The physician shortage will continue to escalate into the next decade with an estimated deficit of between 37,800 to 124,000 U.S. physicians by 2034, according to the seventh annual study released last year by the Association of American Medical Colleges (AAMC) entitled, “The Complexities of Physician Supply and Demand: Projections from 2019-2034.” The report lists primary care as the specialty at the forefront of this shortage followed by surgical specialties.
Despite this mounting shortage, medical school applications have increased with the 2021-2022 school year seeing an all-time record increase of 17.8%, according to the 2021 AAMC report, “Fall Applicant, Matriculant, and Enrollment Data Tables.” As more students have applied, admissions rates have remained relatively the same. This intense competition for pre-medical students has little to no effect on the physician shortage.
Dr. Eric Heine, Director of Health Services at UWG, says that the issues behind this shortage are multifactorial but points to a lack of preparation in the 80s and 90s as part of the reason, combined with the lack of available spots for students in both medical schools and residency training programs.
“Part of the reason is that in the ‘80s and ‘90s, there was a study that estimated we would have too many physicians,” said Dr. Heine. “Thus, no new medical schools were built, nor current schools expanded. This went on for almost 30 years so trying to play catch-up now will take at least a decade.
“Also, many of the schools that are opening are not in areas where physicians are needed or are expected to practice, such as in rural areas,” continued Dr. Heine. “So, in one way [medical school] is too competitive, but not because students are not wanted or qualified; there are just not enough spots for them.”
Dr. Heine says that in order for medical schools and residency programs to increase their cohort, the funds must be present to support this increase. This remains a challenge as most residency programs and resident salaries are supported by the U.S. government.
“There would need to be a cooperative and coordinated effort to increase the number of residency program slots to coincide with the number of graduating medical students,” said Dr. Heine. “This is not always feasible, in that residency programs need to meet certain requirements, as well as have staff that are willing to train the residents in adequate numbers, in addition to the right type of patient population, especially for the subspecialties.
“Traditionally, hospitals that have residency programs are supported by the government to make this possible,” continued Dr. Heine. “There is no question that this bottleneck is an issue of concern for current and aspiring medical students.”
Prior to transitioning to College Health medicine, Dr. Heine was a practicing emergency medicine physician for 30 years in Carrollton. He has seen personal examples of the shortage combined with other pressing issues; including a lack of insurance and high costs of medications. These have come together to create a bottleneck of issues presenting as overcrowding in the emergency department.
“I saw patients in the ER with non-emergent problems secondary to difficulties in accessing primary care, although it is not simply the number of providers available,” said Dr. Heine. “The lack of insurance or the high cost of some deductibles even for those who do have policies, is also a major factor in some people not getting in to see a provider.
“There were also many people who presented to the ER after neglecting their health for many years and then experienced an emergent issue, like a stroke, because they had not gone to see a physician about their high blood pressure even though they did have access,” continued Dr. Heine. “The cost of medications also inhibits some people who have seen a provider and received the correct treatment but can’t afford the medication.”