COLORADO SPRINGS — America's physician shortage—still barely noticeable in much of the country—is here to stay and will grow much worse, panelists agreed at the annual meeting of the American Surgical Association.
On the basis of economic and population projections, the nation will need 10,000 additional first-year residency slots and 60 new medical or osteopathic schools by 2020 to control the crisis, estimated Dr. Richard A. Cooper, professor of medicine and a senior fellow at the University of Pennsylvania's Leonard Davis Institute of Health Economics, Philadelphia.
By Dr. Cooper's estimate, there are 5%–8% too few physicians nationally. “We're not feeling it everywhere because the shortage is early on, and it's not homogeneous nationally,” he said. The shortfall will grow to about 20% within the next 20 years, and not enough physician assistants and nurse practitioners are being trained to offset the shortage, he added.
The shortage has come about because physician training has leveled off while the nation's population keeps growing and aging. Medical schools plateaued in the early 1980s, while the Balanced Budget Act of 1997 froze residency training at 1996 levels.
Dr. Darell G. Kirch, president and chief executive officer of the American Association of Medical Colleges, Washington, praised Dr. Cooper for conducting the pioneering research that is awakening health policy planners to the looming physician shortage.
The AAMC is now recommending to Congress a 30% increase in U.S. medical school capacity. A 17% increase in capacity by 2012 is possible simply by maximizing existing capacity, according to the latest AAMC survey of the 125 medical school deans. An attractive additional strategy is to create regional or branch campuses of existing medical schools, as many osteopathic schools are doing, said Dr. Kirch, a psychiatrist.
He also sees a need for more flexibility in the premedical curriculum. “We still have that emphasis on the core of calculus, physics, general and organic chemistry. … Maybe there can be more flexibility that would allow us to attract people who have got great intellects but aren't quite so oriented toward the physical sciences,” he said.
The physician shortage is compounded by workforce exit issues. Dr. Kirch cited a national survey done last year that showed one in three physicians over the age of 50 years would retire if they could afford to. But the survey also found that part-time work opportunities and less bureaucracy would keep physicians over that age in the workforce.
Currently, less than two-thirds of residency slots are filled by graduates of U.S. medical schools. Most of the rest are filled by non-U.S.-citizen international medical graduates, many from developing countries where physicians are sorely needed. Adding more U.S. medical schools would increase the proportion of U.S. graduates in the postgraduate pipeline and keep more international graduates where they were trained, noted Dr. George F. Sheldon, professor of surgery at the University of North Carolina at Chapel Hill.
Dr. L.D. Britt said the time had come to “give up the ruse and declare what we already know—that the most wasted year in all medical education is the fourth year of medical school.” If it were eliminated, it would make medical school more attractive and would help cut the crushing student debt burden, argued Dr. Britt, professor and chairman of the department of surgery at Eastern Virginia Medical School, Norfolk.
But Dr. Kirch reiterated his interest in increased flexibility in the medical education system. Some medical students would benefit from having the fourth year count as their first year of residency training, he argued. Others enter medical school so highly qualified that much of the first 2 years are of little value. And there are way too many obstacles placed in the way of physicians interested in making a midcareer change in specialty, he added.
By 2020, the nation will need 10,000 additional first-year slots and 60 new schools to control the crisis. DR. COOPER