Sunday, November 13, 2016

A Doctor Shortage? Let’s Take a Closer Look - The New York Times

Many people have to wait too long to see a doctor. And it could get worse. If, as many people believe, we have a shortage of doctors in the United States, then it follows that we can fix this only by training and hiring more physicians.

As with almost everything in our health care system, though, it's complicated. Some people think there's no shortage at all — just a poor distribution of the doctors we have.

The main argument for a physician shortage is that we aren't adding enough new doctors to keep up with changing demographics. The Association of American Medical Colleges has projected that by 2025 there will be a shortfall of between 46,100 and 90,400 doctors. In primary care, it projects a shortfall of between 12,500 and 31,100 doctors.

The baby boomers are getting older and sicker, and they have more complex conditions than they did when they were younger, including arthritis, high blood pressure, pulmonary disease, diabetes and cancer. The Affordable Care Act is expected to accelerate the need for additional medical care. Increased insurance coverage increases demand, and Obamacare alone is projected to require about 16,000 to 17,000 more physicians than would have been required without it.

Adding data to this argument, the United States has fewer practicing physicians per 1,000 people than 23 of the 28 countries that reported data in 2013 (among nations in the Organization for Economic Cooperation and Development).

The United States had 2.56 doctors per 1,000 people, which is more than Canada (2.46), Poland (2.24), South Korea and Mexico (both 2.17). But we were way behind countries like Austria (4.99), Norway (4.31), Sweden (4.12), Germany and Switzerland (both 4.04).

Based on these metrics, it would seem that we need more physicians. It would also seem that we're not training them. When it comes to medical graduates, the United States ranks 30th of 35 countries.

But there is strong evidence that we are thinking about this the wrong way. In 2014, the Institute of Medicine released a thorough analysis on graduate medical education that argued there was no doctor shortage, and that we didn't really need to invest more in new physicians.

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