Looming Doctor Shortage Just TIp of Iceberg?

Stories about the shortage of skilled workers are so frequent these days that many people just take the news with a grain of salt.  But an article like the one published in the Central Penn Business Journal is enough to make you numb.

The Journal reported that a shortage of neurologists has caused a regional health care system to scale back neurology services. (Neurologists deal with disorders of the nervous system. Their patients include people affected by conditions such as stroke, seizure disorders, diseases including multiple sclerosis and headaches stemming from hard-to-identify causes.) Can this be just the tip of the iceberg?

It’s no surprise that the United States and much of the rest of the developed world is in deep trouble when it comes to health care.  But you most likely knew that.  What you may not know is that rising health care costs is only part of the problem. Access to health care due to an aging and growing population may be the straw that breaks the proverbial back.   

The shortage of neurologists is the result of forces that also have created shortages of other specialists, including rheumatologists, who deal with joints; pulmonologists, who deal with the lungs; and endocrinologists, are play an important role in treating diabetics

An 2009 assessment of the supply and demand for cardiologists concluded that there is currently a substantial shortage of cardiologists and that this shortage will increase over the next 20 years. The key drivers of the shortage are a higher demand for cardiology services, as the general population ages, coupled with the fact that 43% of general cardiologists are currently over the age of 55 and will likely retire in the next 20 years. The shortage of general cardiologists is projected to increase from about 1,700 in 2008 to about 16,000 in 2025.  (Source: Association of American Medical Colleges, Recent Studies and Reports on Physician Shortages in the US.)

The shortages don’t stop there.

Another report by the Department of Health and Human Services concluded the nation should have over 30,000 child psychiatrists but there are less than 7,000 currently practicing in the nation.

Gastroenterologists are crucial for detecting colorectal cancer (CRC) as they provide the majority of colonoscopies. A shortfall of approximately 1,050 gastroenterologists is expected by 2020 as demand for colonoscopies is expect to rise by 10 percentage points. Both the aging and growth of the population is causing demand to exceed supply and the number of gastroenterologists entering the field are not going to be able to meet the needs of the growing and aging population.

There are also 723 fewer general surgeons practicing today than were in 1981. The general surgeon to population ratio decreased steadily across the study period, from 7.68 per 100,000 in 1981 to 5.69 per 100,000 in 2005. The overall number of general surgeons has remained static since 1994, despite an increase in the population of 1% per annum during this period. This coupled with the rise in surgical specialization and the decreased interest among medical students in general surgery as a career.

Demand is projected to increase by 48% by 2020 due to the growth in the aged population and to the increasing number of cancer survivors. Supply is only projected to increase by 14% by 2020 due to physician retirements and limited expected growth in the number of oncology fellowship training slots.

The number of generalists is also declining. The numbers of generalist residency graduates have declined each year since 1998, causing concern about future shortages says a study published in Health Affairs. Between 2005 and 2025 the population above age 65 will increase 73 percent, the same group who seeks care from generalists at twice the rate of those under the age of 65. Using 2005 levels as a benchmark, a 20-27 percent shortfall, about 35,000 to 44, 000 generalists, is anticipated by 2025.

The net result is a projected shortage of about 90,000 to 200,000 physicians in 2020 – which is equivalent to approximately ten percent of today’s physician workforce. In 2004, Merritt, Hawkins & Associates, a health care staffing and consulting firm, published, “Will the Last Physician in America Please Turn off the Lights? A Look at America’s Looming Doctor Shortage.”  

The prognosis may not be that dark but solutions for a quick fix are dim.


Ira S Wolfe