Atul Grover

Physician workforce shortages: implications and issues for academic health centers and policymakers.

A physician shortage is likely given current levels of medical education and training. Because an increase in physician supply through expansion of U.S. medical school capacity will require ten or more years, there is little time left to affect the supply of new physicians in 2020 when a substantial number of baby boomers will be over 70 years of age. Even with a substantial increase in medical education and training capacity, it is unlikely that all of the increased demand for health services can be met with physicians. In addition to the challenges of expanding medical school enrollment, the nation will need to grapple with other ramifications of demand exceeding supply. This includes assessing how to deliver services more effectively and efficiently and the future roles of the physician and other health professionals. These challenges are particularly difficult for medical schools and teaching hospitals, the cornerstones of medical education and training in the United States. Osteopathic and off-shore schools targeted to Americans have been willing and able to grow more quickly and less expensively than U.S. medical schools, in part because of their more narrow approaches to medical education. In addition, physicians from less developed countries continue to migrate to the United States in significant numbers. Medical schools, teaching hospitals, and policymakers will need to address several major questions as they respond to the shortages. They will either confront and address these issues in the next few years or they will be forced to change by others in the future.

Shortage of Cardiothoracic Surgeons Is Likely by 2020

Background— Even as the burden of cardiovascular disease in the United States is increasing as the population grows and ages, the number of active cardiothoracic surgeons has fallen for the first time in 20 years. Meanwhile, the treatment of patients with coronary artery disease continues to evolve amid uncertain changes in technology. This study evaluates current and future requirements for cardiothoracic surgeons in light of decreasing rates of coronary artery bypass grafting procedures. Methods and Results— Projections of supply and demand for cardiothoracic surgeons are based on analysis of population, physician office, hospital, and physician data sets to estimate current patterns of healthcare use and delivery. Using a simulation model, we project the future supply of cardiothoracic surgeons under alternative assumptions about the number of new fellows trained each year. Future demand is modeled, taking into account patient demographics, under current and alternative use rates that include the elimination of open revascularization. By 2025, the demand for cardiothoracic surgeons could increase by 46% on the basis of population growth and aging if current healthcare use and service delivery patterns continue. Even with complete elimination of coronary artery bypass grafting, there is a projected shortfall of cardiothoracic surgeons because the active supply is projected to decrease 21% over the same time period as a result of retirement and declining entrants. Conclusion— The United States is facing a shortage of cardiothoracic surgeons within the next 10 years, which could diminish quality of care if non–board-certified physicians expand their role in cardiothoracic surgery or if patients must delay appropriate care because of a shortage of well-trained surgeons.

An AOA critical issue. Future physician workforce requirements: implications for orthopaedic surgery education.

In 2006, after many months of consideration, the Association of American Medical Colleges (AAMC) recommended that medical schools in the United States increase their enrollment by 30% by 2015 and that residency positions be increased to accommodate the growth in U.S. medical school graduates1. This recommendation is based on the belief that there will be a substantial physician workforce shortage in the future as the economy continues to expand, physicians retire, and patients continue to demand more specialized care. How this prediction will affect the workforce dynamic of orthopaedic surgery and other specialties must be examined carefully. Orthopaedic surgery, like most specialties, has an interest in better understanding how many physicians will be required in the specialty in the future. This is not to suggest that there is one single correct number of physicians in a specialty; in fact, the medical system has proven to be highly adaptive. However, it is in the publics interest to have a distribution of orthopaedic surgeons that promotes high-quality care. Furthermore, it is in the specialtys interest that the number of physicians be sufficient to provide the services that the specialty is best qualified to perform but not so many that physicians are underutilized. Having too few orthopaedic surgeons can lead to access problems for patients and/or to less qualified providers caring for patients with particular problems. Having too many can increase competition, flatten incomes, and reduce procedural volume for individual surgeons and thereby affect quality and outcomes— not to mention possibly increasing unnecessary operations to maintain income levels. Therefore, it is beneficial to both the public and the orthopaedic surgery specialty to have a supply that is close to expected utilization. Achieving balance is easier said than done given the many factors that could influence future supply and demand. One must …

Building A Health Care Workforce For The Future: More Physicians, Professional Reforms, And Technological Advances

Traditionally, projections of US health care demand have been based upon a combination of existing trends in usage and idealized or expected delivery system changes. For example, 1990s health care demand projections were based upon an expectation that delivery models would move toward closed, tightly managed care networks and would greatly decrease the demand for subspecialty care. Today, however, a different equation is needed on which to base such projections. Realistic workforce planning must take into account the fact that expanded access to health care, a growing and aging population, increased comorbidity, and longer life expectancy will all increase the use of health care services per capita over the next few decades--at a time when the number of physicians per capita will begin to drop. New technologies and more aggressive screening may also change the equation. Strategies to address these increasing demands on the health system must include expanded physician training.

The Nation׳s Physician Workforce and Future Challenges

There is much debate about the adequacy of the U.S. physician workforce and projections of its future size, distribution and composition. Beginning with 3 observations about the workforce we believe are largely not subject to dispute, we address the debate by providing an overview of the current state of the workforce and Graduate Medical Education in the United States; a brief history of both calls for graduate medical education reform since 1910 and the recent, intense debate about the reliability of workforce projections; and a discussion of the challenges to understanding the physician workforce. We draw 3 concluding observations: (1) Precisely because projections can be unpredictable in their impact on both physician workforce behavior and public policy development, policy makers need to devote more attention to workforce projections, not less. (2) More research devoted specifically to the workforce implications of delivery and payment reforms is strongly needed. (3) Such research must be pursued with a sense of urgency, given the rapid aging of the Baby Boom generation, which will put a disproportionate demand on the nations physician workforce.

Primary care teams: are we there yet? Implications for workforce planning.

Recent studies suggest that team-based primary care models could contribute to eliminating the predicted physician shortages. In this article, the authors explore existing team-based clinical care delivery models, comparing specialist and primary care teams, that include patient-centered medical homes and accountable care organizations. Next, the authors describe the barriers to adopting these models on a large scale, particularly the regulatory, financial, and cultural factors as well as scope of practice considerations for nonphysician providers. The authors’ aim is not to evaluate the merits of team-based primary care models but, rather, to ascertain whether such models should be at the center of current physician workforce planning policies. The authors argue that although emerging evidence indicates that primary care teams can improve patient outcomes, few data exist to suggest that these models will drastically reduce the need for additional physicians or other providers. Thus, the authors conclude that additional research is needed to evaluate the ability of such models to alleviate provider deficits. And, while policy makers should work toward their ideal health care system, they also must expand the physician workforce to meet the growing demand for health care services in the existing one.