The Supreme Court may have signed off on both the scope and legality of President Obama’s health care reform law, but another question is now demanding attention: As the population ages and more Americans gain access to insurance, will there be anyone to treat them?
According to a report in The New York Times, the United States already has a massive shortage of doctors. And by extending insurance coverage to as many as 30 million previously uninsured Americans by 2014, experts say, the health care law will increase the demand for a shrinking number of physicians.
The Association of American Medical Colleges estimates that by 2015, the U.S. will have 62,900 fewer doctors than it will need — and the shortage could double to more than 125,000 by 2025 as aging baby boomers and the newly insured seek more care. (If health care reform had not become law, the AAMC adds, the shortage would still be expected to top 100,000 by 2025.)
Since it takes a decade to train and place a new doctor, experts say, there is no hope of significantly closing the gap anytime soon. U.S. schools simply don’t produce that many new doctors. Also, according to the medical colleges association, a third of current practicing physicians are 55 or older and approaching retirement. (The only specialties not facing a shortage: plastic surgery and dermatology, says Dr. G. Richard Olds, dean of the new medical school at the University of California, Riverside.)
Who the Shortage Hurts Most
In some communities, especially rural areas where doctor deficits tend to be more acute, patients already travel long distances to meet with specialists after waiting weeks for appointments, or visit emergency rooms for non-emergency conditions. As experts pointed out in the Times report, patients who don’t have a relationship with a primary-care physician tend to be less healthy because they don’t get regular checkups or preventive care.
The federal Department of Health and Human Services recommends that communities have 60 to 80 primary care physicians and 85 to 105 specialists for every 100,000 people. Many areas already fall well short of those numbers, but it gets worse: A report by the Center for Studying Health System Change indicates that fewer than half of the nation’s primary-care physicians are accepting new Medicaid patients (based on 2008 research), complicating lower-income patients’ search for a doctor.
While studies show that the poor will continue to be underserved, Americans who can afford care may find themselves dropped as well. Some primary-care physicians are shedding patients to switch to a concierge-care practice model, where fewer consumers pay an annual retainer for improved access to doctors.
Older Americans will face particularly acute challenges finding care in the years ahead. Enrollment in Medicare, now 50.7 million, is expected to rise to 73.2 million by 2025 as more boomers turn 65. But as Next Avenue has reported, it will become especially tough to find doctors specializing in geriatric care.
According to the American Geriatrics Society, the United States currently has 7,100 physicians trained in geriatric medicine, but needs about 16,000. By 2030, it will need 36,000. American medical schools currently produce about 200 new geriatricians each year.
Neither will there be enough professionals to handle the mental health needs of aging boomers. A recent report by the Institute of Medicine of the National Academies found that as many as one in five Americans age 65 or older — between 5.6 million and 8 million seniors — have a mental health or substance abuse problem. And that number's about to get much higher: The next generation of seniors, all of them boomers, already has higher rates of mental illness and drug abuse than the previous generation.
"There'll never be enough geriatric psychiatrists or geriatric medicine specialists to take care of this huge wave of people," Dr. Paul Kirwin, president of the American Association for Geriatric Psychiatry, told the Associated Press.
Can We Ramp Up the Number of Doctors?
Enrollment in U.S. medical schools has increased in recent years, but not nearly enough. To compound the problem, med students are widely expected to continue to avoid high-demand fields like primary care and geriatrics, mainly because they can earn twice as much in other specialties.
The new health care law calls for higher Medicaid payment rates and cash incentives for graduates who become primary-care physicians in high-need communities. But experts told the Times that those measures will produce only about 3,000 additional primary-care physicians in the law's first decade, far short of the 45,000 needed.
In southern California’s underserved Riverside and San Bernardino counties, “we’ll have a 5,000-physician shortage in 10 years, no matter what anybody does," Olds told the Times.
In addition to the number of Americans needing care, the volume of care they need is growing as well. A new study released this week, based on results of the federal National Health Interview Survey, found that 21.3 percent of women and 20.1 percent of men ages 45 to 64 had more than one chronic health condition. In 2000, the rates for the same age group were 16.9 percent for women and 15.2 percent for men.
The increases are largely due to the rising number of Americans living with hypertension, diabetes or cancer. Diagnoses for these conditions continue to rise, while improved treatment helps more people live longer with those diseases.