The debate surrounding a shortage in physicians in the United States has loomed for decades — some experts have offered solutions to problems surrounding a shortage in care, and others have disputed claims of a shortage all together. Possible warning signs have gone unheeded, and over the next 10 years, the pending existence of a shortage in care throughout the nation will come to fruition.
Per a 2016 report conducted by the Association of American Medical Colleges, the United States will face a shortage in the medical workforce ranging between 61,700 and 94,700. The study, conducted by the Life Science division of IHS Inc., a global information company, includes projections of rapid growth in non-clinician physicians and new payment and delivery models.
According to the report, surgical specialties will face the most significant shortage.
Research conducted by the AAMC concludes that, by 2025, projected shortfalls in primary care physicians will range between 12,500 and 31,100, and the demand for non-primary physicians will exceed supply by up to 63,700.
Arizona impact
As of 2014, Arizona ranked in the second lowest number of physicians based on population, with 234 reported active physicians for every 100,000 residents. Surrounding states, including Nevada, Utah and Texas, were reported among the lowest number of physicians for every 100,00 residents.
Although proposals have been made by lawmakers in the U.S. House of Representatives and the U.S. Senate to increase the number of residency positions, the AAMC said action must be taken immediately to eliminate the problem and to ensure that the aging and growing population has enough physician care.
“The doctor shortage has been anticipated for quite a while and I think one of the things that significantly contributes is the lack of increase in training programs and residency spots,” said Dr. Julia Nimlos, MD, a surgery specialist at Banner Baywood Medical Center and Banner Heart Hospital.
For Nimlos, what initially began as a desire to be just like her father, grew into a desire to combine her interests in science and technology with a job that would allow her to serve others.
Nimlos graduated from the University of Arizona College of Medicine in Tucson at age 26. Now, at 32, she believes that the younger generation is shying away from the medical field because of the cost.
“The amount of student loan debt that people acquire going through sometimes undergraduate … as well as medical school is just crippling,” said Nimlos, “and the idea of owing all of that money before you even start your career, I think, is very daunting.”
Cost of career
In general, a medical license requires the completion of a four-year undergraduate degree program, four years of medical school, and three to seven years of residency training.
Per doctorly.org, the median cost of medical school alone for the 2014-2015 academic year was $226,447 for public schools, and $298,538 for private schooling. The average reported cost of medical school debt in the United States was $166,750 in 2012, according to personal finance site NerdWallet.
Nimlos also believes that the younger generation values a balance between work and personal life much more than the older generation, another reason behind the lack of interest in becoming a doctor.
“I think that, being in the medical field, it can be difficult to strike a good work-life balance,” she said, something she has personally struggled with throughout residency and continues to struggle with as a young physician.
“I think we see that trend already because the specialties that have become most popular in the last five to 10 years are specialties that do afford a better work-life balance.”
Waiting for the payoff
Dr. David Virgil, MD, a family physician from the Abrazo Community Health Network, believes that, on top of the amount of student debt, the delayed gratification that comes with joining the medical workforce pushes away younger individuals.
“You know you are going to have to work hard for around a decade before you start seeing the benefits,” said Virgil.
He believes that the younger generation wants to earn a high income early on, and in the medical workforce, he said it takes years of learning and working your way up in the profession.
“You are going to have to work hard and make sacrifices,” he said, “and it is no easy task to become a doctor.”
Dr. Virgil decided to become a family physician while volunteering at a clinic during his undergraduate work at Arizona State University, where an interest in community medicine grew. He became a doctor at the age of 28. Four years later, at 32, he believes the predictions for the physician shortage are underestimated, and the demand is growing much faster than the supply in care.
“It takes at least a decade to train a physician,” he said, “so we should have been planning in the year 2000 for now, and now we are just playing catch-up, and the problem is only just getting worse and worse.”
“What people were saying 20 years ago was that we need to increase the number of positions in medical school to get more people into medical school, so you have seen various medical schools across the country, and internationally, increase their class sizes and increase their cohort student pool.”
Taking action
Dr. Virgil said the underlying problem has shifted, and a separate form of action must be taken to diminish the shortage in physician care.
“You have all these people going to medical school, graduating with their doctorate, but to become a fully licensed physician in the United States, you have to complete your residency program, and that is with all of the specialties. If the residency programs are not increasing their cohort sizes as well, then you see the bottleneck is happening at the residency programs.”
Dr. Tim Bert, MD, a 32-year-old orthopedic surgeon who specializes in sports medicine, also cites the extensive amount of schooling and the long road to earning a paycheck as the reason fewer individuals are choosing to enter the medical workforce.
“You really do not start making money until you are into your early to mid-30s, so I think people see that as an issue, particularly with the rising cost of medical school, the debt that you come out with,” said Bert.
Dr. Bert also believes that the United States has yet to catch up with the high demand in physician care, and said that fewer doctors are completing residency programs compared with other countries.
“Obviously, the Baby Boomers are getting older, sicker, and have more complex conditions, so we are seeing more patients, and because of the Affordable Care Act, there is an increase in people being covered with insurance, so therefore there is an increase in demand in physicians.”
Dr. Bert said that other countries are utilizing more health professionals than the United States, and believes the nation could benefit more by taking advantage of all aspects of the medical workforce.
“We rely too heavily on physicians and not enough on developed practitioners, like physician assistants and nurse practitioners, to be able to provide that level of care that could be provided by them,” he said.
Making a difference
Dr. Bert said that increasing reimbursement for physicians, decreasing the amount of debt from obtaining a medical degree, and financing medical school from a federal level could alleviate the shortage and attract more young people to the medical profession.
“I think you are seeing a lot of the graduates coming out of medical school, choosing professions based on finances, and not what they truly want to do, so you are seeing a move away from the general practitioners or the primary care doctors who do not make as much as people who work as specialists,” he said.
Data provided by the AAMC proves that, in addition to team-based care and better use of technology to provide more effective and efficient care, eliminating the shortage in physicians requires additional federal support, which would allow training of 3,000 more doctors per year.
The Helios Education Foundation and Translational Genomics Research Institute in Phoenix are taking steps toward producing the next generation of the biomedical workforce here in Arizona through their premier internship program partnership, Helios Scholars at TGen.
The partnership program celebrated its 10th year in September, and now has more than 400 alumni.
Through the program, high school, undergraduate, graduate and medical school students can work on research projects under the mentorship of TGen scientists during a paid summer internship.
“They are taking ownership of a project that could have real implications for the laboratory, so they become very invested and also very quickly learn if this is something that they would like to do for the rest of their life,” said Julie Euber, TGen director of education and outreach.
Next generation
Euber said that what students can learn in the laboratory is much different than what they would learn in a classroom. The internship aids students in developing software skills and features seminars on professional etiquette and how to be a good communicator of science, things Euber said provides students with a full experience of the biomedical workforce.
The application for the program opens in January and all applicants must have attended high school in Arizona, or must be currently attending school within the state.
“Our selection panel is all pure scientists, so they ultimately decide who will be in their lab that summer,” Euber said.
Euber believes that by providing students with biomedical experience and the opportunity to see if a career as a medical professional is something they would want to pursue, the program is a step towards alleviating the doctor shortage.
“We have students that are in the program where this is their first time getting a foot in the door, where this is their first research experience and they can build from there, so we give them a starting point,” she said, “and another big part of that is making the field more accessible and open to more people.”
Of those who have graduated from the program, 22 percent are minorities and 52 percent are women.
Congress has also stepped in with the introduction of the Resident Physician Shortage Reduction Act. The act would provide 15,000 new federally funded GME residency spots to teaching hospitals, 3,000 per year for five years, beginning this year.
