The physician specialties at the greatest risk of shortages

In a new report, HRSA's National Center for Health Workforce Analysis used a simulation model to assess whether the country's projected physician workforce supply would be able to meet demand. The model covered the years between 2023 and 2038.

Overall, researchers projected that there will be a shortage of 141,160 full-time equivalent physicians by 2038 across all specialties. Specifically, 30 out of 35 physician specialties assessed were projected to have shortages in 2038. The only specialties without shortages were emergency medicine (+16%), critical care and pulmonology medicine (+12%), endocrinology (+9%), neonatology (+6%), and neurology (+4%).

In comparison, the specialties projected to have the greatest shortages in 2038 were vascular surgery
(-34%), ophthalmology (-28%), thoracic surgery (-27%), plastic surgery (-26%), family medicine (-24%), and hospital medicine (-22%).

According to the report, nonmetro areas will likely experience greater shortages of physicians compared to metro areas. In 2038, nonmetro areas are projected to have 42% adequacy across all physician specialties (representing a 58% shortage) compared to 95% adequacy for metro areas (representing a 5% shortage).

The researchers also noted that shortages in some specialties could be mitigated by increased use of nurse practitioners and physician assistants for certain services. Recent trends, such as declining U.S. birth rates, could also impact the future projections for certain specialties, such as pediatrics and neonatology. 

The researchers also found that mid-career surgeons, or those with 10 to 14 years of experience, were more likely to leave clinical practice than other surgeons. Compared to surgeons with five to nine years of experience, surgeons with 10 to 14 years of experience had a hazard ratio of 2.58, meaning they were more than twice as likely to leave the profession.

In comparison, early-career surgeons (less than five years of experience) had an attrition hazard ratio of 0.91, and surgeons with 15 to 19 years of experience had an attrition hazard ratio of 0.19.

These findings align with other research from the American Medical Association that found that midcareer physicians had the highest rates of burnout and job stress and the lowest rates of job satisfaction.  

"This 'mid-career spike' (10–14 years in practice) parallels literature noting that mid-career physicians often experience the highest rates of burnout, lowest professional fulfillment and greatest administrative burden, while simultaneously balancing leadership roles and family responsibilities," the researchers of the study on surgeons wrote.

"Surgeons deliver a disproportionate amount of high severity, sensitive health care, which is especially critical right now in a country with an aging population," said Timothy Pawlik, a surgical oncologist at The Ohio State University Wexner Medical Center and one of the study's authors. "These findings show that surgical attrition is a real problem, and that we need to address it in a nuanced and tailored way, focusing on certain subspecialties that are highest risk, and focusing on mid-level providers who are most likely to leave surgery."