Nation Faces Shortage of 150,000 Doctors in 15 Years
WaveCameCrashin
Posts: 2,929
http://online.wsj.com/article/SB1000142 ... 24238.html
The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.
Experts warn there won't be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.
That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.
The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.
The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.
Related Video
Medical Training in Second Life (04/12/10)
Getting Doctors, Hospitals to Use Electronic Medical Records (01/26/09)
Faces of Health Care: A Doctor is in the House (12/22/09)
A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients.
Proponents of the new health-care law say it does attempt to address the physician shortage. The law offers sweeteners to encourage more people to enter medical professions, and a 10% Medicare pay boost for primary-care doctors.
Meanwhile, a number of new medical schools have opened around the country recently. As of last October, four new medical schools enrolled a total of about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of 150 slots, according to the AAMC. Some 18,000 students entered U.S. medical schools in the fall of 2009, the AAMC says.
But medical colleges and hospitals warn that these efforts will hit a big bottleneck: There is a shortage of medical resident positions. The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics.
There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions.
Medicare pays $9.1 billion a year to teaching hospitals, which goes toward resident salaries and direct teaching costs, as well as the higher operating costs associated with teaching hospitals, which tend to see the sickest and most costly patients.
Doctors' groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn't make it into the final bill.
"It will probably take 10 years to even make a dent into the number of doctors that we need out there," said Atul Grover, the AAMC's chief advocacy officer.
While doctors trained in other countries could theoretically help the primary-care shortage, they hit the same bottleneck with resident slots, because they must still complete a U.S. residency in order to get a license to practice medicine independently in the U.S. In the 2010 class of residents, some 13% of slots are filled by non-U.S. citizens who completed medical school outside the U.S.
One provision in the law attempts to address residencies. Since some residency slots go unfilled each year, the law will pool the funding for unused slots and redistribute it to other institutions, with the majority of these slots going to primary-care or general-surgery residencies. The slot redistribution, in effect, will create additional residencies, because previously unfilled positions will now be used, according to the Centers for Medicare and Medicaid Services
In addition, the university opened a satellite medical campus in Fayetteville to give six third-year students additional clinical-training opportunities, said Richard Wheeler, executive associate dean for academic affairs. The school asks students to commit to entering rural medicine, and the school has 73 people in the program.
Journal CommunityDISCUSS
“As a specialist physician I will suggest that until primary care physicians can earn 70-80% of what most specialists make without killing themselves, there will be no incentive for the best and the brightest to go into primary care. ”
—Michael Brennan
"We've tried to make sure the attitude of students going into primary care has changed," said Dr. Wheeler. "To make sure primary care is a respected specialty to go into."
Montefiore Medical Center, the university hospital for Albert Einstein College of Medicine in New York, has 1,220 residency slots. Since the 1970s, Montefiore has encouraged residents to work a few days a week in community clinics in New York's Bronx borough, where about 64 Montefiore residents a year care for pregnant women, deliver children and provide vaccines. There has been a slight increase in the number of residents who ask to join the program, said Peter Selwyn, chairman of Montefiore's department of family and social medicine.
One is Justin Sanders, a 2007 graduate of the University of Vermont College of Medicine who is a second-year resident at Montefiore. In recent weeks, he has been caring for children he helped deliver. He said more doctors are needed in his area, but acknowledged that "primary-care residencies are not in the sexier end. A lot of these [specialty] fields are a lot sexier to students with high debt burdens."
When Obama',Pelosi and all the other people that voted for or supported this bill are out of office or are dead and gone that's when we will see just how bad this bill really is.
The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.
Experts warn there won't be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.
That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.
The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.
The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.
Related Video
Medical Training in Second Life (04/12/10)
Getting Doctors, Hospitals to Use Electronic Medical Records (01/26/09)
Faces of Health Care: A Doctor is in the House (12/22/09)
A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients.
Proponents of the new health-care law say it does attempt to address the physician shortage. The law offers sweeteners to encourage more people to enter medical professions, and a 10% Medicare pay boost for primary-care doctors.
Meanwhile, a number of new medical schools have opened around the country recently. As of last October, four new medical schools enrolled a total of about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of 150 slots, according to the AAMC. Some 18,000 students entered U.S. medical schools in the fall of 2009, the AAMC says.
