Is There Really a Looming Shortage of Doctors?

Recently, the American Association of Medical Colleges devoted an entire issue of its journal to a projected shortage of physicians in the U.S. beginning some time between 2020 and 2025. In an introduction to the issue, Dr. David Sklar cited a 2008 article in which the authors stated that the “most plausible estimate” was a deficit of 159,000 full-time equivalent (FTE) positions in 2025. He also noted a report from the Health Resources and Services Administration (HRSA) which stated that in 2020, 976,000 FTEs will be needed to fill patient demand, but there will be only 926,000 practicing physicians, leaving a shortage of about 50,000. Although they differed as to the numbers, Sklar wrote that most analysts  agreed on the general principle that there will be a shortage of doctors.

The problem will arise because our population is both growing and aging, while our physician population is aging as quickly, but growing more slowly. To solve this problem, they recommend that the federal government should fund more slots for residents in graduate medical education (GME) programs. Some have expressed concern that the Medicaid expansion and the influx of the newly insured as the Affordable Care Act becomes effective will lead to a spike in demand to which the existing personnel cannot respond. However, there is evidence that the implementation of health coverage reform in Massachusetts led to a much smaller increase in demand for services.

But others have questioned whether there will be a shortage at all. The growth in the number of physician assistants and advanced registered nurse practitioners may fill the gap. The use of telemedicine may continue to increase. Interestingly, as Dr. Sklar mentioned, the HRSA projections started from a 2005 baseline of 802,100 FTEs needed and 811,800 physicians in practice—9,700 more than the need.

Uneven Distribution

If there is a problem, simply training more physicians would not solve it. Currently, there is a shortage of  doctors in some places and a surplus in others. The number of physicians  per capita varies widely. According to the AACM’s 2011 report, in 2010, there were 258.7 physicians per 100,000 people nationwide. When the number of doctors is measured on a statewide basis, Mississippi had the fewest, with 176.4 per 100,000 people, while Massachusetts had the most, 415.5 per 100,000. However, the number who were actively involved in patient care was significantly lower—219.5 nationwide, 159.4 in Mississippi, and 314.8 in Massachusetts. And the disparity in the number of primary care physicians (PCPs), i.e., general practitioners, family practitioners, general pediatricians, was even more striking. There were 90.5 PCPs per 100,000 population nationwide, but only 63.6 in Mississippi, and 132.0 in Massachusetts.

A statewide measurement doesn’t tell us as much about access as a measure by core-based statistical area, hospital referral region, or primary care service area. According to , even the use of county or zip code can mask differences in access because counties and zip codes can encompass much greater distances in rural areas than in cities or metropolitan areas. But what’s clear is that physicians are more heavily concentrated in urban areas, especially in the northeastern U.S.

Supply-Sensitive Care

As we have discussed before, according to the Dartmouth Atlas Project, where there are more doctors per patient, doctors see their patients more often. They also may be more likely to use medical interventions that are not proven when there is not an established standard. The result is not improved health outcomes. In fact, sometimes the health outcomes are worse when doctors do more.

More Doctors, or More Primary Care Physicians?

Compared to other countries, the U.S. has a much higher percentage of specialists (87.9 percent) in proportion to PCPs (12.1 percent). Research shows that the number of new doctors choosing to be PCPs is decreasing.There are several disincentives to choosing primary care, including perceived prestige and lower income. Some people view the PCP as a gatekeeper, a bureaucratic obstacle between the patient and the “real doctor.” But there is a positive relationship between the number of available PCPs and health outcomes and a negative relationship between the number of specialists per capita and health outcomes.