Stopping the bleed: The way forward on the physician shortage

The United States is currently facing a physician shortage that began in the early 2000s, but the COVID-19 pandemic pushed the floodgates wide open and caused a sizable number of physicians to leave clinical medicine. While some argue that this shortage is confined to certain specialties and areas, a solution is still needed.

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The state of the shortage today

A recent report published by the Association of American Medical Colleges (AAMC) predicted that the physician shortage could lead to a deficit of 37,800 to 124,000 primary and specialty care physicians by 2034. The pandemic demonstrated that when continued demand for physicians exceeds the supply, outcomes for both patients and physicians suffer.[1][2]

A lack of practicing physicians is now more closely associated with physician suicide, burnout, and major shifts in the workforce.[3][4] And the US patient population is aging—and growing. The Affordable Care Act allowed millions of newly insured patients to gain access to medical care, which created a greater demand on the healthcare system.

It can take the better part of a decade to fully and properly train a physician, so concrete steps must be taken sooner rather than later to avoid a potential catastrophe. The problem must be addressed from multiple sides before a long-term solution can be found. 

Considering the aging population

As fewer physicians come into the healthcare workforce, our current practicing physicians are aging towards retirement—and our patient population is no different. America’s population is making a huge shift, and for the first time in history we are on the brink of taking care of more seniors aged 65 years or older than any other patient population. According to the US census, there will be more seniors aged 65 years or older than children aged 17 years or younger by 2035.[5]

This is a significant phenomenon, as older patients have more complex medical issues and see physicians more often than younger patients do. Older patients also account for a higher number of diagnostic tests, medical procedures, and surgeries compared to younger patient populations, thereby putting an additional load on an already strained healthcare system.

The 'bottleneck effect'

More individuals are applying to medical school than ever before, medical schools continue to open around the country, and current medical school class sizes are increasing.

However, the momentum toward creating new practicing physicians stops there.

Without a sufficient influx of available residency positions to keep up with the number of graduating medical school students, those students are left holding hundreds of thousands of dollars in student loan debt, and the number of trained physicians needed to fill the physician shortage goes unmet.

Physicians at work

Whether it is early retirement or leaving clinical medicine to pursue another career, an increasing number of physicians have been leaving medicine due to several factors, such as physician burnout, not enough pay, and poor work-life balance. 

Physician burnout is an ongoing issue that encompasses many factors, such as working long hours, too many administrative tasks, not enough time off, a hostile workplace, and the stress of the COVID-19 pandemic. 

The pandemic was the final straw for many physicians, as they closed up their practice and determined that they had had enough. For those physicians who didn't leave clinical medicine, many switched from full-time to part-time, sought locum tenens positions, or switched to telemedicine in an effort to curb their burnout while still trying to provide some level of patient care.

Addressing today’s needs

As the shortage worsens, drastic changes need to be made to take care of today’s physicians. 

If we continue to burn out our physicians, they will continue to leave medicine, creating a greater problem for tomorrow. Taking care of today’s physicians means dedicating money, time, and resources to retain the current physician workforce. 

Hospital administration, physicians, patients, mid-level providers, and administrative staff need to make a collaborative effort to listen to our physicians and their needs. When physicians declare they need more time off and fewer working hours, this needs to be respected and provided. When physicians declare they need help with administrative tasks, solutions must be developed to lighten their load. 

When physicians are more rested, appreciated, and happy, they are able to provide better patient care. When we are able to provide better patient care, our patients are more willing to trust us, listen to us, and open up to us.

Focus on primary care

Primary care physicians are the bread and butter of medicine. They work in the trenches and act as primary gatekeepers to other medical specialties. As a result, primary care physicians bear some of the greatest burdens of medicine while earning lower salaries compared to specialty care physicians. 

If we cannot recruit and retain our primary care physicians, patients will clog emergency departments with non-emergency medical issues. We need to have solutions to combat this issue.

Considering pay

One potential solution is improving and increasing student loan repayment programs for primary care physicians in addition to increasing their take-home pay.

Leveraging NPs and PAs

To help provide preventive care and education to patients, mid-level, non-physician providers can shine. NPs and PAs can help ease the physician burden by scheduling patient visits to primarily discuss prevention and education in an effort to lessen the healthcare burden of sick patients. 

Working with telemedicine

Thanks to COVID-19, telemedicine is here to stay. Although not a replacement for in-person care, there are many benefits of telemedicine.

Telemedicine allows physicians to see patients regardless of distance, however telemedicine across state lines is becoming increasingly limited by state laws and federal policies. For telemedicine to be considered a viable tool to help bridge the physician shortage gap, medical licensing laws must be readdressed.

Meeting tomorrow’s goals

The solution to the shortage crisis starts with taking care of today’s physicians and making future plans to increase the number of practicing physicians. In other words, we need to keep our current doctors happy, and we need to train more happy doctors for the future. 

There are three key aspects to help us to do this: Increasing residency positions, capitalizing on the non-practicing physician workforce, and expanding physician involvement in leadership and government.

1. Unclog the medical school pipeline

In December 2020, Congress passed a bill that provides more than 1,000 new Medicare-funded residency positions over the next 5 years. This is the first increase in residency allotment spots in over 25 years, but there is still an enormous backlog of unmatched medical graduates. 

Every year, 10% of medical school graduates do not match into a residency program. This means that nearly 9,000 medical school graduates may not go on to become practicing physicians due to a lack of residency slots. More government funding needs to be allotted for graduate medical programs. [9]

2. Capitalize on non-practicing existing workforce

There are approximately 65,000 non-practicing international medical graduates (IMG) who are American citizens or permanent US residents who completed medical school and residency outside the United States. 

Graduate Medical Education and state licensure regulations require that these international medical graduates complete a residency in the United States to gain licensure and become part of the physician workforce. Given the scarcity of residency spots due to funding, this task is nearly impossible. 

Increased funding would allow IMGs to complete their residency and enter the workforce, thereby capitalizing on an existing resource. 

3. Increase physician involvement in leadership and government

Physicians hold a lot of knowledge and power, but we are often so burned out that we don’t have the time or we simply do not know how to use this knowledge and power to make a change. 

Physicians have the power to educate the patient population and inform the general public about the physician shortage in an attempt to empower them at the polls. 

Voters can effectively advocate for themselves and their communities and convince elected officials to legislate change, but only if they are aware of the issue and understand the root of the cause. 

Physicians can also consider running for office at the local, state and national level to advocate for policy change, as seasoned physicians are needed to create and advise national healthcare policy.