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| Opportunities & Exposures: Medicine |
Doctor Dearth
Leana S. Wen
11/01/2005
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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.
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