Help Wanted: More US Doctors

Help Wanted: More U.S. Doctors
Projections Indicate America Will
Face Shortage of M.D.s by 2020
Association of
American Medical Colleges
The United States will face a serious
doctor shortage in the next few
decades. Our nation’s rapidly growing
population, increasing numbers of
elderly Americans, an aging physician
workforce, and a rising demand for
health care services all point to this
conclusion.
Many areas of the country and a number of
medical specialties are already reporting a
scarcity of physicians. An acute national shortage would have a profound effect on access to
health care, including longer waits for appointments and the need to travel farther to see a
doctor. The elderly, the poor, rural residents,
and the 20 percent of Americans who are
already medically underserved would face even
greater challenges as a result.
Because it can take up to 14 years from the time
new doctors begin their education until they
enter practice, the AAMC believes that we must
begin to act now to avert this shortage.
Specifically:
The AAMC has called for a 30 percent
increase in U.S. medical school enrollment
by 2015, which will result in an additional
5,000 new M.D.s annually. We believe that
this expansion should occur through a combination of enrollment increases in existing
schools and the establishment of new U.S.
medical schools.
To accommodate more M.D. graduates, the
AAMC supports a concomitant increase in
the number of federally supported residency
training positions in the nation’s teaching
hospitals.
Recent analysis by the AAMC’s Center for
Workforce Studies indicates several critical
trends are on a collision course that will cause
the demand for doctors to outstrip the supply
by 2020.
A Growing and
Aging Population
Between 1980 and 2005, the nation’s population
grew by 70 million people—a 31 percent increase.
As baby boomers age, the number of Americans over
age 65 will grow as well. By 2030, the number of baby
boomers will double from 35 million to 71 million. Yet,
since 1980, the number of first-year enrollees in U.S.
medical schools per 100,000 population has declined
annually. Consequently, America is producing fewer and
fewer doctors each year relative to our continually
growing population.
Number of Elderly Will Double by 2030
80
Population (in millions)
70
60
65+: 104% increase from 2000 to 2030
50
40
30
20
10
0
2010
2000
2020
2030
Source: U.S. Census
First-Year M.D. Enrollment per 100,000 Population
Has Declined Since 1980
7.5
7.3
Number of Enrollees
7
6.8
6.5
6.4
6.2
6
5.8
5.6
5.5
5.4
5.2
5
5
4.5
4
1980
1985
1990
1995
2000
2005
2010
Source: AAMC; U.S. Census Bureau
Prepared by Center for Workforce Studies, AAMC, Feb. 2006
2015
2020
A Rising Demand for
Health Care
Patients age 65 and older typically average six to seven
visits per year compared with two to four visits annually
for those under 65. If the annual number of physician
visits continues at this rate, the U.S. population will
make 53 percent more trips to the doctor in 2020 than
in 2000.
In addition, the most costly illnesses are more
common among the elderly. As medical advances
extend survival rates and improve the quality of life
for those with chronic conditions, the need for
ongoing health care services will increase.
Doctor Visits Are Sharply Higher for Those Over 65
Average Number of Visits per User
8.0
7.0
1990
2004
6.0
5.0
4.0
3.0
2.0
1.0
0.0
Under 5
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
Age
Source: National Ambulatory Medical Care Survey, 1980, 1990, 2000, and 2003
Prepared by AAMC Center for Workforce Studies
85 and
over
A Dwindling Supply
of U.S. Doctors
Currently, 744,000 doctors practice medicine in the
United States. But 250,000—one in three of these
doctors—are over age 55 and are likely to retire during
the next 20 years, just when the baby boom generation
begins to turn 70. The annual number of physician
retirees will probably increase from more than 9,000 in
2000 to almost 23,000 in 2025. In addition, today’s
younger physicians are more focused on quality of life
issues and are less likely to work as many hours as their
predecessors.
Number of Physicians (in thousands)
The Physician Workforce Is Aging:
250,000 Active Physicans Are Over 55
250
231
224
1985
2005
200
150
133
139
153
146
99
94
100
73
44
50
0
Under 35
35-44
45-54
55-64
65 and Over
Age
Source: American Medical Association (AMA) Physician Characteristics and Distribution
for 1985 data: AMA Masterfile for 2005 data
Active physicians include residents/fellows
NOTE: 1985 data excludes 24,000 DOs.
Prepared by AAMC Center for Workforce Studies, March 2006
Doctor Shortages
Already Exist
Right now, approximately 30 million people live in a
federally designated shortage area where there is an
inadequate supply of health care providers. The U.S.
Department of Health and Human Services establishes
these designations for rural or urban areas, population
groups, or medical facilities.
30 Million People Live in
Federally Designated Shortage Areas
Compared with most developed countries, the United
States also has a low overall physician-to-population
ratio. The Organisation for Economic Co-operation and
Development ranks the United States 13th globally
with 264 doctors per 100,000 people. The 12 countries
that rank higher have 304 to 448 physicians per 100,000.
