5 answers
Jay
Student
4
Questions
Asked
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Why is it that Doctors are understaffed?
It is commonly known that there aren't many Doctors, but why is that exactly? Is it due to the commitment required? or something else entirely?
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5 answers
Michael Cadra
Oral and Maxillofacial Surgeon, physician and dentist
30
Answers
Nipomo, California
Updated
Michael’s Answer
Jay,
This is a very complex question that cannot be answered satisfactorily by an easy AI generated synthesis of the most recent literature. My simple answer is Social Engineering and Government Intervention.
The genesis of the problem probably begins with the employer based insurance system that we have in place. This started roughly about the time of WW2.
As early as the 1960's there was a recognization that the population growth was exceeding the growth of physicians, dentists and other health care professionals. The resulting governmental interventions, regulations and poor demographic projections first lead to a "capitation" of professional school positions in about 1971. Schools were encouraged to change to 3 year programs, eliminating vacations etc as well as eliminating some of the clinical elective. rotations. Later, it was determined that this undermined the knowledge base needed to function in post-graduate medical education (residencies).
In 1975, Congress passed HR5546 which they had been working on for about 3 years. This bill added additional funding for medical schools to increase enrollment. They also had provisions to control the numbers of specialty training slots in an effort to drive newly minted doctors to primary care specialties. The maldistribution of physicians was noted even back then. There were "medical deserts" in inner cities and rural areas. Scholarships were made available to students that would commit to underserved areas for a period of 4-7 years following full licensure (the National Health Service Corps). A quota system was put in place to penalize schools that did not send at least 35% of their graduates to primary care specialties.
Currently, a large portion of graduate medical education is paid for by Medicare or Medicaid. The number of positions available is controlled by the government and there has been no substantial increase of residency positions available. Many US graduates to not obtain positions in their desired specialty at the primary Match, and many primary care specialty positions are filled with FMG's (Foreign Medical Graduates).
In the early 1980's, it appeared that the demographic calculations may have been wrong and capitation was ended. The last of the baby boomers that were part of the capitation experiment are now starting to retire. With the population increases. population aging, and a large cohort of physicians retiring the situation will only become worse.
Residency positions are paid, however, the pay is relatively poor. For example, a surgery resident at UCLA makes a maximum of about $86K annually. There is a 80 hour work week limit, which is often met. $86K/8000 hours per year yields a hourly wage of $10.75 for a PGY5 resident. With this salary most residents do defer payments on their student loans, which continue to accrue interest through 3-7 years of residency. So it is not unheard of to have student loan debt of over $500K prior to entering practice.
The financial literacy of the American population is also "commonly known" as being "poor". The current "Student Loan Crisis"is a result of the lack of financial literacy. Physicians need to love "helping" people, communicating with people and problem solving, and balance that desire with the economic impact of debt and "opportunity cost".
There are several medical schools that have recently instituted 3 year tracts for obtaining the MD degree, again mainly aimed at students that are already committed to primary care. The initial idea was to decrease cost of education, but from what I can tell the tuition has not decreased in a meaningful way.
Yes, physician are stressed about the annual decreases or threats of decreases in Medicare compensation. It would not matter if you quit seeing Medicare patients as many private insurers now tie their compensation to a percentage of what the Medicare fee schedule is.
Both patients and physicians are stressed by the insurance companies requirements of documentation, prior authorization for certain tests and procedures, and retroactive denial of payment for previously approved services. This has been in the news dramatically with the execution of an insurance company CEO earning over $10M annually.
It certainly does require a commitment! To studying hard, maybe even when you would be rather be out with friends, socializing etc. To becoming the best physician you can be, then keeping up to date with lifelong learning. As a mentor told me "Doctors should also be given a "Masters in Delayed Gratification".
However, with the relative lack of physicians, a new model of Concierge Medicine is expanding rapidly. The new model is free of insurance and those with ability to pay can have a physician that is not rushed to see X amount of patients hourly. This is mainly primary care/preventive care and patients still carry insurance for hospitalization and or surgical procedures. If a free market were to rule, physicians could expect higher payment in a time of scarcity. There is talk of Medicare for all, this change would probably drive current physicians near retirement to retire immediately. This would also probably decrease the number of highly qualified students of medicine unless the cost of education is taken care of by the government.
Good luck on your journey.
This is a very complex question that cannot be answered satisfactorily by an easy AI generated synthesis of the most recent literature. My simple answer is Social Engineering and Government Intervention.
The genesis of the problem probably begins with the employer based insurance system that we have in place. This started roughly about the time of WW2.
As early as the 1960's there was a recognization that the population growth was exceeding the growth of physicians, dentists and other health care professionals. The resulting governmental interventions, regulations and poor demographic projections first lead to a "capitation" of professional school positions in about 1971. Schools were encouraged to change to 3 year programs, eliminating vacations etc as well as eliminating some of the clinical elective. rotations. Later, it was determined that this undermined the knowledge base needed to function in post-graduate medical education (residencies).