But medical colleges and hospitals warn that these efforts will hit a big bottleneck: There is a shortage of medical resident positions. The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics.
There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions.
Medicare pays $9.1 billion a year to teaching hospitals, which goes toward resident salaries and direct teaching costs, as well as the higher operating costs associated with teaching hospitals, which tend to see the sickest and most costly patients.
Doctors' groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn't make it into the final bill.
"It will probably take 10 years to even make a dent into the number of doctors that we need out there," said Atul Grover, the AAMC's chief advocacy officer.
While doctors trained in other countries could theoretically help the primary-care shortage, they hit the same bottleneck with resident slots, because they must still complete a U.S. residency in order to get a license to practice medicine independently in the U.S. In the 2010 class of residents, some 13% of slots are filled by non-U.S. citizens who completed medical school outside the U.S.
One provision in the law attempts to address residencies. Since some residency slots go unfilled each year, the law will pool the funding for unused slots and redistribute it to other institutions, with the majority of these slots going to primary-care or general-surgery residencies. The slot redistribution, in effect, will create additional residencies, because previously unfilled positions will now be used, according to the Centers for Medicare and Medicaid Services
In addition, the university opened a satellite medical campus in Fayetteville to give six third-year students additional clinical-training opportunities, said Richard Wheeler, executive associate dean for academic affairs. The school asks students to commit to entering rural medicine, and the school has 73 people in the program.
Journal CommunityDISCUSS
“As a specialist physician I will suggest that until primary care physicians can earn 70-80% of what most specialists make without killing themselves, there will be no incentive for the best and the brightest to go into primary care. ”
—Michael Brennan
"We've tried to make sure the attitude of students going into primary care has changed," said Dr. Wheeler. "To make sure primary care is a respected specialty to go into."
Montefiore Medical Center, the university hospital for Albert Einstein College of Medicine in New York, has 1,220 residency slots. Since the 1970s, Montefiore has encouraged residents to work a few days a week in community clinics in New York's Bronx borough, where about 64 Montefiore residents a year care for pregnant women, deliver children and provide vaccines. There has been a slight increase in the number of residents who ask to join the program, said Peter Selwyn, chairman of Montefiore's department of family and social medicine.
One is Justin Sanders, a 2007 graduate of the University of Vermont College of Medicine who is a second-year resident at Montefiore. In recent weeks, he has been caring for children he helped deliver. He said more doctors are needed in his area, but acknowledged that "primary-care residencies are not in the sexier end. A lot of these [specialty] fields are a lot sexier to students with high debt burdens."
When Obama',Pelosi and all the other people that voted for or supported this bill are out of office or are dead and gone that's when we will see just how bad this bill really is.
Post edited by Unknown User on
0
Comments
http://www.census.gov/Press-Release/www/releases/archives/facts_for_features_special_editions/006105.html
Also, we have see and heard about large shortages in the nursing industry as well as education (teachers) industry. Is this Obama's fault as well?
Our government is the potent, the omnipresent teacher. For good or for ill, it teaches the whole people by its example. Crime is contagious. If the government becomes a law-breaker, it breeds contempt for law; it invites every man to become a law unto himself; it invites anarchy. - Louis Brandeis
dude -what you said about being like China has nothing to do with the issue either. Focus, man, focus - use logic to back up your opinions and explain yourself clearly, please.
What this simple illustration. You see how we go from a pyramid in which the more will support the few... we'll we're getting close to the point of the few trying to support the many in age, care, retirement and similar. It has zero to do with Obama.
http://en.wikipedia.org/wiki/File:United_States_Population_by_gender_1950-2010.gif
Our government is the potent, the omnipresent teacher. For good or for ill, it teaches the whole people by its example. Crime is contagious. If the government becomes a law-breaker, it breeds contempt for law; it invites every man to become a law unto himself; it invites anarchy. - Louis Brandeis
The American Academy of Family Physicians (http://www.aafp.org)says:
“The AAFP believes that the Patient Protection and Affordable Care Act, signed in to law by President Barack Obama on March 23, 2010, is an important step forward in improving health care in this country. Support of this legislation is consistent not only with family medicine’s long-held priorities, but with advocacy principles adopted by the AAFP Congress of Delegates in October 2009”
The American Academy of Pediatrics (http://www.aap.org) says:
“The American Academy of Pediatrics supports the current health reform law… The Academy has established clear priorities for health reform at every stage of the process. Each of these priorities has been addressed in the current health reform law.”
