Sunday, November 4, 2007

The Doctor Shortage

Merritt and Hawkins is one of the largest healthcare recruiting firm in the U.S. They published the results of a study that showed 48% of the physicians age 50-65 years of age are planning to cut back their office hours or retire within the next 1-3 years. The disturbing fact is that 1/3 of ALL physicians are in this age group.

To prepare for the physician shortage, new medical schools have opened and there is a small increases in the number of medical students in training. But there is a 8-12 year lag between training and practice and with the aging population it isn't hard to see what is around the corner. At a time when people want and need more medical care, there will be a serious shortage. Universal health coverage won't matter if there isn't anyone to take care of you. Having insurance and having access are not the same thing. Ask anyone on Medicaid or people who live in rural communities.

There is already a near crisis in California to find doctors to cover the Emergency Room. A wealthy community in Northern California cannot find a surgeon to be on call. Neurosurgery, ortho, ENT, opthalmology are all in short supply for ER call. Hospitals are paying large fees to doctors just to be available. It is traditionally younger, eager physicians who take ER call but there are no young, eager doctors in many places. According to this study we won't have any old tired ones either.

The largest decline in physicians is the primary care specialties (General Internal Medicine, Family Medicine, Pediatrics). I have written before about these specialties being grossly undervalued in our society. At the very least, it is time to recognize this and ensure that primary care specialties, with the the cognitive and coordinating value they bring, are reimbursed on par with procedural specialties. This is the only way young doctors will choose these specialties. THE ONLY WAY!

The unintended consequence of ignoring these facts will adversely affect our nations healthcare for decades to come.


Vance Esler said...

Amen, Sister!

I don't know how old you are, but I'm in that 50-65 year-old bracket, and I'm wearing out. I, like everyone else in medicine, am working longer hours, taking care of sicker and more complicated patients -- all while facing another 10% pay cut from Medicare in 2008.

I realize no one feels sorry for us. Everyone thinks doctors make too much anyway. Yet what do they think will attract smart, young people to the profession?

It is nice to imagine that some noble calling will gather enough souls to care for the sick and dying, but the reality shock of the debts incurred for college, medical school, and post-graduate training quickly brings to the surface the need to actually acquire some cash at the end of the day.

Unfortunately, we don't get paid for thinking, for caring, for explaining, for filling out innumerable forms, for refilling prescriptions -- all the stuff that people want. We only get paid for "doing" some "procedure" (such as 99213). Thus the migration of medical trainees into the procedure-oriented specialties.

This issue was addressed last year in a NEJM editorial. I also talked about it from my own perspective here.

Rich said...

I've noticed that there are not many doctors over 50 walking around the hospital I work at. Although there are a few, youth seems to out number years of experience.

razormd said...

Reimbursement?...screw reinbursement...taxes take most of any increase in salary beyond a certain point...I'm 54 and retired 4 years ago from the ER...more money would not have made much difference...I got tired of the hassles -- insurance forms; disability forms; staff meetings; handling complaints from nurse, patients, pharmacists and other hospital staff...well, that list could go on for pages...also, probably 90% of my patients were not emergencies but simple ambulatory care for people that couldn't get timely attention from their regular physicians or people lacking insurance...boredom plus hassles leads to early retirement.

Taki said...

Hi Toni,

It was my pleasure. I enjoy reading your blog. I'm interested in many of the same issues.

Take Care,


DDx:dx said...

I agree with your point about primary care and the "need" for it. But we are at a systems impasse. The Medical Industial Complex is designed to drive costs, whereas most primary care docs are trained and practice to decrease costs, so, we're swimming against the current.
I too read the Merritt Hawkins study. Family doc searches up 30%, Family doc reimbursement up 10%.
The real way to empower, envigorate, and activate primary care is to address the crippling cynicism.( See razor comment). And the only way to do that is with a system change.

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