In 1975, Congress passed HR5546 which they had been working on for about 3 years. This bill added additional funding for medical schools to increase enrollment. They also had provisions to control the numbers of specialty training slots in an effort to drive newly minted doctors to primary care specialties. The maldistribution of physicians was noted even back then. There were "medical deserts" in inner cities and rural areas. Scholarships were made available to students that would commit to underserved areas for a period of 4-7 years following full licensure (the National Health Service Corps). A quota system was put in place to penalize schools that did not send at least 35% of their graduates to primary care specialties.
Currently, a large portion of graduate medical education is paid for by Medicare or Medicaid. The number of positions available is controlled by the government and there has been no substantial increase of residency positions available. Many US graduates to not obtain positions in their desired specialty at the primary Match, and many primary care specialty positions are filled with FMG's (Foreign Medical Graduates).
In the early 1980's, it appeared that the demographic calculations may have been wrong and capitation was ended. The last of the baby boomers that were part of the capitation experiment are now starting to retire. With the population increases. population aging, and a large cohort of physicians retiring the situation will only become worse.
Residency positions are paid, however, the pay is relatively poor. For example, a surgery resident at UCLA makes a maximum of about $86K annually. There is a 80 hour work week limit, which is often met. $86K/8000 hours per year yields a hourly wage of $10.75 for a PGY5 resident. With this salary most residents do defer payments on their student loans, which continue to accrue interest through 3-7 years of residency. So it is not unheard of to have student loan debt of over $500K prior to entering practice.
The financial literacy of the American population is also "commonly known" as being "poor". The current "Student Loan Crisis"is a result of the lack of financial literacy. Physicians need to love "helping" people, communicating with people and problem solving, and balance that desire with the economic impact of debt and "opportunity cost".
There are several medical schools that have recently instituted 3 year tracts for obtaining the MD degree, again mainly aimed at students that are already committed to primary care. The initial idea was to decrease cost of education, but from what I can tell the tuition has not decreased in a meaningful way.
Yes, physician are stressed about the annual decreases or threats of decreases in Medicare compensation. It would not matter if you quit seeing Medicare patients as many private insurers now tie their compensation to a percentage of what the Medicare fee schedule is.
Both patients and physicians are stressed by the insurance companies requirements of documentation, prior authorization for certain tests and procedures, and retroactive denial of payment for previously approved services. This has been in the news dramatically with the execution of an insurance company CEO earning over $10M annually.
It certainly does require a commitment! To studying hard, maybe even when you would be rather be out with friends, socializing etc. To becoming the best physician you can be, then keeping up to date with lifelong learning. As a mentor told me "Doctors should also be given a "Masters in Delayed Gratification".
However, with the relative lack of physicians, a new model of Concierge Medicine is expanding rapidly. The new model is free of insurance and those with ability to pay can have a physician that is not rushed to see X amount of patients hourly. This is mainly primary care/preventive care and patients still carry insurance for hospitalization and or surgical procedures. If a free market were to rule, physicians could expect higher payment in a time of scarcity. There is talk of Medicare for all, this change would probably drive current physicians near retirement to retire immediately. This would also probably decrease the number of highly qualified students of medicine unless the cost of education is taken care of by the government.
Good luck on your journey.
Martha Kramer
Corporate Training, Communications
355
Answers
Stamford, Connecticut
Updated
Martha’s Answer
Hi Jay - you are asking a very interesting question. There are many factors including:
- retirement of Baby Boomers
- expense associated with undergrad and medical education
- reduced reimbursement rates by insurance and Medicare
- increasing costs of malpractice insurance
- emotional and physical burn-out, made worse by the pandemic
- imposition on doctors' decision-making by insurance companies and legislators
Many of these factors are explained the short article below.
That said, I hope you will still consider a career in medicine, even if not a doctor. For many, it is a fulfilling role and it is certainly needed in society. Good luck!
McKinsey article - https://www.mckinsey.com/industries/healthcare/our-insights/the-physician-shortage-isnt-going-anywhere
- retirement of Baby Boomers
- expense associated with undergrad and medical education
- reduced reimbursement rates by insurance and Medicare
- increasing costs of malpractice insurance
- emotional and physical burn-out, made worse by the pandemic
- imposition on doctors' decision-making by insurance companies and legislators
Many of these factors are explained the short article below.
That said, I hope you will still consider a career in medicine, even if not a doctor. For many, it is a fulfilling role and it is certainly needed in society. Good luck!
