A report published earlier this month by the Washington, D.C.-based Association of American Medical Colleges (AAMC), which represents 172 U.S. and Canadian medical schools and over 400 teaching hospitals and health systems, is predicting significant shortages of physicians nationwide in the coming years.
As a June 11 press release noted, “A growing and aging population that will need more care, combined with an aging workforce of physicians nearing retirement, leaves the United States facing a severe shortage of doctors as it tries to address health system vulnerabilities that were exposed by COVID-19, warns a new report from the Association of American Medical Colleges (AAMC). The country’s rapidly increasing demand for physicians over the next 15 years will outpace its supply, leading to a shortage of between 37,800 and 124,000 physicians by 2034, according to the report, ‘The Complexities of Physician Supply and Demand: Projections from 2019-2034.’ That shortage includes shortfalls of 17,800 to 48,000 primary care physicians and 21,000 to 77,100 specialists.”
Indeed, the press release noted, “The report’s data was gathered before the COVID-19 pandemic, which exacerbated the challenges to the nation’s health care system.” And the press release quoted David J. Skorton, M.D., the AAMC’s president and CEO, in stating that “The COVID-19 pandemic has highlighted many of the deepest disparities in health and access to health care services, and exposed vulnerabilities in the health care system,” Skorton said. “The pandemic also has underscored the vital role that physicians and other health care providers play in our nation’s health care infrastructure and the need to ensure we have enough physicians to meet America’s needs.”
Further, Michael Dill, AAMC’s director of workforce studies, noted the element in the report that the continued growth in the number of advanced practice registered nurses (APRNs) and physician assistants (PAs) could help to fill some of the gap. “Without APRNs and PAs, the health workforce crisis the nation is facing would be much, much worse,” Dill said. notes the AAMC’s director of workforce studies, Michael Dill. The study, which is the AAMC’s seventh annual report on physician workforce projections, calculates ranges of physician supply and demand based on numerous possible scenarios, using data that came primarily from 2019.”
Key findings:
Ø The country’s growing population, particularly of those age 65 and older, will demand more medical care. People in that age group now account for 34% of the demand for physicians; by 2034, they will account for 42% of the demand.
Ø In raw numbers, that means that while people age 65 and up required 280,700 physicians to provide their care in 2019, they will need up to 407,300 physicians by 2034.
Ø The nation’s aging population is expected to fuel a continuing growth in demand for physicians in surgical subspecialties.
Ø As a result, the healthcare system will see a primary care physician shortage of between 17,800 and 48,000 is projected by 2034.
Ø And the healthcare system will see a shortage of non-primary care specialty physicians of between 21,000 and 77,100 by 2034.
Ø Among those will be between 15,800 and 30,200 for surgical specialties; between 3,800 and 13,400 for Medical Specialties; and between 10,300 and 35,600 for all other specialties.
Importantly, the AAMC leaders note that the research on which the report was based was performed before the full impact of the COVID-19 pandemic. Per that, the report states that:
“An ever-present challenge in making these workforce projections is the rapid pace of change in the healthcare system and the dearth of data available to quantify these changes. We have identified seven areas where additional data and research could improve health care workforce projections:
• COVID-19 impact: The COVID-19 pandemic is likely to have short- and long-term consequences for the nation’s physician workforce, including for:
o Training (e.g., interruption of education, cancellation of clinical rotations, changes in
curriculum, the potential need to cross-train physicians in preparation for future pandemics).
o Regulation (e.g., changes in licensure and reimbursement).
o Practice (e.g., uptake of telehealth, many private practices being hit hard economically).
o Workforce exits (due to death from COVID-19, early burnout-induced retirement, or postponed retirement due to the economy).
o Well-being (e.g., short- and long-term burnout and trauma).
o Specialty mix (interest in some specialties, like infectious disease, may increase while interest in others may decrease).
o Demand (e.g., scope-of-practice changes for other professions, changes in demand due to delayed care, sudden need for critical care for COVID-19 cases, longer-term demand decreases due to COVID-19 deaths).
o Deployment of technology (e.g., acceleration in the use of telehealth and its attendant underscoring of inequitable broadband access).
o Equity (e.g., women physicians bearing a greater share of childcare).”