Even the American Academy of Medical Colleges (http://www.aamc.org) - the organization referenced in the article - says:
“Today we have taken the first step towards truly transforming health care in this country… The nation's medical schools and teaching hospitals have expressed their full support for this bill to President Obama, and now stand ready to work with the administration and Congress to implement these significant changes to our health care delivery system.”
Additionally, in February, a “Joint Letter from Primary Care Physicians Regarding Health Care Summit” was written to Congress outlining what they thought needed to be done to ensure a sufficient primary care workforce for the currently- and newly-insured. All of their requests were met by this bill. (http://www.aafp.org)
Workforce development measures in the bill include (http://www.kff.org):
“– Establish a multi-stakeholder Workforce Advisory Committee to develop a national workforce strategy. (Appointments made by September 30, 2010)
– Increase the number of Graduate Medical Education (GME) training positions by redistributing
currently unused slots, with priorities given to primary care and general surgery and to states with the
lowest resident physician-to-population ratios (effective July 1, 2011); increase flexibility in laws and
regulations that govern GME funding to promote training in outpatient settings (effective July 1, 2010);
and ensure the availability of residency programs in rural and underserved areas. Establish Teaching
Health Centers, defined as community-based, ambulatory patient care centers, including federally
qualified health centers and other federally-funded health centers that are eligible for Medicare
payments for the expenses associated with operating primary care residency programs. (Initial
appropriation in fiscal year 2010)
– Increase workforce supply and support training of health professionals through scholarships and
loans; support primary care training and capacity building; provide state grants to providers in
medically underserved areas; train and recruit providers to serve in rural areas; establish a public
health workforce loan repayment program; provide medical residents with training in preventive
medicine and public health; promote training of a diverse workforce; and promote cultural
competence training of health care professionals. (Effective dates vary) Support the development
of interdisciplinary mental and behavioral health training programs (effective fiscal year 2010) and
establish a training program for oral health professionals. (Funds appropriated for six years beginning
in fiscal year 2010)
– Address the projected shortage of nurses and retention of nurses by increasing the capacity for
education, supporting training programs, providing loan repayment and retention grants, and
creating a career ladder to nursing. (Initial appropriation in fiscal year 2010) Provide grants for up
to three years to employ and provide training to family nurse practitioners who provide primary care
in federally qualified health centers and nurse-managed health clinics. (Funds appropriated for five
years beginning in fiscal year 2011)
– Support the development of training programs that focus on primary care models such as medical
homes, team management of chronic disease, and those that integrate physical and mental health
services. (Funds appropriated for five years beginning in fiscal year 2010)
• Improve access to care by increasing funding by $11 billion for community health centers and the
National Health Service Corps over five years (effective fiscal year 2011); establishing new programs
to support school-based health centers (effective fiscal year 2010) and nurse-managed health clinics
(effective fiscal year 2010).
• Increase Medicaid payments in fee-for-service and managed care for primary care services provided by primary care doctors (family medicine, general internal medicine or pediatric medicine) to 100% of the Medicare payment rates for 2013 and 2014. States will receive 100% federal financing for the increased
payment rates. (Effective January 1, 2013)
• Provide a 10% bonus payment to primary care physicians in Medicare from 2011 through 2015. (Effective for five years beginning January 1, 2011)”
Need I remind you that NOTHING was being done about the provider shortage before this bill was passed?
That made me laugh. I'm easily amused tonight.
1. Doctor shortage - Anyone paying attention to demograhics have seen that one coming. Europe is there already for the most part. It has nothing to do with policy, just a tide of aging people that will last a couple of decades before it passes. (the baby boomers) The US is in a lot less trouble than European countries, cause your fertility rates have been higher.
Conclusion: If anything, the reform bill adresses this issue. It doesn't cause it.
2. Doctor-owned hospitals (in the other thread) - Relly a safeguard (already in place for years in most places) that is to ensure that doctors dont fraud the system and refer patients to themselves for extra income. That's just about the principle that one party shouldn't sit at both sides of the table.
Conclusion: Not caused by this bill, and actually pretty common sense.