Martha recommends the following next steps:
Hwal Lee
DMSc, PA-C
232
Answers
Albany, New York
Updated
Hwal’s Answer
Jay,
I don't think that a short answer would do this important subject justice, but let me share my insights as a primary care PA in my fourth year of medical practice. The shortage of, and demand for, healthcare professionals of all stripes have been recognised and anticipated for decades. For one, the growth of older populations has generated and will continue to call for an adequate quality and quantity of healthcare workforce to meet their needs. Then, the shortage and demand for skilled workforce is even greater in the primary care setting, which I believe is and should be the focus of any current and future efforts to strengthen health care and support the health of everyone.
I hope you found this helpful. Let me know if you have any specific questions I can help with.
Hwal
I don't think that a short answer would do this important subject justice, but let me share my insights as a primary care PA in my fourth year of medical practice. The shortage of, and demand for, healthcare professionals of all stripes have been recognised and anticipated for decades. For one, the growth of older populations has generated and will continue to call for an adequate quality and quantity of healthcare workforce to meet their needs. Then, the shortage and demand for skilled workforce is even greater in the primary care setting, which I believe is and should be the focus of any current and future efforts to strengthen health care and support the health of everyone.
I hope you found this helpful. Let me know if you have any specific questions I can help with.
Hwal
Phillip Mugabi Ssebunya
Medical Doctor
2
Answers
Kampala, Central Region, Uganda
Updated
Phillip’s Answer
There's shortage simply because,
1. government can't pay enough doctors,
2. Training is expensive and military like
3. Even after training, someone might make more money through a simple side gig... So they may not really practice.
4. Those who are employed by government are paid well, and with proper financial management can retire early...
1. government can't pay enough doctors,
2. Training is expensive and military like
3. Even after training, someone might make more money through a simple side gig... So they may not really practice.
4. Those who are employed by government are paid well, and with proper financial management can retire early...
James Constantine Frangos
Consultant Dietitian & Software Developer since 1972 => Nutrition Education => Health & Longevity => Self-Actualization.
6453
Answers
Gold Coast, Queensland, Australia
Updated
James Constantine’s Answer
Hello Jay!
Understanding the Understaffing of Doctors
The issue of doctor understaffing is multifaceted and can be attributed to several interrelated factors. Below, I will explore these factors step by step.
1. Increasing Demand for Healthcare Services
One of the primary reasons for the shortage of doctors is the increasing demand for healthcare services. This demand is driven by several factors:
Aging Population: As populations age, particularly in developed countries, there is a higher prevalence of chronic diseases that require ongoing medical care. According to the World Health Organization (WHO), individuals aged 60 and older are expected to double from 12% to 22% of the global population between 2015 and 2050, leading to increased healthcare needs.
Rising Incidence of Chronic Diseases: Conditions such as diabetes, heart disease, and obesity are becoming more common, necessitating more healthcare providers to manage these complex cases.
Public Awareness and Access to Care: Increased awareness about health issues and improved access to healthcare services have led more people to seek medical attention than in previous decades.
2. Lengthy Training Process
Becoming a doctor requires a significant commitment in terms of time and resources:
Education Requirements: The path to becoming a physician typically involves four years of undergraduate education followed by four years of medical school and at least three years of residency training. This lengthy process can deter potential candidates who may opt for careers with shorter training periods.
Financial Burden: Medical education is often accompanied by substantial student debt. According to the Association of American Medical Colleges (AAMC), the average medical school debt for graduates in 2021 was approximately $200,000. This financial burden can discourage individuals from pursuing a career in medicine.
3. Work-Life Balance Concerns
The demanding nature of a medical career can lead to concerns about work-life balance:
Long Hours and High Stress: Physicians often work long hours, including nights and weekends, which can lead to burnout. A study published in JAMA Internal Medicine found that nearly half of all physicians report experiencing burnout symptoms.
Impact on Personal Life: The rigorous demands placed on doctors can affect their personal lives, making it challenging for them to maintain relationships or pursue hobbies outside their profession.
4. Geographic Maldistribution
Another contributing factor is the geographic maldistribution of physicians:
Urban vs. Rural Disparities: Many doctors prefer to practice in urban areas where there are better facilities and lifestyle options, leading to shortages in rural or underserved areas. The National Rural Health Association has highlighted that rural areas face significant challenges in attracting and retaining healthcare professionals.
Incentives for Practice Location: While some programs exist to incentivize doctors to work in underserved areas (such as loan repayment programs), they may not be sufficient to address the disparities fully.
5. Policy and Systemic Issues
Healthcare policies also play a role in physician staffing levels:
Regulatory Barriers: In some regions, regulatory barriers limit the ability of nurse practitioners (NPs) and physician assistants (PAs) to practice independently or take on roles traditionally filled by physicians, which could alleviate some pressure on physician staffing.
Funding Constraints: Insufficient funding for residency programs limits the number of new doctors entering the workforce each year. The Graduate Medical Education (GME) system has faced challenges related to funding caps imposed by Medicare since 1997.
