In my July 2019 blog entry I mentioned the various shortages Americans have faced with regard to healthcare. Today, I will focus on the coming shortage of doctors.
In 2018, Dr. Kevin Pham wrote an enlightening article on the implications of the looming doctor shortage in the United States. In his article on the website of The Heritage Foundation, Dr. Pham reviewed the causes and possible remedies associated with this issue. I’d like to discuss some of the findings and offer my own take on this worrisome topic.
Mark Twain was supposed to have popularized the phrase “There are three types of lies: lies, damned lies and statistics.” This statement has also been attributed to Benjamin Disraeli though, apparently, no one knows who actually originated it. But, no matter who said it, we have to consider it when examining the stats related to the coming doctor shortage. For if the estimates are true, our country is in for trouble, as far as access to doctors goes.
The AAMC (American Association of Medical Colleges) estimates that by 2032, there will be a shortage of between 46,900 and 121,900 doctors in our country, and well over a third of that shortage will come in the areas of primary care. (A 2019 review by the AAMC essentially confirmed the 2018 findings that Dr. Pham references.)There will be a shortage as well of surgeons and specialists, but this shortage of primary care physicians—those who practice internal medicine, family practice, pediatrics and the other “front line” medical specialties—will be particularly stinging for those patients who need even the most basic care and medical attention.
The key takeaways from Dr. Pham’s article are these:
1. By 2028, the number of doctors
will be insufficient to meet America’s growing and aging populace.
2. Because people live longer and with more complicated illnesses, this decrease in doctors will literally be a matter of life and death.
3. Policymakers must address the laws, rules and other factors that have led to this shortage and that interfere with the doctor-patient relationship.
It is telling that a recent survey of doctors by the Physician’s Foundation said that about half of those queried would NOT recommend the medical profession for their own children. Part of the reason, according to Dr. Pham, is that the regulations and complex and confusing policies associated with medical practice is ever more onerous. So too is the disruption in the relationship between the doctor and her/his patient, where people outside the scope of the medical profession and issues inherent in that relationship are insinuating their views, attitudes, rules and policies. A lot of this comes from third-party payment arrangements that “too often intrude on physician’s decision making, impeding a doctor’s ability to practice according to…best clinical judgment.”
The article makes mention of broad areas that need improvement: Reform of medical education and the residency system…reform of state licensure laws and accreditation rules…alternatives to third party payment…and a reduction in administrative and regulatory burdens that plague doctors.
I can attest to all of these. In my almost 40-year career in medicine, I was faced with issues and situations that I thought absurd. One was the overly burdensome task of obtaining licensure in each state that I practiced in, with the need for producing excessive and repetitive documentation, much of which needed to be notarized. Another was the intrusion of the government into my daily practice, with various regular and redundant attestations to policies, rules and regulations in order to get reimbursed by government payers and other third parties. Still another was the consistent and often arbitrary practice algorithms that were often based on “research” that later proved not to be entirely accurate or consistent with my philosophy of healing and my medical training. For example, if my own research and learning pointed to the value of trying a certain medication, treatment or procedure that was not part of a protocol approved by a system or health delivery entity under which I practiced (I will not mention names, for I have practiced in a wide variety of settings), I was often discouraged or outright forbidden to employ that method, even though I felt there was a good chance to help the patient.
And then there’s burnout, a huge problem in medical care delivery among doctors, nurses and ancillary staff alike. As Dr. Pham so correctly said:
“The essential health care interaction occurs between the physician and the patient, and anything that interferes with that relationship makes the practice of medicine harder. The legitimate demands of patient care alone are a stressor endemic to the vocation, but adding the…intrusive interference…by third parties is corrosive…”
In fact, Dr. Pham quotes a Physicians Foundation survey that revealed 49% of doctors feel often or always burned out. As he quotes, “58.3 % … complained about regulatory and paperwork burden, and the second-most common complaints were ‘erosion of clinical autonomy and ‘inefficient electronic health records design/interoperability.” Medscape also sited bureaucracy, overwork, lack of respect from administrators and others and increased use of electronic health records.
The article also says doctors are considering retiring early, and this was not due to the doctor’s health issues. No, it was due primarily to an inability to have a practice where “purposefulness, responsibility to patients and intellectual stimulation” were the norm, rather than the burnout factors I listed above.
So, if by 2030 our population will grow to almost 360 million people and the number of people above 65 is expected to increase by 50%, these more numerous and sicker Americans will clearly tax an already stressed system. What can you do to help yourself? I have some ideas.
1. First and foremost, take better care of yourself! See my prior blogs on this.
2. Find a physician you like and hang on to her/him like gold. Get to know the other doctors in the practice, if that is possible.
3. Do your homework. Shop for health plans or managed care organizations that let you and your doctor decide what’s best for you, not some bureaucrat.
4. Ask around for recommendations about doctors. Maybe your friends or extended family have a great person for you to see.
5. Search the web for doctor recommendations, and critically read the reviews. Do they seem reasonable of overly biased and based on a bad single experience?
6. Get politically active. Read the article I have described and write to your legislators to enact laws that lessen the disruption between doctors and patients.
But above all else, take may first advice: get to the right weight, exercise and manage your stress. Then you might not need a doctor at all!
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