With regard to primary care physicians, the report notes that “Comparing projected supply and demand for Primary Care physicians predicts a shortage by 2034 of between 17,800 and 48,000 physicians (Exhibit 4). This range for 2034 is lower than the 2020 report shortage projection of between 21,400 and 55,200 Primary Care physicians by 2033. The updated projections use higher estimates of the annual number of new Primary Care physicians entering the workforce than were used last year: 8,584 compared with 8,366, plus a portion of new GME [graduate medical education] slots funded through Consolidated Appropriations Act of 2021. It is unclear how much of this increase in the number of graduates is due to a real increase in physicians entering primary care and how much is due to improved estimates of physicians completing GME now that a single accreditation system is in place.” Importantly, the report states, “Each modeled supply and demand scenario is based on assumptions about the continuation of current trends or changes in care delivery that might happen at a future date, so each scenario has a degree of uncertainty. The projected shortage range widens over time, reflecting (1) that some trends have a compounding effect (such as annually training more APRNs and PAs [advanced-practice registered nurses and physician assistants]) and (2) greater uncertainty in supply and demand determinants as we move further into the future.” It notes that projections involving primary care physician shortages assume that “the number of new APRNs and PAs trained each year will continue growing at high rates and the proportion of new entrants choosing primary care will remain at recent levels and [that] APRNs and PAs will offset demand for physicians at the rates discussed later in this report. Despite large increases over the past decade in the number of APRNs and PAs entering primary care, as well as a large number of primary care physicians trained annually,” the report notes, “the demand for primary care providers remains strong. The rate of growth in training APRNs and PAs cannot be sustained indefinitely, but at what level the nation will reach market saturation is unknown.”
Meanwhile, when it comes to medical specialist supply, the report notes that “The demand for physicians in internal medicine subspecialties is growing rapidly due to population growth and aging, with slower growth in demand for pediatric subspecialties. The demand projections reflect that an aging population requires more complex care and thus greater reliance on specialized care. The degree to which more care might be provided in the future by specialists that historically was provided by generalists is unclear. The supply of specialists is also growing rapidly. Under the scenarios modeled, this update projects a shortage range of between 3,800 and 13,400 FTEs by 2034, lower than the range of between 9,300 and 17,800 projected in the 2020 report. Included in the lower shortage range is the updated estimate of new physicians entering medical specialties.”
And, when it comes to surgical specialists, “Based on current trends, the supply of surgeons is not projected to change substantially over the next 15 years and might decline as future attrition offsets or exceeds the number of newly trained surgeons. Demand continues to grow, with projected demand exceeding projected supply under all scenarios modeled,” the report notes. “The projected shortage for 2034 is between 15,800 and 30,200 surgeons, which is a slightly larger range than the 17,100 to 28,700 surgeon shortage for 2033 in our 2020 report.”
The report finds a brighter scenario when it comes to hospitalists, who are analyzed as a category separate and apart from other primary care physicians. “Supply projections suggest that at current rates of physicians becoming hospitalists, there would be more than required to meet projected demand for services, with supply by 2034 between 2,700 and 7,000 higher than the level required to meet the demand for Hospitalist services,” the report notes. Indeed, “Having more hospitalists reduces the amount of time required for primary care physicians to do hospital rounds, freeing them up to see more patients in ambulatory settings. The increase in the productivity of primary care physicians might not offset the loss to the hospitalist workforce of primary care providers, however. Hospitals will not hire more hospitalists than are needed, so, as with many relatively young professions, a shift has been taking place that is not being captured by the assumptions in our model. The
rapid growth in hospitalist supply over the past two decades has been facilitated by (1) financial considerations that increased the willingness of primary care physicians to turn inpatient care over to hospitalists, (2) the widespread implementation of electronic health records and hospitals’ focus on quality and patient safety, and (3) the availability of newly trained generalists trained in hospital settings. It is unclear whether this surge in the growth of hospitalist employment will continue or the nation will reach saturation ― at which point, hospitalist demand will change at roughly the same rate as demand for inpatient services. Likewise, if saturation is reached, physicians who would otherwise choose to become hospitalists will, presumably, choose other specialties or other settings.”