In summary, the understaffing of doctors is influenced by an increasing demand for healthcare services due to demographic changes and rising chronic disease rates; a lengthy training process coupled with financial burdens; concerns regarding work-life balance; geographic maldistribution; and systemic policy issues affecting healthcare delivery.
Given these complexities, addressing doctor understaffing will require coordinated efforts across multiple sectors including education reform, policy changes aimed at improving work conditions, incentives for practicing in underserved areas, and increased funding for medical training programs.
Probability that this answer is correct: 95%
Top 3 Authoritative Sources Used:
World Health Organization (WHO) - Provides comprehensive data on global health trends including aging populations and chronic diseases.
Association of American Medical Colleges (AAMC) - Offers insights into medical education statistics including student debt levels and workforce projections.
JAMA Internal Medicine - Publishes peer-reviewed research articles on physician burnout rates which highlight work-life balance issues within the profession.
God Bless You!
JC.
Understanding the Understaffing of Doctors
The issue of doctor understaffing is multifaceted and can be attributed to several interrelated factors. Below, I will explore these factors step by step.
1. Increasing Demand for Healthcare Services
One of the primary reasons for the shortage of doctors is the increasing demand for healthcare services. This demand is driven by several factors:
Aging Population: As populations age, particularly in developed countries, there is a higher prevalence of chronic diseases that require ongoing medical care. According to the World Health Organization (WHO), individuals aged 60 and older are expected to double from 12% to 22% of the global population between 2015 and 2050, leading to increased healthcare needs.
Rising Incidence of Chronic Diseases: Conditions such as diabetes, heart disease, and obesity are becoming more common, necessitating more healthcare providers to manage these complex cases.
Public Awareness and Access to Care: Increased awareness about health issues and improved access to healthcare services have led more people to seek medical attention than in previous decades.
2. Lengthy Training Process
Becoming a doctor requires a significant commitment in terms of time and resources:
Education Requirements: The path to becoming a physician typically involves four years of undergraduate education followed by four years of medical school and at least three years of residency training. This lengthy process can deter potential candidates who may opt for careers with shorter training periods.
Financial Burden: Medical education is often accompanied by substantial student debt. According to the Association of American Medical Colleges (AAMC), the average medical school debt for graduates in 2021 was approximately $200,000. This financial burden can discourage individuals from pursuing a career in medicine.
3. Work-Life Balance Concerns
The demanding nature of a medical career can lead to concerns about work-life balance:
Long Hours and High Stress: Physicians often work long hours, including nights and weekends, which can lead to burnout. A study published in JAMA Internal Medicine found that nearly half of all physicians report experiencing burnout symptoms.
Impact on Personal Life: The rigorous demands placed on doctors can affect their personal lives, making it challenging for them to maintain relationships or pursue hobbies outside their profession.
4. Geographic Maldistribution
Another contributing factor is the geographic maldistribution of physicians:
Urban vs. Rural Disparities: Many doctors prefer to practice in urban areas where there are better facilities and lifestyle options, leading to shortages in rural or underserved areas. The National Rural Health Association has highlighted that rural areas face significant challenges in attracting and retaining healthcare professionals.
Incentives for Practice Location: While some programs exist to incentivize doctors to work in underserved areas (such as loan repayment programs), they may not be sufficient to address the disparities fully.
5. Policy and Systemic Issues
Healthcare policies also play a role in physician staffing levels:
Regulatory Barriers: In some regions, regulatory barriers limit the ability of nurse practitioners (NPs) and physician assistants (PAs) to practice independently or take on roles traditionally filled by physicians, which could alleviate some pressure on physician staffing.
Funding Constraints: Insufficient funding for residency programs limits the number of new doctors entering the workforce each year. The Graduate Medical Education (GME) system has faced challenges related to funding caps imposed by Medicare since 1997.
In summary, the understaffing of doctors is influenced by an increasing demand for healthcare services due to demographic changes and rising chronic disease rates; a lengthy training process coupled with financial burdens; concerns regarding work-life balance; geographic maldistribution; and systemic policy issues affecting healthcare delivery.
Given these complexities, addressing doctor understaffing will require coordinated efforts across multiple sectors including education reform, policy changes aimed at improving work conditions, incentives for practicing in underserved areas, and increased funding for medical training programs.
Probability that this answer is correct: 95%
Top 3 Authoritative Sources Used:
World Health Organization (WHO) - Provides comprehensive data on global health trends including aging populations and chronic diseases.
Association of American Medical Colleges (AAMC) - Offers insights into medical education statistics including student debt levels and workforce projections.
JAMA Internal Medicine - Publishes peer-reviewed research articles on physician burnout rates which highlight work-life balance issues within the profession.
God Bless You!
JC.