Friday, October 3, 2008

physician shortge, primary care - Physician Shortage in Context

Physician Shortage in Context

In my last blog, I estimated U.S. medical schools would produce 1850 graduates who would become primary care doctors engaged in direct patient care.

Let’s put that number in context. In 2002, in a landmark Health Affairs article, Richard Cooper, MD, et al at the University of Wisconsin in Milwaukee (R.A. Cooper et al, “Economic and Demographic Trends Signal and Impending Physician Shortage, “ Health Affairs, Jan/Feb, 2002) estimated the U.S. would be 50,000 physicians short by 2010 and 200,000 by 2020. Among other things, the authors said, U.S. medical schools had badly underestimated,

• the population explosion and economic expansion in the U.S..
• American’s willingness to spend discretionary income on health care increased demand for physicians.
• The dilutional effect of women physicians on the physician supply: women work 25% fewer hours because of pregnancy and family demands.
• The unlikelihood that physician extenders, nurses, physician assistants, nurse practitioners, and foreign medical graduates will fill the physician shortage gap.
• The need for 12 new U.S. medical schools to fill the need for more physicians.

Even with expanding medical school classes and 5 new U.S. medical schools coming on board, the physician shortage will escalate. This will be particularly acute in primary care. Three hundred and seventy medical graduate entering direct primary care over the next two years and a projected 6000 over the next 12 years will simply not be sufficient to care for the demands of an aging population,

Seventy five U.S. nursing schools have put in place nurse doctor programs, with the thought that nurse practitioners with PhDs can substitute and even replace primary care physicians. This may have some promise but many Americans will still want to see a medical school-trained physician.

Within the next five years, I anticipate the primary care shortage will create a deepening political crisis, triggered by the entry of thie first wave of 78 million baby boomers becoming eligible for Medicare but being unable to find a doctor. Many of these baby boomers will expect and will demand to be seen by a physician.


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