At this rate, you might start to get a serious debate about health care as wild claims get shot down one by one.
Peace
Dan
"Every judgment teeters on the brink of error. To claim absolute knowledge is to become monstrous. Knowledge is an unending adventure at the edge of uncertainty." - Frank Herbert, Dune, 1965
Of course, our fertility rates have been higher because our access to healthcare/family planning services is not as good. Now this bill is going to screw that up too!
tee hee... you said 'screw'
this is yet more fear mongering by the opening poster. I'm surprised he hasnt started a really reactionary thread about how the sun is going to die out in 6 billion years.
Fear Mongering ????? :roll: Whatever... I think this is a very serious issue,and besides you don't even live in america,so why you even commented or care is beyond me.
I am concerned... I also respect your opinion cos I know that you are in the medical feild. and Im glad you posted those links for me to read. Are there not a lot of physicians that do not agree with and don't belong to those organazations ? I still have not met one doctor or dentist that like this Health care bill.
I mean think about it.. Under this new bill 30 million more people will have health Ins, So there for we are going to need more doctors. A lot more ,and lets not forget about the individual mandate requiring that everybody must have health Ins. Im also still convinced when this bill really kicks in 4 years from now or when you have to wait longer to get a procedure done that's when I think a lot of people are going say :wtf: were those politicians thinking. How could anyone not think that healthcare is not going to be rationed ? So tht goes back to my point that this is and will be Obama's fault.
turn that frown upside down sunshine...we're going to be ok...
I've been hearing about this doctor shortage for years...reason: baby boomers...yup...
let's turn on the time machine and go back to 2002...
http://www.cbsnews.com/stories/2002/07/ ... 4761.shtml
July 10, 2002
Baby Boomers Face Doctor Shortage
A Disaster Predicted As Generation Starts Turning 65
(CBS) A disaster is what health care experts are predicting as the baby boomer generation starts turning 65. That means medical professionals will not only be seeing more elderly patients, but treating the diseases that affect them, like dementia, bone and joint ailments and vision impairment.
Yet, as CBS News Correspondent Bobbi Harley reports, doctors, nurses and pharmacists have little or no expertise in caring for senior citizens and medical schools aren't teaching them.
"There are only three out of 125 that really train doctors for the largest segment of our population," says Sen. John Breaux, D-La. "It's something that cannot continue.
"We're headed for a real cliff."
By 2010, more than 39 million Americans will be senior citizens. That number jumps to 69 million people by 2030, and by 2050 the elderly population will count more than 80 million Americans over the age of 65.
"As a society, we are in denial that our health care system is really a geriatric health system," says Daniel Perry, executive director of Alliance for Aging Research.
Already senior citizens make up half of all patients. But, ironically, there's a glut of medical professionals specializing in infant care — often a more prestigious and much more lucrative practice than geriatrics.
"There's no incentive," says Dr. Bernard Roos, of the University of Miami Medical School. "Everybody wants to be a gastroenterologist, or a cardiologist or a neurosurgeon."
In ten years Roos has trained only 50 geriatricians. Primarily, he blames budget cuts to Medicare, the government health insurance program for seniors.
"The reimbursement for those patients is so low, you will actually lose money," says Roos.
And that is costing the rest of America money. Experts say better geriatric treatment could save more than $50 billion in one year alone, but that still has not been enough incentive for change.
"We've got less than ten years to get it right before it starts directly affecting the baby boomer generation," says Perry
It's already a crisis for today's seniors.
Some of whom consider themselves lucky to escape the coming crunch.
i don't care and I commented on the post because it's reactionary and prophesies fear... and unless you're some kind of gypsy who can see shit in your crystal balls then you're just posting other people's regurgitated fears.
do you ever have your own opinion on anything? or is it all stuff you read and then post here to convince the free thinkers that they've got it all wrong?
might be one of the greatest things your country has ever done... the healthcare of millions... and yet here you are, along with many other right wingers like you, trying to convince everyone that the end is nigh, etc, etc.
Americans.... there is no i in Team, but there is me.
I used to laugh at some of the people on the left who blamed Bush for anything and everything, and now the some on the right have take that to a new level with Obama.
was like a picture
of a sunny day
“We can complain because rose bushes have thorns, or rejoice because thorn bushes have roses.”
― Abraham Lincoln
.......................
