The New York Times recently published an op-ed claiming "No, there won't be a doctor shortage."
The authors, University of Pennsylvania Vice Provost Dr. Ezekial J. Emanuel and American Enterprise Institute fellow Dr. Scott Gottlieb, say that Massachusetts' experience with reform contradicts reasonable fear of a physician shortage after coverage expansion. Not only has the state seen improvements in access since implementing reform, they also anticipate a decreasing need for physicians thanks to better technology, remote health monitoring, and an expanding role for advanced practitioners (APs).
It's an intriguing point, but is it correct? There are several questions to weigh when considering Gottlieb and Emanuel’s claims.
Is Massachusetts a representative case study for the rest of the country?
According to the AAMC, Massachusetts actually has more physicians per capita than any other state. Compared to the median of 244.2 physicians per 100,000 people, Massachusetts has a whopping 415.5.
Because of this, using the state to gauge how increased coverage will impact provider availability nationwide may be similar to basing world hunger on the prevalence of malnutrition in Luxembourg.
How quickly will improved technology result in productivity gains?
Some models estimate the average panel size could double with the potential impact of technology, such as telehealth and remote monitoring, on physician demand. However, if we've learned one thing from EMR implementation, it's that integrating new technology into legacy clinical protocols is complex—and it's unwise to expect an immediate productivity bump.
How many APs are entering medical fields with the worst physician shortages?
Although many new treatment models call for increased primary and chronic care, fewer medical students are choosing to become PCPs—a trend now cascading to APs. A 2010 census report indicated that only 31% of physician assistants were working in primary care and 67% were choosing to specialize, largely in surgical subspecialties.
How do the demographics of future physicians impact the provider supply?
The increasing percentage of part-time physicians (largely women and older physicians) will have a significant impact on the amount of care provided. The Department of Health and Human Services projects that, from 2005-2020, new physicians will increase by 16% while hours of care provided will increase by 13%. Additionally, women and older physicians may not work during the weekend and evening hours being demanded by the next generation of patients.
While others share Emanuel and Gottlieb's optimism that this shortage can be solved with creative staffing and technology, there remains cause for caution. In fact, The American Association of Medical Colleges projects a shortage of 91,500 physicians by 2020. Medical group leaders should continue to recruit carefully, especially in primary care, to ensure that they are fully staffed for future needs.
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