Be careful what you wish for: Is there a doctor in the house…anywhere?

"Dammit, Jim. I'm a doctor not a bricklayer"

The Association of American Medical Colleges recently released a statement that by 2015, there is a predicted shortfall of physician supply in the United State of 62,900 physicians.  Deemed a “critical shortfall” by the authors(1), the shortfall includes primary care physicians, specialists, and sub-specialists.

Physician engagement and affiliation has been a reoccurring hot topic for the last three to four decades.  Its most recent resurgence (and reincarnation) has been attributed to (a) physicians unable to absorb the costs of practicing health care independently, (b) the need for critical mass when negotiating reimbursement, (c) reform measures stressing the interdependence of physicians in a medical home model, value based purchasing, or any of the the ACA initiatives, and (d) the desire of recent graduates to look back at a three decade career and realize family did not sacrifice.
Projected shortfalls in 201 total 13,700.  By 2015, the projection is a shortfall of 62,900; 202 a shortfall of 91,500; and by 2025 a total shortfall of 130,000.
Traditional response to these values is to increase medical school enrollment; thereby, creating a greater supply of physician FTE (full time equivalent).  If we have learned anything from the recent debate over improving the quality and lowering the overall cost of health care — all the while improving access of all Americans to a minimum standard of health, we should consider:
  1. Distribution of physicians by geography.  Working toward a national access of consumer to physician standard in urban and rural areas.
  2. Better articulate the role of primary care physician and specialist.  The role function in a medial home model, in a world dominated by EHR, or reduced reimbursement is vastly different than today’s standards.
  3. Define a new business model for physician AND physician extender.  To support #1 and #2 above, physician in-fighting for patient panel size, solo-management by specialist of patient needs, and provider inability to document, record, bill easily must be wiped out of the industry.

I was watching a movie from the 1950’s recently on TCM.  The family practice physician lived comfortably, not wealthy and not poor.  Their lifestyle was difficult; essentially 24/7 coverage.  The physician’s son went to medical school and chose to be a hospital-based specialist becuase it was more lucrative, better hours, and a sense of reimbursement for the skills and competencies he brought to his patients.  The industry has experienced change and the providers have adopted and morphe into different business models.

Our challenge is to imagine a commencement address in 2021 calling on the new cadre of physicians entering the market to recall the purpose of their profession, understand the financial ramifications of this decision (perhaps more akin to teachers versus corporate giants), and the need to work collaboratively.

(1)  Source:  (c) 2010, Association of American Medical Colleges.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.