No doubt there are some physicians who don't belong to or agree with the professional organizations that represent their specialties. Though I literally don't know a single physician who doesn't belong to these organizations. It's pretty standard. It makes sense to me that the organizations would represent the majority opinion in their specialties. Remember too, I only quoted the professional organizations for primary care, since the concern is about not having enough primary care docs. I have no idea what the professional organization for plastic surgeons would say. Also, I think you have to consider the AAMC a good source, since that's the source your article used.
I have NOT EVER met one single doctor, dentist, or public health professional who does not support this bill. I know plenty who don't like the bill, but they all have the same problem with it: they think it doesn't go far enough and believe we should have enacted a single-payer plan. In the absense of single-payer legislation, however, they support this bill as a good step in the right direction. These are the people who, more than anyone else in the country by my estimation, have the greatest interest in making sure our healthcare reform best benefits the public and have the most knowledge of how to accomplish that. As a family and community health department, I would say that we know/care more about health on a population level than other departments/specialties in general, which is what we're dealing with here.
Do you have examples of primary care organizations - or letters to Congress on behalf of large groups of primary care docs - who oppose this legislation for any reason other than that it doesn't go far enough?
Yes, we will need more doctors - more primary care doctors, specifically, as your article pointed out. But we already needed more primary care physicians. Currently, about 30% of our docs are primary care and about 70% are specialists. It's the opposite in other countries and needs to be the opposite here. So not only do we need more docs in general but, specifically, we need more of the docs we have to go into primary care. This law is the first thing we've done nationally to solve this problem. As you saw in the letter I posted, a letter was written representing primary care docs that laid out what they believe we need to do to solve this pre-existing problem - and the law gave them everything they asked for. For instance, so many opponents of this law claim we'll have fewer doctors because they'll make less and won't be able to afford their student loans. But this law provides lots of money for loan repayment AND increases payment to primary care docs. (As a side note, 20% of our graduating medical students this year have chosen to specialize in Family Medicine - and that's not even including the other primary care specialties!)
Have you a better solution to increase the supply of primary care doctors? Remember, we would have to not only not provide care to more people, but we'd also have to REFUSE to provide care to many who ALREADY receive it in order to solve the problem by reducing demand.
Regarding healthcare rationing... For one thing, healthcare is already rationed in this country, largely by income. And even regardless of income, there are still long waits for outpatient and ER visits. I know this as a patient and as a person who schedules patients. This is mainly due to the primary care shortage, which is being addressed by this new law. I don't see how you can blame the primary care shortage and consequent healthcare rationing on Obama, when it was already a problem under Bush.
you met me. . . I am in public health
but in all seriousness, I don't like this bill. Do I like what it is attempting? oddly enough yes, I just think they are seriously going about it the wrong way.
It is terrifying when you are too stupid to know who is dumb
- Joe Rogan
Okay, ONE then.
I agree that they're going about it in the wrong way. But what I think is the right way was not an option and I think it's better than letting the status quo stand.
I went to a panel discussion about this law recently, and this older gentleman who had been working for healthcare reform for many, many years spoke. He said he doesn't like the bill because he feels very strongly that single payer is the only way to go. But then, in explaining why he supports it anyway, he told this story: He said he once asked Ted Kennedy why, after being a proponant of single-payer, he had sold out and supported a bill that did not create a single-payer system. He said Kennedy actually teared up and told him that he thought of all the people who had died for lack of healthcare coverage in the time since he had opposed a similar bill because it wasn't just what he wanted, though it would have increased access, and he felt responsible. It's better to do something, if it's a step in the right direction, than to accept the status quo until the perfect reform comes along -especially since we know this will take many, many years.
disclaimer: i know this does not apply to everyone.
Our government is the potent, the omnipresent teacher. For good or for ill, it teaches the whole people by its example. Crime is contagious. If the government becomes a law-breaker, it breeds contempt for law; it invites every man to become a law unto himself; it invites anarchy. - Louis Brandeis
plus the pharmaceutical companies profit off of millions of people on diabetes, cholesterol high blood pressure meds.
Our government is the potent, the omnipresent teacher. For good or for ill, it teaches the whole people by its example. Crime is contagious. If the government becomes a law-breaker, it breeds contempt for law; it invites every man to become a law unto himself; it invites anarchy. - Louis Brandeis