The doctor shortage was fostered in 1996 when Congress capped the number of new doctors Medicare would pay to train, a practice that continues to this day. Teaching hospitals, which now make up about 10% of hospitals nationwide, depend on those Medicare funds to pay about two-thirds of the cost of doctor-training. (Training costs include residents' salaries, malpractice insurance, equipment, the extra time that teaching procedures add to patient care, as well as the added costs associated with caring for the sickest patients.)
Recently, the President's National Commission on Fiscal Responsibility and Reform proposed cutting Medicare funding to train doctors even further, by $60 billion through 2020. If this cut is enacted, the doctor shortage would get far worse.Training new doctors has substantial costs because of all they must learn and how carefully they must be supervised. Without Medicare reimbursements, many hospitals could not afford to maintain these critical training programs. Already, 30% of hospitals lose money, according to the American Hospital Association, and even more barely break even. Across the country, demand for doctors exceeds supply.
The numbers are striking.
Health-care reform will add an estimated 32 million people to the ranks of the insured, driving them to seek medical attention that in the past they may have avoided due to expense. The aging population will also create much greater demand. The number of seniors who need more medical care is expected to soar to 72 million by 2020—nearly double today's number.
According to a 2010 report by the Association of American Medical Colleges, the increased demand means that our nation will need an additional 130,000 doctors, both general-practice physicians and specialists, 15 years from now. That's about 20% more doctors than we have currently.
But doctors are aging, too. Almost a third of doctors in the country—about 250,000—are over the age of 55. By 2020 they plan on retiring.
Right now we train roughly 16,000 doctors a year. To keep pace with demand, this nation will need to train an additional 6,000 to 8,000 each year for the next 20 years. If we increased the number of training slots today, it would take seven to 10 years for the new doctors to see patients (four years of medical school, plus three years of residency and additional specialty training).
In many parts of the country, the shortage of doctors is already a reality. Statistics from the Health Resources and Services Administration say that 10% of the population lives in an area where there is an inadequate supply of health-care providers. These people may wait months to see a doctor. Sometimes no specialists exist where they live. While some responsibilities of doctors can be absorbed through other trained medical professionals, including nurses and physician assistants, they don't have the same unique expertise. If we don't make changes, long waits and limited access will become much more common for all patients.
The first step should be a political version of the Hippocratic oath: Do no harm. The deficit commission's recommended cuts in training funds must be set aside.
Secondly, the cap enacted in 1996 on training new doctors should finally be lifted. These two steps would go a long way to addressing our country's medical needs.
Patients searching fruitlessly for a physician or waiting months for a routine appointment are glimpsing what could be the future for millions more. That future is preventable, and we must ask Congress and the Obama administration to make sure it is.
Dr. Pardes is president and CEO of New York-Presbyterian Hospital.
http://online.wsj.com/article/SB10001424052748703959104576082430910575332.html
