What doctor shortage?
What’s the job security potential for today’s pre-med students, and for those just beginning med school?
It depends on who you ask. The AAMC says the U.S. could be as much as 130,000 doctors short in just a decade or so. The Association of Medical Colleges predicts a lower doctor shortage of 40,000 to 104,900 by 2030.
What are the underlying reasons? Well, of course, there is a whole generation—the baby boomers, of course—getting ready to retire. Due to medical advancements, people are living older, and diseases are being diagnosed at a higher rate. All of those people will need care, often from specialists like cardiologists and orthopedic surgeons. And the Affordable Care Act—known as Obamacare—has increased access to millions of additional patients.
Yet there’s a finite number of physicians being trained since the federal funding in Medicare for medical residency programs is capped at around $10 billion. Without greater availability of residencies, med students can end up with no residency, which means their medical degree is basically useless. And since schools and hospitals have not historically been able to bear the cost of providing residency programs, this is one area where the government will likely have to step forward if there is a doctor shortage or the need for doctors increases to any extent.
A move to primary care
While medical training has seemed to be shifting to a much greater focus on specialized care, the greatest need in the future may be for primary care physicians. That’s because it’s becoming crystal clear that greater attention to preventive medicine and care can help to prevent or stop diseases in the early stages, requiring less need for specialized care and making specialists less in-demand than they are now. But that shift will take time as medical schools integrate more attention to natural, preventive methods of improving health (and patients see the advantages in changing their lifestyles to healthier ones).
The PA/NP relief valve
There are many providers—such as physicians’ assistants and nursepractitioners—who are being trained in higher numbers, who can work under the supervision of physicians. This can bring about more efficient and cost effective care. Certain health centers like the Mayo Clinic are extremely good at using newer models of care to bring down the cost—and bump up the quality—of medical care.
Changes in health care delivery are coming, with an eye to the bottom line. Recent studies examining the effectiveness in care show that in one hospital (Ronald Reagan UCLA Medical Center) it takes just 40 physicians to do the same work that 50 doctors at another hospital (Cedars-Sinai in Los Angeles) do. At the Mayo Clinic in Rochester, Minnesota, 20 doctors were able to do that same amount of work, and achieve even better medical outcomes. That’s a huge savings in labor cost, from which the U.S. health care system could benefit greatly.
Models being established by places like The Cleveland Clinic, Mayo andvarious emergency care clinics focusing on efficiency and best use of personnel, will bring a new emphasis on quality, yet economy, to the health care market. Any doctor shortage could be pre-empted by these structural changes.
So is a doctor shortage coming?
The answer is that certain regions of the country do indeed have a doctor shortage, which is why doctors can command greater salaries and benefits often by choosing to work in more rural settings. It’s also true that certain specialties will be short as diseases like heart disease, diabetes and obesity increase. Some of the emerging trends are fairly clear, yet there are factors that will determine how great the coming physician needs will be. Given the anticipated growth in the U.S. population (9.5% between 2013 and 2025), it would seem clear that more physicians will be needed. The government will likely step forward at some point and fund a greater number of residencies to keep up with the increased patient load.
People will always need doctors. And for the time being, that need is expected to grow. So job security for physicians should be satisfyingly robust for the forseeable future. Given changes in technology and practice, there are specialties that could see less demand, while others are more valued and needed. Today’s pre-med students, and tomorrow’s med students, should choose their specialty carefully looking at all the current trends.
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