disease, are an urgent concern.

Table. Projected Physician Shortages by 2033

Medical Areas Shortage Range
Primary care 21,400 - 55,200
Nonprimary care specialties 33,700 - 86,700
Surgical specialties 17,100 - 28,700
Medical specialties 9,300 - 17,800
Other specialties (eg, pathology,radiology, psychiatry, etc.) 17,100 - 41,900

 

Population trends continue to be the biggest drivers of the shortage. Report authors found that by 2033, the US population is expected to grow by 10.4% from 327 million to 361 million, with wide differences by age.

The under-18 population is expected to grow by 3.9%, whereas the numbers of those age 65 and older is expected to balloon by 45.1% in that time, thus stoking demand for specialties focused on care for older Americans.

Physician age is also a large factor in the projections. More than 2 in 5 currently active physicians will be 65 or older in the next 10 years, according to the report. A wave of retirements will have a large impact on the supply of physicians.

The report explains that the projected shortages remain under predictable scenarios: an increase in the use of advanced practice nurses (APRNs) and physician assistants (PAs), more care in alternate settings such as retail clinics, and changes in payment and delivery.

According to the report, the supply of APRNs and PAs is on track to double over the next 15 years (with growth rates varying by APRN and PA specialty).

"At current rates of production, by 2033 APRN supply will grow by 276,000 [full-time equivalents (FTEs)] and PA supply by nearly 138,000 FTEs," the report states.

However, authors acknowledge there is scant evidence on what effect these numbers will have on demand for physicians.

The report points out that if underserved communities were able to access healthcare in numbers similar to those without barriers imposed by where they live or what insurance they have, demand could rise beyond the projections in this report by an additional 74,000 to 145,000 physicians.

Stemming the Shortages

The first step in addressing the shortage, Skorton said, is assuring a healthy physician pipeline to meet the demand for generations.

"One essential step that we believe Congress must take is to end the freeze that has been in place since 1997 that limits federal support for residency training of new physicians," Skorton said.

He noted that AAMC supports the bipartisan Resident Physician Shortage Reduction Act, introduced to Congress in 2019, which calls for an increase in Medicare support for 3000 new residency positions each year over the next 5 years.

However, additional steps are needed, including enabling advanced practice providers to play a greater role in increasing the healthcare workforce, Skorton said.

Pointing out some of the effects of physician shortages, Janis M. Orlowski, MD, chief health care officer for the AAMC, noted that high rates of maternal morbidity are partially linked to lack of adequate numbers of physicians in the US, and a lack of behavioral health specialists has exacerbated effects of the opioid epidemic.

Shortages are already evident in the current pandemic, she added, saying, "Today we see governors calling for retired physicians or physicians from other states to come and help battle the pandemic within their states."

The report explains that long-term effects on physician numbers from the pandemic likely will include workforce exits because of COVID-19 deaths, early retirements from burnout, or a shift in interest in certain specialties.

Karen Fisher, JD, chief public policy officer for AAMC, said telehealth will also play an important role in bridging gaps in access to care and its importance has already been seen in this first wave of the pandemic.

She noted that temporary federal waivers have made it easier for those enrolled in Medicare, Medicaid, and the Children's Health Insurance Program to receive telehealth services during the pandemic.

Expanding the access to telehealth permanently will be important in helping to fill gaps, Fisher said.

Skorton, Orlowski, and Fisher have disclosed no relevant financial relationships.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune and Nurse.com and was an editor at the Chicago Sun-Times, The Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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