United States Has Low Physician-to-Population Level
Greece
Italy
Belgium
Austria
Slovak Republic
Switzerland
Denmark
France
Spain
Germany
Portugal
Sweden
United States
Australia
New Zealand
Ireland
Canada
United Kingdom
Japan
Korea
448
405
388
383
368
351
342
329
326
326
318
304
264
244
223
222
210
201
193
130
0
50
100
150
200
250
300
350
400
450
500
If we start now, a significant investment of both time and resources will
be needed to boost enrollment by 30
percent. It will take at least seven years
to see any increase in the number of
practicing physicians.
Time Needed to Increase
Medical School Enrollment
by 30 percent
4 Years of
Medical
School
3-7 Years of
Residency
Training
2006
2007-2014
2015
2019
2022-2026
Growing
evidence of
future workforce shortages
leads AAMC to
call for a 30%
increase in
enrollment
Expansion requires
additional capital,
construction and/or
renovation of
classroom space,
and faculty
If the 30%
increase is
achieved, 5,000
additional students
will enter U.S.
medical schools
in 2015
Class of 2015
completes
medical school
and begins
residency
training
Class of 2015 begins
to enter physician
workforce; some
M.D.s will pursue an
additional 3-7 years
of subspecialty
training before they
enter the workforce
The Physician Pipeline
Although the U.S. population has grown by 70 million
since 1980, the number of U.S. graduates with M.D.
degrees has remained flat at around 16,000 per year.
One way the nation has accommodated the expanding
population is by relying on an increasing supply of
foreign-educated physicians. Currently, one in four
new U.S. physicians is an international medical graduate
(IMG). Each year, 6,500 IMGs enter our health care
system through U.S. residency programs. The vast
majority of these physicians stay in this country when
they complete their training. Many come from less
developed nations that have physician shortages of
their own. This trend raises concern on two levels—
continuing dependence on IMGs, rather than U.S.educated physicians, and the health care impact of a
“brain drain” on the populations of less developed
countries.
Another way the nation has met our growing need is
through the expansion of osteopathic medical education. The number of individuals receiving doctor of
osteopathy (D.O.) degrees has grown from about 1,000
in 1980 to nearly 3,000 in 2006. D.O.s are licensed to
practice medicine in all states.
U.S. M.D.s Represented Two-Thirds of Physicians
Entering Training in 2005
IMGs
6,436 (26%)
U.S. M.D. Graduates
15,411 (62%)
D.O. Graduates
2,888* (12%)
Total 24,735
* All M.D.s, IMGs, and one-half of the D.O. graduates (1,478) enter Accreditation
Council for Graduate Medical Education (ACGME) residency programs.
Source: AAMC Center for Workforce Studies
A recent poll conducted by the AAMC
revealed that a majority of voters
believe there are too few doctors in
America currently and there will
continue to be an inadequate supply
of physicians 10 years from now.
Voters Believe There Are Too Few U.S. Doctors
Today
Next 10 Years
60%
66%
22%
28%
5%
5%
Source: Public Opinion Strategies, Voter Survey, June 2006
Conducted for the AAMC
Too Many
Too Few
Just Right
The Solution
Given the lengthy time it takes to educate and train
physicians, the AAMC believes our nation should take
immediate action to address the coming doctor shortage.
The solution has many parts:
A 30 percent increase in total medical school
enrollment by 2015 accomplished via
a) Boosting class sizes in existing U.S. medical
schools.
b) Establishing new medical schools.
An increase in the number of residency training
positions funded by Medicare to accommodate
additional medical school graduates.
Increasing annual awards to physicians by the
National Health Service Corps by 1,500 to encourage
more doctors to practice in underserved areas of the
country, and to address rising medical student debt.
The AAMC believes increases in enrollment are particularly appropriate in areas of the country where the population has grown rapidly over the past 25 years and in
areas where the population is projected to grow rapidly
in the future.
While the AAMC agrees that better coordinated care
and more efficient use of resources are essential, quality health care requires, first and foremost, that physicians be there for patients. The need for more doctors
is real and will become more urgent as our nation ages
and grows.
The AAMC’s Center for Workforce Studies will continue
to monitor and analyze changes in the number of practicing physicians over the next several years to provide
guidance and updates to policymakers and the public.
For more information go to
www.aamc.org/workforce
The Association of
American Medical Colleges
is a nonprofit association
representing all 125 accredited U.S. and 17 accredited
Canadian medical schools;
nearly 400 major teaching
hospitals and health systems,
including 68 Department of
Veterans Affairs medical
centers; and 96 academic
and scientific societies.
Through these institutions
and organizations, the
AAMC represents 109,000
faculty members, 67,000
medical students, and
104,000 resident physicians.