COVID-19 recovery is hampered by mounting physician shortages, AAMC finds

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Recovery from the COVID-19 pandemic was never going to be an easy proposition for the healthcare industry, but efforts to bounce back are complicated by an ongoing shortage of physicians, which is poised to worsen over the next decade-plus.

Data published by the Association of American Medical Colleges shows the U.S. could see an estimated shortage of between 37,800 and 124,000 physicians by 2034, including shortfalls in both primary and specialty care.

Conducted for the AAMC by the Life Science division of IHS Markit, a global information company, the analysis was conducted in 2019, prior to the start of the COVID-19 pandemic. It includes supply-and-demand scenarios. It was also updated with the latest information on trends in healthcare delivery and on the state of the industry's workforce, such as data on physician work hours and retirement trends.

Primary care, including family medicine, general pediatrics and geriatric medicine, is on pace for a shortage of between 17,800 and 48,000 physicians. But the numbers for non-primary care specialties are even direr: A shortage of between 21,000and 77,100 physicians is expected over the next several years.

Surgical specialties, encompassing general surgery, obstetrics and gynecology, and orthopedic surgery, are expected to see a physician shortage between 15,800 and 30,200. Medical specialties, such as cardiology, oncology, infectious diseases and pulmonology, will see a shortage between 3,800 and 13,400. Other specialties, such as anesthesiology, neurology, emergency medicine and addiction medicine, will see a shortage between 10,300 and 35,600.

The issue of increasing clinician burnout, which has been intensified by the pandemic, could cause doctors and other health workers to cut back their hours or accelerate their plans for retirement, exacerbating these already-existing issues.

WHAT'S THE IMPACT?

Even before the COVID-19 pandemic, physician shortages were being felt by patients across the country. In 2019, the U.S. Health Resources and Services Administration estimated that an additional 13,758 primary care physicians and 6,100 psychiatrists would have been needed to remove Health Professional Shortage Area designations for areas with primary care and mental health shortages.

According to public opinion research conducted by the AAMC in 2019, 35% of survey respondents said they or someone they knew had trouble finding a doctor in the past year or two. That's a 10-point increase from when the question was asked in 2015.

The new report contains a number of other key findings. In demographics, population growth and aging will continue to be the primary driver of increasing demand from 2019 to 2034. During this time, the U.S. population is projected to grow by 10.6%, from about 328 million to 363 million, with a projected 42.4% increase in those aged 65 and above. That means demand for physician specialties that predominantly care for older Americans will continue to increase.

A large portion of the physician workforce is nearing traditional retirement age, and supply projections are sensitive to the workforce decisions of older physicians. More than two of every five active physicians in the U.S. will be 65 or older within the next decade. Their retirement decisions will dramatically affect the magnitude of national workforce shortages. 

Plus, according to the AAMC's 2019 National Sample Survey of Physicians, 40% of the country's practicing physicians felt burned out at least once a week before the COVID-19 crisis began. The issue of increased clinician burnout could cause doctors and other health professionals to reduce their hours or retire sooner.

Meanwhile, if marginalized minority populations, people living in rural communities and people without health insurance had the same healthcare use patterns as populations with fewer barriers to access, up to an additional 180,400 physicians would be needed immediately. 

COVID-19 has put a spotlight on disparities in health and access to care among underserved populations, and the analysis underscores the systematic differences in health services by insured and uninsured people, those in urban and rural locations, and individuals of differing races and ethnicities. 

These estimates, which are separate from the shortage projection ranges, help illustrate the magnitude of the current barriers to care, and provide an additional reference point when gauging the adequacy of physician workforce supply.

THE LARGER TREND

At the end of 2020, Congress attempted to address the physician shortage by adding 1,000 new Medicare-supported graduate medical education (GME) positions – 200 per year for five years – targeted at underserved rural and urban communities and other teaching hospitals nationwide, ending a nearly 25-year freeze on Medicare support for GME. 

Bipartisan legislation recently introduced in both the U.S. House of Representatives and the Senate, the Resident Physician Shortage Reduction Act of 2021, would build on that investment and help expand the physician workforce by adding 2,000 federally-supported medical residency positions annually for seven years.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com