CRYSTAL CITY, VA. — The shortage of primary care physicians schooled in caring for elderly patients will continue to worsen, according to an analysis of federal physician data.
“Our nation is facing a growing shortage of physicians for the care of adults,” Dr. Jack Colwill said at the 2008 Physician Workforce Research Conference. “We potentially will have limited ability to provide the sort of comprehensive and coordinated care we're talking about for the growing aging population.”
In a recent study, Dr. Colwill, professor emeritus of family and community medicine at the University of Missouri-Columbia, and colleagues looked at data from the 2003–2005 National Ambulatory Medical Care Survey to project what physician workloads might be in the future. The researchers predicted that by 2025 there will be a 29% increase in demand for physician visits by adults, fueled in part by the aging of the population (Health Aff. [Millwood] 2008;27:w232-41 [Epub doi: 10.1377/hlthaff.27.3.w232]).
“There have been dramatic changes in internal medicine, with [a more than] one-third drop in the numbers entering general internal medicine from the peak in 1998,” Dr. Colwill said at the conference, which was jointly sponsored by the Association of American Medical Colleges and Harvard Medical School.
If this trend continues, by 2025 there will be an increase in generalists in adult care of 11% compared with 2005 levels, trying to respond to that 29% increase in workload, he continued. “That doesn't adjust for the fact that physician supply is getting older, and that the percentage of women [physicians] is going from 33% of physicians to 49%,” he said; women physicians may work fewer hours to accommodate lifestyle considerations. “With those adjustments, the increase is up only 7% from 2005. If you assume the continuing decline in generalists goes through 2008, then the increase in 2025 is only 2% above 2005 levels.”
“That's roughly 35,000–44,000 additional physicians we'd need to provide as many visits as we do today for adult care,” Dr. Colwill said. “That would require 2,800–3,600 additional medical graduates per year. [However], as we progressively find ourselves in primary care doing more and more management of patients with severe chronic illnesses, [even] today's benchmark may not be adequate.”
Medical specialists also “say they have overloads right now, and abundant data out there says medical specialists see themselves as medical specialists and primary care not as a major part” of their practice, he added.
Physician extenders such as nurse practitioners and physician assistants will definitely help take up some of the shortfall. But “physician assistant program output has been flat, and nurse practitioner programs have literally dropped from above 8,000 graduates per year to 6,000 per year between 1998 and 2005,” Dr. Colwill said.
This whole scenario paints “a pretty bleak picture,” he continued. “I think it's a serious problem we face.”
Dr. Colwill also mentioned the concept of a medical home for all patients, which he said “is the wave of the future. The question is, will we have the workforce to pull it off?”