Primary Care Physician Shortage: A dire public health crisis

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physician shortage

Healthcare professional shortage is a global concern with detrimental consequences. According to the World Health Organization, there are 15% more healthcare professionals needed worldwide. In the United States, there will be an expected physician shortage of 130,600 by the year 2025. This is especially detrimental in certain specialties and rural areas is a significant concern and impediment to public health. However, certain regulations effectively limit the number of training sites, leaving increasing number of graduates “unmatched” with a residency spot. Residency is the paid training that medical graduates must go through in order to get licensed.

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Regulations in the United States create an effective freeze on these spots. Medicare provides an important source of funding that helps offset some of the costs associated with educating residents, caring for patients who require more intense and complex care, and the other special missions of teaching hospitals. The Balanced Budget Act of 1997 (BBA) limited the medical residency spots that would be counted for purposes of calculating Medicare indirect medical education (IME) and direct graduate medical education (GME) reimbursement to the unweighted number on each hospital’s most recent cost report as of December 31, 1996 (BBA Section 4621). The Institute of Medicine release documents questioning the veracity of the physician shortage claims.

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More recently, the Resident Physician Shortage Reduction Act of 2015 that was introduced in the House sought to create 15,000 new resident positions (about a 15 percent increase in residency slots). By 2025, the projected need of 52,000 additional primary care physicians can only be addressed by increased funding. Remember, this reduction act will go through only if you voice support in the respective Congressional committees.

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6 Responses to “Primary Care Physician Shortage: A dire public health crisis”

  1. 08branding Says:

    As someone who is currently in the medical school application process, you bring up an important issue that has been very near and dear to my heart for some time. Even with the 15% increase in residency slots, I have to wonder how this fits in with the overall competitiveness of DO and MD graduates, as well as future students who want to still fulfill the primary health care need. It seems that with every year, there is an increase in medical school applicants who want to fulfill this need but there is not enough funding for these schools to adequately educate students for the profession. More MD and DO schools are opening up around the country but it is still nowhere near fulfilling the demand. George Washington University School of Medicine, for example, receives over 10,000 applicants with only 300 acceptances every year (http://www.usnews.com/education/best-graduate-schools/the-short-list-grad-school/articles/2015/03/31/10-medical-schools-that-are-most-competitive-for-applicants). The cost of medical school and payout during residency is another hurdle that many students see in their future. Although there are student loans available, I can see these costs as contributing even further to the national debt with physicians not being able to pay back their loans until they are in their late 30s or early 40s. I agree that our concerns should be brought to congressional committees but there must be another way of balancing the budget for the sake of healthcare in general. In no other country is the cost of medical school and the training involved as expensive as it is in the United States. The progressive research and technology that the United States has to offer may be one factor but as it relates to the issue of training primary care physicians, perhaps more incentives can be offered by the federal government to open up the slots for the much needed field. I know that the primary health care demand is opening up to Nurse Practitioners to fulfill this demand, but then that brings into question why hundreds of thousands of dollars are put into training primary care physicians. The US has done some creative practices in opening up the primary health care field through different degree problems (MD, DO, PA, NP) but as was mentioned, this still does not fulfill the void for primary health care physicians and funding is still a problem for post-graduate residency programs.

  2. anudevabhaktuni Says:

    Thank you for your post! I am a US medical graduate applying for residency and I believe the issue of physician shortages and funding for an increase in residency positions is incredibly important. Over the past decade, many new medical schools have opened in an attempt to resolve the predicted physician shortage. However, there has not been an increase in residency positions which is necessary to train all of the newly graduated medical students. The Resident Physician Shortage Act of 2015 is imperative not only to address the physician shortage but to guarantee training for all US medical students.
    Another important consideration in encouraging individuals to pursue medical education and perhaps primary care training is medical debt and low resident compensation during training. In inflation-adjusted terms, resident compensation has been essentially unchanged for 40 years (http://www.nejm.org/doi/full/10.1056/NEJMp1402468?query=featured_home&amp😉 despite the increasing costs of medical school debt, housing, and child care. National policies enable hospitals to treat resident physicians as reliable revenue sources resulting in cost-effective sources of labor for the hospitals. This is unfair. Residents should have more say in contract negotiation considering the 4 years of schooling, its associated debt, and the length of residency training they endure.

