Some Experts Dispute Claims Of Looming Doctor Shortage
You hear it so often it鈥檚 almost a clich茅: The nation is facing a serious shortage of doctors, particularly doctors who practice primary care, in the coming years.
But is that really the case?
Many medical groups, led by the Association of American Medical Colleges, say there鈥檚 little doubt. 鈥淲e think the shortage is going to be close to 130,000 in the next 10 to 12 years,鈥 says Atul Grover, the group鈥檚 chief public policy officer.

But others, particularly health care economists, are less convinced. 鈥淐oncerns that the nation faces a looming physician shortage, particularly in primary care specialties, are common,鈥 wrote an expert panel of the (IOM) in a report on the financing of graduate medical education in July. 鈥淭he committee did not find credible evidence to support such claims.鈥
Gail Wilensky, a health economist and co-chair of the IOM panel, says previous predictions of impending shortages 鈥渉aven鈥檛 even been directionally correct sometimes. Which is we thought we were going into a surplus and we ended up in a shortage, or vice versa.鈥
Those warning of a shortage have a strong case. Not only are millions of Americans gaining coverage through the Affordable Care Act, but 10,000 baby boomers are becoming eligible for Medicare every day. And older people tend to have more medical needs.
鈥淲e know essentially with the doubling of the population over the age of 65 over the course of a couple of decades, they鈥檙e driving the demand for services,鈥 says Grover.
In addition to a numerical shortage, there鈥檚 also a mismatch between what kind of doctors the nation is producing and the kind of doctors it needs, says Andrew Bazemore, a family physician with the Robert Graham Center, an independent project of the .
鈥淲e do a lot of our training in the northeastern part of our country, and it鈥檚 not surprising that the largest ratio of physicians and other providers, in general, also appear in those areas,鈥 says Bazemore. 鈥淲e have shown again and again that where you train matters an awful lot to where you practice.鈥 That ends up resulting in an oversupply in urban centers in the Northeast and an undersupply elsewhere.
Even aside from geography, there are other questions, he says, such as 鈥渄o the providers reflect the populations they serve? And that means by their race and ethnicity, by their age, by their gender?鈥
While few dispute the idea that there will be a growing need for primary care in the coming years, it is not at all clear whether all those primary care services have to be provided by doctors.
鈥淭here are a lot of services that can be provided by a lot of people other than primary care doctors,鈥 says Wilensky. That includes physician assistants, nurse practitioners, and even pharmacists and social workers.
鈥淗ow many physicians we 鈥榥eed鈥 depends entirely on how the delivery system is organized,鈥 Wilensky says. 鈥淲hat we allow other health care professionals to do; whether they are reimbursed in a reasonable way that will increase the interest in having people go into those professions.鈥
Currently, physicians who are specialists than those who practice primary care, which many experts say is a huge deterrent to doctors becoming generalists, particularly when they have large to pay off.
At the same time, 鈥渢eam-based care,鈥 in which a physician oversees a group of health professionals, is considered by many to be not only more cost-effective, but also a way to lower the number of doctors the nation needs to train.
鈥淎ll of the efforts to the future鈥re to mold and morph our medical system into one that is less 鈥榮ingle-combat warriors鈥 practicing medicine here and there, and physicians and others practicing in efficient systems,鈥 says Fitzhugh Mullan, a professor of medicine and health policy at George Washington University.
Until that happens, though, Atul Grover of the AAMC says the nation needs to be training far more physicians.
鈥淲e don鈥檛 think we should put patients at risk by saying 鈥楲et鈥檚 not train enough doctors just in case everything lines up perfectly and we don鈥檛 need them,鈥欌 Grover said in a recent appearance on C-SPAN.
Wilensky is among those who find that attitude wasteful. 鈥淎re you really serious?鈥 she says. 鈥淵ou鈥檙e talking about somebody who is potentially 12 to 15 years post high school, to invest in a skill set that we鈥檙e not sure we鈥檙e going to need?鈥
And it鈥檚 not just the individuals who could be at risk for wasteful spending. 鈥淭raining another doctor isn鈥檛 cheap,鈥 says Mullan. 鈥淚sn鈥檛 cheap for the individual doing the training, isn鈥檛 cheap for the institution providing the education, and ultimately isn鈥檛 cheap for the health system. Because the more doctors we have, the more activity there will be.鈥
Princeton health economist Uwe Reinhardt points out that groups like the AAMC have a self-interest in saying there鈥檚 a shortage, to move more money towards the medical schools and hospitals it represents.
鈥淎nything that would move money their way they would favor,鈥 he says.
Reinhardt also says that a small shortage of physicians would probably be preferable to a surplus, because it would spur innovative ways to provide care.
鈥淢y view is whatever the physician supply is, the system will adjust. And cope with it,鈥 he says. 鈥淎nd if it gets really tight, we will invent stuff to deal with it.鈥