by Katherine Bolton
The upcoming U.S. physician shortage is a real and concerning event that Americans will start to feel in the coming years.
The challenge is two-fold. The large numbers of physicians leaving the workforce as they retire is creating openings that are difficult to fill while then also having their healthcare needs increase as they age. This is creating the healthcare industry to face great challenges by the year 2030. The aging patient population will cause significant demands on the healthcare system as the weight of the population will rise to over 65. This demographic tends to generally require more healthcare. The swing that is coming is pushing hospitals to prepare for this decline. It takes ten years for a physician to be fully trained. So, the shortage needs to be addressed now.
According to the Association of American Medical Colleges, there will be a U.S. shortage of approximately 100,000 doctors. Physicians are already stretched, with many appointment times squeezed into just 10 minutes, some physicians seeing forty to fifty patients each day. Even still, there’s not enough time to go around to fill the patient demand. Appointment dates are being scheduled months in advance, especially in specialty practices. This kind of pace and numbers is, without a doubt, going to directly affect patient care. The longer a patient has to wait for care could result in much different outcomes for their long-term prognosis regarding the disease or the challenges they’re facing.
So, what are hospitals doing?
Bronson Methodist Hospital, a teaching hospital in Kalamazoo, Michigan, works very closely with Western Michigan University, also in Kalamazoo, in order to ensure a direct flow of new physicians into their hospital. It’s a way to have an eye on the upcoming physicians and direct access to them, as well as giving them great opportunities for residency placement. In 2017, the graduating medical class was proud to receive 100% placement throughout the country. Bronson (BMH) works hard to recruit great talent. This flow of physicians exiting medical school is a prime spot to look. This type of placement is not typical, however. With a less than 1% increase in residency placement, medical student graduates are finding it difficult to complete their education and are clamoring for the fixed number of slots available.
Support from the Federal Government is essential in this process. Teaching hospitals, like Bronson Methodist Hospital, receive Medicare funding for training physicians in residency. Direct Graduate Medical Education (DGME) is part of Medicare and is, therefore, a federally funded program that also supports educating physicians. When Medicare was established in 1965, it acknowledged the need for financial support to train and supply physicians in the U.S. There have been adjustments made each year, based on inflation, in order to keep the reimbursement amounts on par, but since 1997, the financial support has remained fairly unchanged primarily due to HMO’s being in place.
There is a great need for increased financial support in order to allow medical student graduates the opportunity to finish their training and start providing care in the U.S. Unfortunately, there are limits in place to the number of residents Medicare will reimburse for as well as the type of physician being trained. General medicine receives the highest reimbursement and residency training for more specialized areas such as Urology or Orthopaedics receive less. There is a great need for specialists in all areas and this lack of solid reimbursement may lead to hospitals feeling discouraged from training these types of physicians or merely having their ‘hands tied’ financially without the opportunity to fully train all types of physicians. The challenge is making sure that the highly trained physicians that graduate from medical school have a place to go for residency. There is a real possibility that there will not be enough slots for these physicians to fill. There is a 3-4% increase in medical school graduates and only less than 1% increase in residency placements. This can leave trained medical students in ‘limbo’ between being a medical school graduate and falling short of finishing their practical training through residency. This gap is reducing the number of fully qualified physicians to be available. There is a significant need for Medicare reimbursement to be examined further in order for the pipeline of physicians to be as productive as possible.
There are resources for medical student graduates. The Association of American Medical Colleges significantly understands the needs and challenges. https://www.aamcaction.org/
At this time, if focus is placed on increasing federal funding as well as a steady flow of students choosing medicine as their path, the physician shortage can be addressed much easier. It’s a whole system working together and the parts are interdependent. In order to churn out more fully and broadly qualified physicians, there has to be a full spectrum of support.
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