Olds: We need more doctors
The United States is facing a deadly doctor shortage. More than 81 million Americans currently live in places with insufficient access to primary care doctors. Those shortfalls are responsible for thousands of needless deaths every year, according to new research published last month in the Annals of Internal Medicine.
Things could get worse over the next decade. By 2033, the U.S. will need up to 55,000 additional primary care doctors to meet patient demand, according to the Association of American Medical Colleges.
Closing that gap requires a massive increase in our physician supply. That starts by training many more doctors — at medical schools in both the United States and abroad — and creating more residency positions where physicians-to-be can complete their training.
Demand for health care is outstripping supply nationwide. There are over 7,200 federally designated primary care shortage areas across the country. These are places where there aren’t enough pediatricians, family medicine or internal medicine practitioners to meet patients’ needs.
Public health experts believe changing demographics could drive that number up further. According to David J. Skorton, president of the Association of American Medical Colleges, “The challenge of having enough doctors to serve our communities will get even worse as the nation’s population continues to grow and age.”
Nearly 70% of older adults have at least two chronic illnesses. People with these conditions need to see primary care practitioners and specialists more frequently than healthy patients.
Demographic change is also coming for the physician workforce. Over 40% of active doctors are close to retirement age. Many are hanging up their stethoscopes earlier than usual because of the pandemic. As of August, nearly 10% of doctors had closed their practices due to COVID-19, according to a survey from The Physician’s Foundation.
To replace these clinicians, we need to train more doctors. We can start by admitting more aspiring doctors to medical school. In the 2019-2020 cycle, American medical schools received more than 900,000 applications, but only about 22,000 students matriculated.
Some schools are increasing their class size — but not fast enough to meet our growing doctor shortage. Between 2015 and 2020, the number of U.S. medical school graduates increased by just 7%.
International medical schools can help narrow that shortage by offering another path to medicine, particularly for the thousands of qualified applicants who are not admitted to U.S. medical schools. Many are already heading abroad for their medical degrees. More than 75% of the students at the international medical school I lead, St. George’s University in Grenada, are U.S. citizens.
We also need to increase the number of medical residencies — the training programs that every medical school graduate must complete after receiving their degrees. Without a residency under their belt, those new doctors aren’t allowed to practice. Between 2002 and 2018, the number of available slots grew by just 1% each year.
That sluggish growth is the result of insufficient federal funding. Medicare is the largest source of funds for residency programs. Until recently, federal support for residencies through Medicare was capped at 1996 levels. That’s in spite of the fact that the U.S. population has grown by more than 61 million people in the last 25 years.
Thankfully, Congress lifted that cap as part of coronavirus relief legislation in December. Congress will fund 1,000 new medical residency spots over the next five years.
It’s a promising step. These programs will be located in both rural and urban teaching hospitals. Public health experts estimate that about 50% of residents remain in the areas where they train. So creating more programs in underserved areas should establish a more direct physician pipeline to historically needy communities.
The pandemic has demonstrated just how deadly it can be when patients don’t get the care they need. Creating more medical training opportunities will strengthen our future healthcare workforce — and ensure physicians can go to the places they’re needed most.
Dr. G. Richard Olds is president of St. George’s University (sgu.edu) in Grenada.