Not just primary care, the coming 'Silver Tsunami' will hit specialists as well

Just about everybody in healthcare is planning for, or bracing against, the coming Silver Tsunami and the demands an aging population will place on the healthcare system facing a shortage of primary care physicians.

Consulting firm Merritt Hawkins has now spotted a lesser-known trend that could cause major issues and barriers to care: a shortage of medical specialists.

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"The notion that we should be training more primary care physicians while maintaining or reducing the supply of specialists is a grave miscalculation," said Mark Smith, president of Merritt Hawkins. "We should be training more of both."

The aging population will put major demands on medical specialists. Though seniors 65 and older make up only 14 percent of the population, they account for 34 percent of inpatient procedures and 37.4 percent of diagnostic treatments and tests. Merritt Hawkins research shows at least 10 percent of nearly each state's population is 65 or older, which means the need for specialists will likely ramp up at a national level, rather than regionally.

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In-demand specialists will include cardiologists, orthopedic surgeons, neurologists, rheumatologists, vascular surgeons, and others who care for the declining health and organ systems of elderly patients, and that number will only grow as the elderly population increases.

Overall population growth is also a contributing factor. Citing U.S. Census Bureau data, Merritt Hawkins said that from 2000 to 2020, the country's population will grow by 50 million people, boosting demand for both primary care and specialist doctors. Also, while diagnostic technology and the use of physician assistants and nurse practitioners can help satisfy demand for primary care, they have less of an effect on specialty care because these physicians perform the most complex types of procedures and care.

Still another factor is a transitioning healthcare delivery system that is more focused on prevention and population health management. This emerging model may reduce utilization of specialty services at some point in the patient's continuum of care, but nothing stops or reverses the eventual decline of the human body.

It can also be said that the healthcare system's success in helping people live longer actually adds to demand for specialists.

"There are over 15 million cancer survivors in the U.S. today who will need the continued attention of oncologists and other specialists, and the same point can be made of survivors of heart attacks, strokes and other conditions that in the past were frequently fatal," the research said.

But it's not just societal demands that are fueling the need for specialists. The doctors themselves are generally older than primary care doctors, and a wave of retirements is coming. 

"The Association of American Medical Colleges in 2017 projected a deficit of up to 104,900 physicians in the U.S. by 2030. While this projection includes a deficit of up to 43,100 primary care physicians, it should be noted the AAMC projects an even larger deficit of 61,800 specialist physicians," Merritt Hawkins said.

Merritt Hawkins new research paper also said 80 percent of specialists currently are overextended or at capacity. Only 20 percent could see more patients or take on new duties. The time it takes to schedule appointments with specialists has increased considerably since 2014.

"In certain medical specialties, vascular surgery being just one, there are only a few thousand physicians, while patients with the conditions they treat number in the tens of millions," said Smith. "The data indicate that medical specialists will be in increasingly short supply, and this should be a serious concern for healthcare policy makers and the public."

Merritt Hawkins is not the only predicting specialist shortages. Societies governing the following specialties have released reports forecasting shortages: Allergy and immunology, anesthesia, cardiology, child psychiatry, critical care, dermatology, emergency medicine, endocrinology, gastroenterology, general surgery, geriatric medicine, medical genetics, neurosurgery, neurology, oncology, pediatric subspecialties, psychiatry, rheumatology and thoracic.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com