The Primary Care Physician Shortage [Part I]: Are Shorter Medical School and Expanded Residency Programs The Answer?
March 18, 2014
Let’s start with the problem. If the ACA is successful, eventually we’ll have as many as 30 million more people who will be insured. We don’t have enough primary care physicians to meet this new demand. There are many possible solutions. We’ll explore three of them in a series of posts:
1. Shortening the amount of time it takes to get a medical degree and expanding residency programs to get more doctors into the workforce more quickly.
2. Empowering medical professionals to take on more of the responsibilities of primary care physicians, working under their supervision. These professionals include physicians’ assistants, nurse practitioners, pharmacists and nurses.
3. Using technology — telephones, email and telemedicine, and remote monitoring — to extend the reach of physicians, especially for people in remote and rural areas.
Today’s blog is Part I. Click back to the blog for Part II and Part III in the series in coming weeks.
The ACA will enable millions of uninsured Americans to get health insurance. But experts say that a shortage of primary care physicians could prevent many of the newly insured from getting access to medical care.
The Department of Health and Human Services (HHS) estimates that there will be about 15,230 too few physicians in coming years to meet the need and that the shortage will only grow.
In response to this estimate, the Obama administration has proposed spending $5.23 billion over the next 10 years to support new physicians, especially those entering the field of primary care.
One of the roadblocks to increasing is the ranks of primary care physicians is the length of medical school. Another is the relative scarcity of residency spots.
The average length of medical school is four years, with an additional internship and residency requirement tacked on. This is in addition to the standard four year undergraduate degree in a related field like biology or chemistry. If we could shorten that formidably long schooling and clinical experience training time, we could get more doctors into the workforce faster.
But here’s a question: Would shortened medical school programs help understaffed hospitals and practices overwhelmed by an influx of newly insured? Or is it a dangerous shortcut that may do more harm than good?
Advocates have suggested shorter medical school programs could be structured without compromising the quality of the care for patients of these newly (and quickly) minted doctors.
The Journal of the American Medical Association published an article on this topic by University of Pennsylvania Vice Provost Ezekiel Emanuel and Stanford economist Victor Fuchs. The authors proposed that a year of medical school could be eliminated “without adversely affecting academic performance” and “without affecting patient care or eroding clinical skills.”
A handful of schools already offer three year MD programs. The “oldest” of these programs received approval in 2010, so there still aren’t enough graduates to determine if this is a suitable substitute for a traditional four year program. However, if they do prove successful, this could help alleviate the shortage and lead the way for other schools to follow suit.
But what about after formal schooling is over and it’s time for med students to complete a residency? This is the second roadblock.
The main problem is that the federal government funds residency programs through the Medicare Direct Graduate Medical Education (DGME) payment system, but it has capped the number of spots. This means residencies are in short supply.
“In 1997, the federal government essentially froze spending on residency slots, limiting the number to around 100,000 over three-to-four years, and in turn freezing the number of newly licensed physicians available for hire each year to around 26,000. Over the past 17 years, a few hospitals have established new residency programs for primary care doctors, raising the number to around 27,000, or a less than 4% increase. Meanwhile, the U.S. population has risen by 50 million, or almost 20%.”
In response, medical schools are pressing lawmakers to pass legislation that would add more residencies as means to get more doctors ready for “active duty” faster. This is not without cost — in fact, it may cost taxpayers as much as $9 billion to subsidize.
Whether in the form of shortening med school or upping the number of residencies, many observers agree that steps must be taken to address the impending shortage of doctors. For example, Atul Grover, chief public policy officer for the Washington-based Association of American Medical Colleges, predicts that without remedy the shortage will only get worse. The Association estimates a shortage of as many as 130,000 doctors by 2025.
Something’s gotta give.