Physician Shortage in the U.S.: Increasing Wait Times

The shortage of American doctors has arrived, and it is becoming critical. There are more physicians who are retiring than we are training, and fewer people are entering medical school as a profession. This shortage has become critical in some states, and even forced closure of some hospital emergency rooms that can no longer provide the services that there communities require.

In my field, surgery, we have felt this for over twenty years, when we have graduated about 1000 surgeons a year and 1300 to 1600 retire every year. This has become critical for a number of small rural communities that are no longer served by surgeons. Wait times to get in for elective surgery from these communities has increased to over six months. The general surgery has had an impact in larger cities, where surgeons are less interested in taking call from emergency rooms and patients who arrive to ER’s with surgical issues (such as appendicitis) have to be transferred to other facilities. The number of hospitals who have had to divert patients away from their ER because of not having adequate specialty coverage has increased dramatically in the last few years.

Once the busiest emergency rooms in Phoenix, a hospital had to close its operating rooms after 5 pm because of surgeon attrition. This means that people arriving at its emergency room who need surgical care are likely to be transferred to another facility. For some patients this can be simply an inconvenience, but for others this can mean the difference between receiving timely care or not. While Phoenix has one of the premier neurosurgery training programs in the country, patients who arrive at other emergency rooms needing urgent neurosurgery, may not be able to be transferred in time.

The number of Surgeons is decreasing in this Country

In the state of Nevada there are no transplant programs. People who need transplants have been forced to move to other states in order to be near the transplant center should they receive “the call.” The number of transplant surgeons, as well as programs, nationwide has decreased, while the demand for transplants continue. We may soon reach a time when the critical shortage of organs isn’t the rate limiting step, but the critical shortage of transplant surgeons is.

In the field of ENT (otolaryngolology) there are currently 8600 in the U.S., already a shortage, but this will become even more critical as the number of specialists needed in ten years will be 2500 short of the demand. One of the most common operations is placing tubes in the ears of children – decreasing the number of infections, and saving hearing. Delay in getting this procedure can have devastating impact on the children.

A recent report from the Association of American Medical Colleges states that in 8 years, the US will be short over 46,000 medical specialists, and about the same number of primary care physicians, or over 91,500 physicians.

Suffering a heart attack in the town of Winterhaven, California – Edward was transported to the hospital in Yuma, where an emergency heart catheterization revealed the critical blockage in his heart. Taken by helicopter to Phoenix he had a stent placed within two hours of his symptoms, but it was too late for some of his heart that suffered severe damage in that time. Edward went from a vigorous man who had been the Vice President of Finance of a major corporation to a nursing home resident for cardiac rehabilitation. He never returned to work.

While some blame the Affordable Care Act, or Obamacare, the physician shortage has been looming for two decades. Those who make political hay out of this problem state that increasing insured without increasing supply of physicians is the answer. Sadly they ignore the simple fact: people get sick whether they have insurance or not. People with insurance are more likely to see a physician earlier, thus treating diseases at a less costly stage. Obstetrics is the most common example: the ability to receive pre-natal care can mean the difference between a normal and a high risk delivery, as well as a child who is born healthy, or one that is born with defects requiring life-long care.

In Las Vegas, a metropolis of over 2 million people, it takes six months or longer to get a routine check up. Some physicians have resorted to concierge medicine, where they insure access to patients, and time with patients through a pre-paid system. Bottom line, it is getting harder and harder to see your family doctor, and one study showed that people going to Urgent Care Centers while costing more, are seen faster.

Some cite a study where 83% of physicians were considering retiring because of Obamacare.  However that was a right wing group that polled itself, and not reflective of current situations. Most of the physicians in that group are near retirement age, and want to have “the old way,” back. It is sad when people use the medical profession to prove a point- but the bottom line is that the physician shortage will impact your health care in the future – and not in a good way.

No matter which side of the political aisle, from those who wish single payor system to those who want to expand the free-market system: no one has an answer for the declining number of physicians.

Currently the US ranks #17 in all health care measures, we are no longer number one in the industrialized world for medicine. This is a critical problem over two decades in the making. We need to solve this by encouraging more people to go to medical school.  The number of applicants to medical school has been dropping for twenty years. Some of this stems from fewer people taking math and science classes – as our public education system has declined.  But our health care needs increase, as our population ages, so do our healthcare needs.

Until then, some of the slack will be taken up by foreign medical school graduates. We have the resources to have the physician shortfall taken up by our own citizens, and that would be a better course.

 

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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Latest Comments

  1. Lynn says:

    It would appear that there are more applicants to medical schools than there are spots for all those who are qualified. I wonder how many of them that do get in, are from foreign countries and they plan to go back to those countries and practice.
    Then there is also the daunting cost of Medical school, the relatively low salary during residency, and the high malpractice insurance rates which make medicine a less popular choice than business or technology.
    It would seem that much of health care that is delivered by physicians, could be given more cheaply by physician’s assistants and nurse practitioners at a lower cost. For example, pre-natal care is often handled adequately by nurse midwives unless a problem arises. Anesthesia is also sometimes given by specially trained nurses. Probably much of geriatric care could also be handled by PAs and nurses. The nurses and PAs could triage patients and send only those who really need a doctor, to the appropriate physician.

  2. thedoc says:

    You can have health aids do a lot of work- but they can’t do the complicated diagnosis, surgery, and other issues. But you identified many issues that give kids pause. Bottom line: being a doctor is a calling. But if people are not given the basics in science they won’t hear the call

  3. Lynn says:

    Unfortunately many doctors want 9 to 5 jobs so they go into dermatology and pathology. This is not to say that they are worthless but they are not usually performing emergency surgery. I see lots of plastic surgeons putting ads for procedures that are not covered by insurance which means that people pay the asking price out of pocket.
    Countries such as India and Pakistan seem to do a better job educating students in science and math than American schools do. Americans who send their children to private schools or who live in wealthy neighborhoods with better schools have a better shot at getting their kids into medical school than those in lousy districts. Of course genetics plays a part as well. Smart parents usually have smart kids. Just look at how many Yale students are children of alumni.

  4. Lynn says:

    Another question: why must tympanostomy be done by a physician? Can a PA or NP be trained in the procedure? It looks as though it takes dexterity and anatomical understanding but it is not an invasive procedure. It only takes minutes to put tubes in a baby’s ears. I am seeing physicians get into lucrative alternatives such as laser therapy for sports injuries and back pain (not covered by insurance but they are paid per treatment out of pocket). There are also physicians who operate weight loss clinics where only medical and not surgical care is given. Apparently the money is there and not in caring for the under-insured sick or elderly.
    I think that distinction must also be made between populations with little access to health care and populations who would not seek treatment until late in the game, even when health care does exist in their communities. In the urban community where some of my grandchildren are growing up, there are doctors on every corner but then why is the vaccination rate inadequate to prevent epidemics?

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