Solving the Physician Shortage Crisis

By Kevin Dayaratina

With the health care debate currently dominating headlines, many Americans may be unaware of a more subtle issue that is affecting the U.S. health care system.
That issue is an increasing shortage of medical professionals. An analysis by the Association of American Medical Colleges estimates that by 2030, America will likely experience a shortage of anywhere between 40,800 and 104,900 physicians.
However, the problem has already gotten worse. As of May 25, the Health Resources and Services Administration had designated over 6,000 areas of the country as having a shortage of primary care providers.
This issue is compounded by the fact that the demand for health care is expected to significantly increase within the next few decades.
A new Heritage Foundation policy paper, co-written by this author (Kevin Dayaratna), describes how changing demographics, an uneven geographic distribution of physicians, and government policy have all contributed to this impending health care crisis.
The report elaborates on the various factors contributing to this crisis:

• America’s aging population has too few physicians.

The Association of American Medical Colleges projects that the number of Americans over the age of 65 will grow by 55 percent by 2030.

As these people age, they will of course need more medical care. Additionally, as a third of physicians may retire in the next decade, they may not be adequately replaced in a manner commensurate with the projected increases in demand.

• Rural areas have a notable lack of physicians.

The physician shortage is particularly striking in rural areas. In fact, the analysts note that “although nearly 20 percent of the country lives in rural areas, fewer than 10 percent of primary care providers practice there.”

Doctors tend to practice near the teaching hospitals where they completed their residency programs, and these hospitals are generally not located in rural areas.

• Graduate medical education is not producing an adequate workforce—in part due to government policy.

This shortcoming is in part due to the fact that funding for graduate medical education is often “focused on the narrow needs of the teaching hospital rather than the broader health care needs of the population as a whole.”

Graduate medical education, a pre-requisite for medical licensure as well as board certification to practice medicine in the United States, has failed to produce the appropriate supply and distribution of doctors to meet patient demand.

• A surplus of medical graduates that policymakers can enable the medical field to take advantage of.

As a result, many of these graduates cannot help treat patients even in areas of the country most desperately in need of care. Each year during the main residency match, there are several thousand medical graduates who do not place into a graduate medical education training position, and thus cannot acquire the training necessary to practice medicine in this country.

The paper offers one possible way for state governments to begin to address the problem of physician shortages—especially shortages in primary care.
That solution is to offer provisional medical licenses to qualified medical school graduates that were not able to attain residency positions to work under the structured supervision of a collaborating physician.
>>> Read the full Heritage Foundation paper here.
Missouri, Kansas, Arkansas, and Utah have already instituted such laws, which can also be significantly improved upon.
Offering provisional licenses to qualified medical graduates could both broaden the opportunities for medical graduates to receive training and help ameliorate the physician shortage.
Given that physician assistants and nurse practitioners currently provide patient care with appropriate supervision, it only makes sense to provide the opportunity for qualified medical graduates to contribute to the health care system through collaboration with practicing physicians.
Innovative solutions such as these could ultimately spawn ideas about alternative training mechanisms that may be better able to respond to the demands of the changing health care marketplace.