The potential—sometimes-contradictory—impacts of the pandemic
The statistical analysis was performed before some of the impacts of the COVID-19 pandemic could possibly be calculated, by the AAMC leaders note towards the end of their report that “News reports indicate that physician concerns about health risks to themselves and their families, trauma and burnout from front-line exposure, frustration over lack of personal protective equipment, and other nonfatal COVID-19 impacts are encouraging some current physicians to leave the field. The pandemic may delay or extend trainees’ training times or affect their choice of specialty, which could discourage them from choosing specialties already experiencing shortages.48,49 While data are not yet available to quantify these impacts, anecdotes abound, and some relevant data are captured in estimates of retirements and practice closures discussed below. We will continue to study these potential impacts and report them in future reports.”
They write that “It is likely that few early or midcareer physicians, who invested the effort and money required to enter medicine, will leave the field permanently compared with those who choose a more suitable practice setting or find other work temporarily in response to COVID-19. However, the situation may be quite different for physicians close to retirement age (and thus at higher risk from COVID-19 complications if the disease continues to mutate and becomes an annual event like the flu). While many factors influence physician retirement decisions, those who are financially able to retire may be more likely to accelerate retirement dates, which will have a short-term impact on supply. Counterbalancing this, other physicians who experienced adverse financial impacts from revenues lost to lockdowns and patients’ apprehension about seeking care during the pandemic and/or the COVID-19-induced recession may delay their retirement plans. The net effect on retirements will likely not be known for several years.” Meanwhile, “The number of solo and small-group physician practices was declining before the pandemic, and the financial pressures of last spring’s lockdowns and subsequent lower demand for non-emergent health care have intensified this trend.50,51 This phenomenon has many potential impacts. To the extent that physicians who sold their practices are retiring or leaving the field, it decreases the supply of physicians. To the extent that physicians are selling to health systems or venture capital firms (or moving to employee or contract relationships with them), it intensifies the consolidation of providers and raises concerns about accessibility as smaller practices in underserved areas shut their doors.”
More broadly, the AAMC leaders note that “COVID-19 appears to have accelerated a deepening crisis in the well-beinCOVID-19 appears to have accelerated a deepening crisis in the well-being of physicians, nurses, and other health care workers. Health care workers already experience burnout, post-traumatic stress disorder (PTSD), and suicide at disproportionate rates. COVID-19 is adding undue stress to health care workers caused by safety concerns when they put themselves and their family members at risk of COVID19 infection; many health care workers have found themselves in situations that require long hours at work and exposure to overwhelming numbers of preventable deaths, which leads to physical, mental, and emotional fatigue. Physician supply will decrease to the extent that providers leave the field (temporarily or permanently) in response to these factors, as will the quality of health care being delivered by providers who have burned out or have job-related depression and post-traumatic stress symptoms. The impact will be short term for some and long term for others. Given that physician burnout and job-related depression and PTSD were not being addressed adequately pre-pandemic, the effect is unlikely to resolve merely with a successful vaccination campaign.” Still, they add, “ In a rare COVID-19 bright spot, the pandemic has spurred a notable increase in medical school applications, dubbed the ‘Fauci effect.’ Medical school applications have increased sharply this year.58 However, this effect will only translate into an increase in overall physician supply if training capacity in both medical schools and residency programs also increases. The Consolidated Appropriations Act of 2021 does provide funding for more GME slots over five years, the first increase in Medicare funding for GME in nearly 25 years.”
