Leana S. Wen
11/01/2005
Access to health care is a problem that plagues primarily the 45 million people in America who lack health insurance. If current trends continue, however, access to qualified, competent doctors could soon become a problem even for patients who can afford high-quality medical care.
Demand for doctors is quickly outpacing supply. The U.S. population has been steadily increasing, as has the percentage of elderly citizens. Beginning in 2011, baby boomers will begin to turn 65, and the number of Americans reaching that age each day will eventually rise from 6,000 to 10,000. These aging boomers will place enormous pressures on the health care system and will create demand for tens of thousands of new doctors.
Unfortunately, the medical community had, until recently, developed a consensus that there were likely to be too many, rather than too few, doctors. Some groups in organized medicine wanted to restrict the supply of doctors to drive up salaries, and the data available on the composition of the workforce was too scant to contradict their assertions. Consequently, while several new osteopathic medical schools have recently opened, the number of graduates from allopathic medical schools (schools granting the MD degree) has remained steady since the 1980s. This occurred despite the many qualified students applying to medical schools; each medical school currently turns away two applicants for every student it accepts.
Over the last few years, multiple studies have confirmed that a physician workforce shortage rather than an oversupply will likely develop, with midrange shortfall estimates at 90,000 doctors by 2020. Shortages are predicted to be more dramatic in primary care than in the specialty fields. Distribution and access-to-care issues will likely be exacerbated as well, with even fewer physicians willing to work in underserved inner-city and rural areas.
In retrospect, simple laws of macroeconomics could have predicted the shortage years earlier: The supply of physicians stayed steady even though demand was expected to increase exponentially. Yet not until earlier this year did the government-appointed Council on Graduate Medical Education finally reverse its policy and admit that if trends continue, demand for physicians will far outstrip supply. Both it and the Association of American Medical Colleges are finally taking up the call to propose solutions to the looming shortage.
Home Grown
The solution is simple enough: Train enough physicians to meet the needs of our society. The most ethical and financially sound method of accomplishing this is to expand our physician workforce by training more medical students within our own country. Currently, we rely on graduates of international schools to fill our training positions—25 percent of residency positions are filled by international graduates, who subsequently become practicing physicians in the United States. Reliance on international graduates creates an unfair burden on the developing world, draining it of intellectual talent and health care providers. It is also a far better investment for our country to expand medical school capacity, particularly because we have the resources and the human capital to fill the schools.
We also need to ensure that our new doctors are well trained to reflect the changing needs of society. A 2003 survey found that one-third of graduating students did not find their training in the care of the elderly to be adequate. Less than 10 percent of medical schools require students to complete even one course in geriatrics. Yet by some estimates, doctors spend more than 50 percent of their time with elderly patients. In the era of aging baby boomers, each school should train students in areas like geriatrics, which are becoming far more important in medicine.
After many years of self-denial, the medical profession is finally beginning to acknowledge the shortage, but it must do more. It must act swiftly to avoid this looming crisis and start opening medical schools and implementing curricular changes now. It must also acknowledge that the problem of access runs deeper than just whether one person can find a single physician at a single point in time. Our country needs fundamental reform of the health care system—which starts with training more doctors—so that everyone can have access to physicians and health care services.
Leana S. Wen is president of the American Medical Student Association, based in Reston, Va.