A perfect storm is brewing in the American healthcare system; too many new patients and not enough new doctors.
The U.S. is experiencing a demographic shift. The Baby Boom population is aging and increasing the numbers of elderly patients who require healthcare for age-sensitive conditions. Those numbers will continue to rise for many years to come. The Affordable Care Act (“Obamacare“) is a less influential factor that will allow 30 million new patients access to insured healthcare.
“This is a national problem across the board and it is going to get much worse,” said Christiane Mitchell, director of medical affairs for the [Association of American Medical Colleges]. “We have an aging population and a whole lot of doctors retiring. We need to increase the pipeline of new doctors.”
It is estimated that the U.S. will need 65,000 additional primary care doctors by 2025. That sounds like a long time to prepare, but it takes a decade for most doctors to complete their schooling – action needs to be taken right away in order to avoid a crisis.
Implications for Patients
With fewer available doctors, patients will soon feel the healthcare pinch.
As a solution, The American Academy of Family Physicians believes that the best way to reduce the shortage is through patient-centered medical homes. The medical home is a team-based approach, where every patient has a personal physician who leads a team of professionals, including nurse practitioners, physician assistants, nurses and other health care professionals. With plenty of staff support for a small number of M.D.’s, patient care is streamlined. However, the Association of American Medical Colleges (AAMC) doesn’t believe that medical homes are the cure-all solution for the looming shortage. Team-based approaches may help reduce the shortage, but will not eliminate it.
Why don’t we have enough Family Physicians?
The doctor shortage isn’t really a “Doctor” shortage per se; there are 17,364 new doctors that graduated in 2011 according to the AAMC. The real problem is that too few of those doctors chose primary care as a career, preferring to specialize in more lucrative areas of medicine.
In a 2008 census by the AAMC and the American Medical Association, research revealed that the number of medical graduates choosing a career in family medicine dropped nearly 27 percent. This is partially a financial decision; primary care physicians in the United States make $140,000 to $150,000 annually, but specialists can make up to 2-3 times as much. For medical school students buried under a mountain of debt after 10+ years of schooling, choosing a more lucrative career choice is the logical course of action.
Students also take into consideration their future satisfaction in their chosen field. During medical school, 2-week rounds of clinical rotations is where students get first-hand experience in many different medical specialties. In these clinical rotations, Dr. Phillips of Harvard said that medical students often observe “primary care doctors unhappy doing with what they are doing…Practicing [family] doctors feel overworked and under supported and are generally unhappy,” he added. Clinical rotations don’t do justice to the benefits of a career in primary care; the true payoff in family medicine comes from long-term relationships with patients. “The values of primary care don’t come out in a two-week rotation. You don’t get that experience that a primary care physician loves,” said Jon Kole, a fourth-year medical student at the University of Pennsylvania.
Implications for Medical Admissions
Many academics say that medical schools could do a lot more to encourage students to study primary care, and it all starts in the Admissions department. Professors suggest that admissions could select more students whose applications indicate a preference for family medicine. The AAMC has also put forth an initiative urging all U.S. medical schools to increase enrollment by 30%. According to the AAMC’s annual enrollment survey, many schools will have met that goal by 2016.
Some schools are already trying to counteract negative perceptions about family medicine. Seeing an opportunity to fill a gap, New York’s Mount Sinai School of Medicine is starting a new Department of Family Medicine. Dr. Dennis Charney, dean of the medical school, says “It’s a big deal for our institution. We want to be one of the leading medical schools that educates the next generation of primary care doctors.”
Schools can’t do it all alone, though. Amidst a climate of deep budget cuts for education, Congress must switch gears and support medical education funding, especially for primary care physicians. The U.S. government has already offered financial incentives such as loan repayments and scholarships to get doctors to practice in under-served areas.
“As a result of ongoing budget discussions, cuts to doctor training will worsen the physician shortage and jeopardize the health of patients around the nation. It takes years to train a doctor. For more doctors tomorrow, there must be increased funding for doctor training today,” says the AAMC
A good defense is the best offense
Medical schools must take action now in anticipation of the doctor shortage. They can begin by re-evaluating the end goal of their admissions procedures and adjusting school culture to be more encouraging of family care physicians. For example, Texas Tech is trying to encourage students to choose family medicine, by reducing the cost of medical school with an accelerated three-year program that allows primary care physicians to graduate a year early.
AMP is another example of an admissions tool that medical school admissions offices can use to prepare for this complicated and ever-changing world of medical admissions. Customizable applicant reports can allow admissions staff to efficiently evaluate the demographics of students, including ratios of how many students are interested in family medicine vs. pursuing a specialty. Visit Paperless Admissions to learn about how AMP can streamline and help your admissions office better evaluate applicants in your medical admissions process.