The shortage of doctors in the US is an alarming trend. It’s important to understand why this is happening and what it means for us as patients.
Dr. Jesse M. Ehrenfeld, The American Medical Association’s (AMA) president says the physician shortage is a “public health crisis”. “It’s an urgent crisis, hitting every corner of this country – urban and rural with the most direct impact hitting families with high needs and limited means.” (NPR.org)
“A 2021 report published by the Association of American Medical Colleges projects the U.S. will be short as many as 48,000 primary care physicians by 2034, a higher number than any other single medical specialty.” (CBSNews.com)
Why is there a doctor shortage?
There are multiple reasons for this shortage:
- The U.S. population is growing and getting older. Older people usually need more medical care, which means we need more doctors to take care of them.
- Education. Becoming a doctor takes a long time and a lot of schooling. Not enough students are going into medical fields to meet the growing demand. Plus, medical schools can only accept a certain number of students each year. This limits how many new doctors can enter the field.
- Primary doctors do not get paid as much as specialists. Of course, doctors are not poorly paid. But, when you think about the fact that most medical students graduate with an average of just over $200,000 in medical school debt, making a higher salary matters. The average annual salary for primary care doctors (family medicine, internists, and pediatricians) is between $250,000 and $275,000, according to Medscape’s annual physician compensation report. Specialists can make twice that much or more: Plastic surgeons make around $619,000 annually; orthopedists $573,000; and cardiologists $507,000. (CBSNews.com)
- Doctor burnout – The administrative burden on primary care physicians (with the rise in telehealth, patient portals, and electronic medical records) along with seeing patients is more than they could possibly have time for.
Doctor Burnout
Doctor burnout is when doctors feel super stressed and tired because of their work. They work long hours, deal with life-or-death situations, and have a lot of pressure.
Burnout is like feeling completely exhausted, physically and emotionally, because of your job. It’s when the demands of your job become too overwhelming and start affecting your overall well-being.
“Physician burnout is an epidemic in the U.S. health care system, with nearly 63% of physicians reporting signs of burnout such as emotional exhaustion and depersonalization at least once per week.” (ama-assn.org)
When healthcare workers are burnt out and unhappy with their jobs, they might decide to leave the field altogether. Many are retiring early. Or they may be forced to leave the profession, due to health issues caused by burnout. The stress of the COVID-19 pandemic also caused many doctors to retire or quit.
This is a big problem because it takes many years of education and training to become a doctor. And losing experienced healthcare professionals can be really tough on the healthcare system.
“The average primary care physician’s patient roster is about 1,500. Multiply that by the projected 48,000-doctor shortage in 2032, you’ve got 72 million patients without primary care physicians if that trend continues.” (Fox5NY.com)
Fewer doctors mean more work for those who remain. This can become a cycle that makes the shortage even worse. It’s important for us to recognize this problem and support the efforts to improve the working conditions for our healthcare professionals.
Doctor shortage by state
The doctor shortage isn’t the same everywhere in the U.S. Some states have more doctors, while others have fewer. States with bigger cities like New York or California might have more doctors. But in rural areas, where there are fewer people and it’s harder to get to big cities, there can be a real problem with not having enough doctors. Each state is different, so the shortage can look different depending on where you are.
“A KFF Health News analysis of federal data has identified more than 180 places that have been listed as not having enough primary care providers since before 1984. The primary care “health professional shortage areas,” known as HPSAs, count primary care physicians only.” (KFFHealthNews.org)
Shortage of doctors in South Carolina
South Carolina is one of the states that’s really feeling this doctor shortage. In some parts of South Carolina, especially rural areas, people might have to travel a long way to see a doctor. This can be tough, especially for older people or those without a car. It can also be dangerous in an emergency.
The Palmetto State has a worse shortage than most states. “In South Carolina, there are 12,197 active physicians, or 235.0 for every 100,000 people, the 15th fewest among states.” (247wallst.com) In comparison, Massachusetts has the largest number of doctors, at 459 per 100,000 patients. That’s almost twice as many as South Carolina!
Two of South Carolina’s counties have experienced a shortage of primary care providers for over 40 years! Williamsburg County since 1979, with only 3.8 full-time primary care doctors for 29,689 people; and Lee County since 1981, with only 2.8 full-time primary care doctors for 15,889 people. (KFFHealthNews.org)
You can see why the South Carolina shortage could cause such a huge problem.
The state is trying different ways to fix this, like encouraging more students to study medicine and offering programs that make it easier for doctors to work in areas that need them most.
Problems patients face due to the shortage of doctors
Shortages are forcing many patients to resort to urgent care facilities and emergency room visits for something as simple as getting a refill on a prescription.
Establishing an ongoing relationship with a regular primary doctor is best, especially as people get older and begin to develop chronic conditions or other medical problems. Studies show that patients with a regular primary doctor are more likely to receive preventive care, such as vaccines and screenings (for cancer or other diseases).
Also, when someone sees the same doctor regularly, patterns of minor concern that could eventually add up to serious issues are more likely to be noticed.
Yalda Jabbarpour, a Washington, DC family physician poses this scenario, “What happens when you go to four different providers on four platforms for urinary tract infections because, well, they are just UTIs…But actually, you have a large kidney stone that’s causing your UTI or have some sort of immune deficiency like diabetes that’s causing frequent UTIs. But no one tested you.” More than likely, if you were going to the same primary doctor, instead of the four different providers, that doctor would do more research and run whatever tests are necessary to find out the cause of the many UTI’s. (KFFHealthNews.org)
Possible solutions to the shortage of doctors
Dr. Ehrenfeld says, “Our nation’s physician shortage is a complex challenge that doesn’t allow for quick and easy solutions. But it is not hopeless.”
He says there are five steps that already have Congressional bipartisan bills pending that would help to hold onto the physicians we have as well as strengthen the US physician workforce:
- Give doctors the financial support they need to take care of patients.
- “Reduce administrative burdens like the overused, inefficient prior authorization process that insurers use to try to control costs.’
- “Three bipartisan bills that seek to expand residency training options; provide greater student loan support, and create smoother pathways for foreign-trained physicians, who already comprise about one-quarter of our nation’s physician workforce.”
- “Stop criminalizing health care that is widely recognized as safe, and that is backed by science and many years of evidence.”
- Do not punish physicians for taking care of their own mental health needs, especially when affected by burnout.
(AMA—Assn.org)
The shortage of doctors in the US is a huge issue. But understanding the problem is the first step to finding solutions.
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