  3. lseifu1 Says:

    Thank you for posting this! As a current medical student, it is a topic that I have thought about a lot. I completely agree with you that there should be an increase in residency slots in order to increase the number of physicians, particularly primary care physicians, in the United States. Without their residency training, medical graduates are unable to practice medicine – so having enough residency spots is really key to having enough physicians. However, I do think that an EQUALLY important consideration here is medical school debt, which is a huge impediment to producing more primary care physicians (rather than specialist physicians). Right now, given the high cost of medical school and the long training time (4 years + 3 or more years of residency), the incentives of individual medical students are not aligned with the incentives of the overall health care system. Medical students, after all of this debt and training, want a high-paying specialty. Further, because so many students desire these high-paying specialties, they become so competitive and are often viewed as the more “elite” and “intelligent” specialties because they are more difficult to get into for residency programs. Medical students are thus incentivized to “aim for the best” throughout medical school, working to become competitive enough so that they can go into these high-paying, well-respected specialties. On the other hand, the healthcare system needs more primary care physicians – this is the greatest shortage area of medicine in the United States. Unfortunately, this is not aligned with individual medical student needs. Until medical education is restructured to align these incentives, there will be a primary care physician shortage.

  4. rupaltbhakta Says:

    Thank you for this post. As a physician that is a few years out of training, I understand the struggle of those that enter into medical school and training and the influences that are factored when deciding on specialty training versus primary care.

    As a country that suffers from a high mortality and morbidity from preventable diseases, it may seem obvious to train more physicians and physician-extenders in the realm of primary care and preventative care. However, our current system actively encourages medical school graduates to pursue specialties that offer them the best balance of pay and workload. All too often, the exposure to primary care providers reveal clinicians that are overworked and underpaid. Admittedly so, this was one of the reasons I pursued a specialty. The incentives for pursuing primary care as a residency need to be improved and also offer clinicians the ability to spend quality time with their patients for preventative and health lifestyle counselling.

  5. sloboda2016 Says:

    I agree with a lot of the statements made above. I’m currently about to start the residency application process as well, so the increase number of applicants with the restricted number of slots in a little scary. One issue is that in order address the shortage, there has been an increase in the number of medical school slots as well as new medical schools. Some even focus on primary care, rural populations, and underserved populations, like Central Michigan University School of Medicine in my home state. Like you said though, the number of residency slots hasn’t really increased, especially in primary care specialties.

    As brought up previously, medical schools, residents, and attendings (rather consciously or unconsciously) really push students to the most competitive specialties possible, which is not really the primary care fields. They look down at primary care fields as well. Another issue is primary care fields are on the front line of social determinants of health, and medical schools aren’t really geared towards accepting and training socially responsible and passionate students as many students are still more interested in prestige and salary. Although, there are still plenty of these types of students and doctors out there as you can see in this comment chain. I also honestly think a medical student should go into any speciality they want or dream of. Just because you’re a neurosurgeon or orthopedic surgeon, doesn’t mean you’re not as passionate about public health and underserved populations.

    Finally, debt is a huge issue, especially when you’re coming from working class families and have to take out all federal loans or your grades and scores are not competitive enough for merit scholarships. If you go to a private medical school, you can pay almost twice as much in loans as public medical schools, and tax payers also often pay for the other half of what it actually cost to train medical students even at private schools. It’s really a symptom of how incredibly expensive our whole health system is, so training doctors is very expensive as well. There are some enticing primary care debt forgiveness programs, but they aren’t always as straight forward or great as they first appear.

    • skbanergt Says:

      Sloboda,
      I agree that under ideal conditions an individual should not be limited by financial constraints and should pursue specialties like neurosurgery or orthopedic surgery if they so choose. Unfortunately, the limitation in supply of residency spots makes pursuing this goals all the more difficult.

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