There are some debates that never seem to end.
Which band was greater, the Beatles or the Rolling Stones? What’s the better choice, paper bags or plastic? Popular opinion leans one way, then another, without a definitive conclusion ever being reached.
There is an ongoing debate in my field – health care – that is similarly endless. Do we have too many doctors, or too few?
The question goes back to at least 1980, when a panel of health care experts called the Graduate Medical Education National Advisory Committee projected the nation was training too many doctors and warned that by 2000 we would have a major glut on our hands. Based on this perceived wisdom, Congress placed a cap on federal funding for doctor training in 1997. The number of physicians entering medicine each year has been virtually unchanged ever since.
Today, however, many health care analysts have reversed field and are reporting signs of an emerging physician shortage. The Association of American Medical Colleges, for instance, projects that there will be 130,000 too few physicians by 2025. Dozens of medical societies and other organizations have come to a like conclusion.
But the issue is far from decided. Scott Gottlieb and Ezekiel J. Emanuel, both physicians and former government health care policy advisers, are the latest to stoke the debate. Writing recently in the New York Times, Gottlieb and Emanuel argued that more services can be delivered by fewer physicians through the expanded use of other types of clinicians such as nurse practitioners, and that technical innovations such as remote monitoring devices will free up doctor time. Hence, no doctor shortage is to be anticipated and there is no need to increase the number of physicians being trained.
So who is right?
Consider that the Centers for Disease Control and Prevention projects that 27 million additional Americans will have hypertension by 2030, that 8 million more Americans will have coronary heart disease, and that 3 million more will have heart failure. Growth in the number of Americans diagnosed with diabetes could reach 86 percent by 2034 and growth in the number with Alzheimer’s could reach 40 percent by 2030. While there are 10 million cancer survivors today, there will be 18 million by 2020. That equates to a lot of extra demand for medical services, driven mostly by our aging population.
The Affordable Care Act, under which millions of previously uninsured Americans will eventually gain coverage, also will increase demand for doctors. And while technological advancements can free up physicians to see more patients, medical discovery and innovations will also drive up demand for new types of surgeries, new drug therapies and other emerging treatments provided by doctors.
Moreover, the number of doctors and hours they are willing to work 10 years from now will be quite different from the number today. More than 42 percent of physicians in active patient care in the United States – about 290,000 – are 55 years old or older. In 10 years, the majority of these physicians will be retired. The doctors taking their place will see fewer patients per day and work fewer hours than their predecessors if current trends hold. The United States currently ranks 46th in the world in physicians per capita, and for the first time in the modern era of medicine that number is set to decline.
With the need for carefully managed, quality patient care skyrocketing, the downside of having too few doctors appears to be considerably steeper than the downside of having too many. The federal government spends about $10 billion a year to train physicians. If this number is increased, and it turns out we do not need more doctors, some money will have been wasted. If this number is not increased, and it turns out we do need more physicians, the consequences for many people will be dire and even fatal.
Although we do not know yet who is right in this debate, common sense and the sheer math of an aging patient and physician population come down on the side of more U.S. licensed doctors, not fewer.
As for those other great, unresolved questions, I’ll take paper bags and the Beatles.
Susan Salka is the president and CEO of San Diego-based AMN Healthcare, a hospital staffing company.