One consequence of the expanded access to health care facilitated by health care reform will be a shortfall in the necessary numbers of physicians and other advanced medical professionals. According to a study published in the June issue of the Journal of the American College of Surgeons, the United States will face serious shortages in the combined workforce of physicians, advance practice nurses, and physician assistants over the next two decades. The study concluded that, without an adequate supply of advanced medical professionals, the U.S. won't meet the goals of health care reform.
Study researchers drew upon data from the American Medical Association, the American Association of Colleges of Nursing, and the Physician Assistant Education Association among others, to project the future supply of practitioners. They then contrasted these figures with separate projections of demand, based on expectations of expenditures made by the Centers for Medicare and Medicaid Services (CMS), the President's Council of Economic Advisors (CEA) and the Congressional Budget Office (CBO).
"It is important to note that more than two-thirds of advanced clinicians are physicians and that the U.S. is training fewer physicians per capita each year. Despite the participation of more advance practice nurses and physician assistants in both primary and specialty practices, the physician shortage has increased about one percent annually and is now 7-8 percent nationally, although its severity varies in different locales," according to senior study author Richard Cooper, MD, professor at the Perleman School of Medicine at the University of Pennsylvania.
Although training programs for advance practice nurses and physician assistants are expected to grow continually, there is little evidence that the same will be true for physicians. Yet if physician training programs are not expanded, the current shortages are expected to expand to 20 percent by 2025. Because of the long lead times necessary to train more physicians, adding as many as 500 additional entry-level positions annually will decrease the future shortages by only a few percent; even with 1,000 more entry-level positions added annually, shortages will be 14-15 percent in 2025, double the current rate.
"Long before the health care reform bill was written, our nation was headed for serious physician shortages. As these shortages deepen, physicians will focus on areas of care that demand their high levels of skill and education most," said Michael Sargen, the study's lead author, an MD candidate at the Perleman School of Medicine. "It will not be possible for physician assistants and advance practice nurses to fill the void, even with the increases in supply that we have projected. Therefore, it will be necessary not only to expand the training capacity of all three disciplines, but also to widen the spectrum of health care workers and integrate them into the processes of providing of care."
- Michael Sargen, Roderick S. Hooker, Richard A. Cooper. Gaps in the Supply of Physicians, Advance Practice Nurses, and Physician Assistants. Journal of the American College of Surgeons, 2011; 212 (6): 991 DOI: 10.1016/j.jamcollsurg.2011.03.005
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