MORE DOCTORS NEEDED

IS THERE A DOCTOR SHORTAGE?
source: NEJM 1.23.2008

We find ourselves in a health care crisis with not enough doctors. Ten years ago there were too many doctors, especially specialists. Congress capped the number of funded Medicare residencies in 1997. The shift is not toward more general practitioners.

Because of increased economic growth, the residencies were increased to 10.000 graduates annually. Medical school enrollment was raised 15%. A shortage of doctors has occurred. Because of our aging population and increased physician visits, decreased productivity by part time female doctors working fewer hours, and doctor needs for more balanced lifestyles, It was felt that there would be a 10% deficit by 2020 with 90,000 more doctors needed. With universal health care, the shortage would become more acute.

The Association of American Medical Colleges has expanded recommendations for 30% more medical school graduates and more federal funding to support residency positions. Medical schools plan a 17% increase by 2012. Most of this increase will go to fill additional residency positions.

How will it help by adding more doctors to a system that frustrates patients who are disappointed with their current health care? Patients are angry at today’s goals for performance, workforce policies and initiatives, access to care, and absent personal and compassionate care.

Some regions have very few doctors in badly needed communities. Regional supply of cardiologists is badly needed in areas with Medicare patients. Some areas have a surplus of doctors and other areas with severe problems fail to meet the medical needs of communities. No one compares patient preference and needs in deciding the number of physicians needed in an area.

Doctors don’t go to areas of patient needs. Areas with low-income minority residents have great health needs. Yet few doctors open offices in these areas. Call it’ the inverse distribution of care law’.

Once enough doctors flock to an area, patients rarely get any benefit. This is confirmed in university academic centers treating elderly patients with chronic diseases It takes 16 doctors per 1000 patients to take care of end of life patients @ UCLA and only 8 in the average health center. Yet patients have the same outcome with a variable number of doctors giving service. Patient satisfaction is the same at both kinds of medical care. Better access to care provides better outcomes. The number of doctors does not equate to better quality of care.

Despite a 50% increase in supply of doctors over the last 20 years, only one out of 5 went to an area with a low supply of doctors. Eighty percent went to areas of oversupply.

How can you change physician settlement patterns? More doctors result in the elderly having a higher hospitalization rate, higher ICU rate, and more doctors caring for each patient in an uncoordinated manner. Specialty services result in a lot of hospitalizations and a large number of expensive tests.


If we don’t increase the number of doctors our health care will suffer. But there are better ways to stop obsolete resources by having more primary care doctors. They can provide the best outcomes @ the lowest costs. Fewer Medicare specialists would be involved and there would be fewer ICU and hospital days resulting in lower health care costs.

Certainly, the doctor work force is now effective. Expanding the work force dramatically would be however being disruptive. Covering more uninsured children and reforming the payments to doctors would be money well spent. Lowering the litigation climate would also be a big saver in over utilized testing.

The goal should be to provide more access, better quality, and more efficiency with better outcomes.
Adding more doctors per capita will by itself not improve the system.

What do you think?
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