Looming Shortage of Physicians Raises Concerns About Access to Care

Abstract

ABOUT A DECADE AGO, THE powers-that-be proclaimed an emerging physician surplus in the United States and called for a capping of residency slots for the training of future physicians. In 2001, the consensus emerged that physician supply was in equilibrium. Today, the conventional wisdom is that a shortage looms, raising questions about the medical community’s ability to provide care to an aging population that is living longer and living with chronic conditions. “We’re dealing with an overall physician shortage of 10% today, but we’re going to go to 20% in just a few years,” said Richard Cooper, MD, a professor of medicine and a senior fellow in the Leonard Davis Institute of Health Economics at the University of Pennsylvania, in Philadelphia. “We fought the war of surpluses, but it was the wrong war.” Getting physician supply right is important. Today, the worry is that having too few physicians limits patient access to care and possibly increases morbidity and mortality risk. In the mid-1990s, policymakers feared having too many physicians would lead to even greater overall health care costs, as most physicians are able to generate vigorous income levels regardless of patient demand. An oversupply of physicians also would waste billions of dollars in taxpayer money being spent to train unneeded physicians. In 1996, the Institute of Medicine released a report called The Nation’s Physician Workforce: Options for Balancing Supply and Requirements, in which it called for immediate steps to reduce the overall number of physicians-in-training by cutting residency funding and freezing medical school s l o t s . T h e r e p o r t ’ s a u t h o r s — academic physicians, economists, and health policy experts—argued that while the number of physicians had increased at 1.5 times the rate of the general population from 1970 to 1992, there was little improvement in the cost and quality of, or access to, health care. They also worried that an oversupply of physicians could lead to higher aggregate health care costs. But the report did not change training patterns. Just 5 years later, the winds shifted. At a 2001 colloquium on US physician supply, hosted by the Association of American Medical Colleges (AAMC), the chair of the Council on Graduate Medical Education (COGME) said the number of physicians-in-training was “about right.” (COGME provides ongoing assessments of physician workforce trends, training issues, and financing policies, and recommends appropriate federal and private-sector efforts on these issues. The council also advises the Secretary of the US Department of Health and Human Services and certain Congressional committees.) By 2005, however, COGME was thinking differently. The council, in its Sixteenth Report (http://www.cogme .gov/16.pdf), stated that the number of full-time-equivalent physicians is expected to increase from 781 200 in 2000 to 971 800 in 2020. At the same time, though, because of an expanding and aging population, the demand for physicians is expected to grow even faster. COGME forecasts a shortage of about 85 000 physicians in 2020. The AAMC responded to COGME’s report in 2006 by calling for a 30% increase from 2002 levels in medical