For many Americans, the COVID-19 pandemic accelerated an already alarming trend—a shortage of physicians in primary and specialty care. Research reveals that the situation isn’t likely to improve anytime soon: The American Association of Medical Colleges predicts that the physician shortage in the United States could escalate to more than 100,000 physicians across primary care and other specialties in the next decade.
Key drivers in this shortage include an aging population that will increase demand and, at the same time, an aging physician population that will shrink the available workforce. In particular, healthcare systems operating in designated Healthcare Professional Shortage Areas are in dire need of primary care and mental health providers. The U.S. Health Resources and Services Administration estimates that 100 million Americans live in a primary care health shortage area, while 71 million live in a dental health shortage area and 163 million live in a mental health shortage area as of April 2023.
Healthcare shortage areas overlap with healthcare deserts. Both describe geographical areas that suffer from a deficit of accessible healthcare. Evidence-based research reveals that Americans who inhabit these areas experience worse healthcare outcomes than those who live in areas of non-shortages. These shortages also impact physicians.
While there are efforts to alleviate physician shortages, whether these efforts can actually solve the systemic issues that have caused these problems is open to debate. This article will explore some of these issues.
Impact on Patients and Providers
Not only are millions of patients affected by physician and provider shortages, but many of those affected lack health insurance. While the number of uninsured Americans has dropped since the introduction of the Affordable Healthcare Act a decade ago, there are still more than 10% of Americans without health insurance who are also highly concentrated in healthcare provider shortage areas.
As the COVID-19 healthcare emergency ends, 16 million Americans are also at risk of losing their health insurance coverage. Americans without health insurance who live in underserved areas face a high bar to accessing healthcare. Declining rates of reimbursement for services associated with primary care create an additional barrier to care, potentially leading to more physicians and providers leaving the industry.
The shortage of physicians—and, ultimately, residency spots—doesn’t just affect patients. It also affects many physicians. The American Medical Association estimates that 5% of U.S. allopathic and 10% of U.S. osteopathic medical school graduates don’t match into a specialty their first year applying. These numbers are further inflated by the unmatched American-born medical school graduates of Caribbean medical schools and physicians trained overseas who wish to emigrate to the United States but have an extremely difficult path to finding legal entry into the country and training spots to repeat their graduate medical education.
If you add up this pool of physicians, many of whom are victims of circumstance rather than being uncompetitive applicants, the number is not enough to make up for the shortage in total, but it could make a significant difference, especially in light of some of the benefits made available by regions experiencing care shortages.
Additional Residency Slots Allocated
Last year Congress approved funding for more than 1,000 additional graduate medical education (GME) slots, significantly expanding the amount of residency slots available for the first time in over 25 years. The legislation—a portion of the yearly appropriations act—additionally calls for 200 more slots to be added each year. The Consolidated Appropriations Act of 2023, passed in January, did fund these 200 slots for the current year.
While these increases are an encouraging first step, some arithmetic clearly illustrates that it will make only a small dent in the shortage. As noted above, the shortage among underserved populations currently exceeds over 10 times the added slots among primary care physicians alone, and only 10% of those slots are allocated for hospitals in rural areas, hospitals training more residents than their caps allow, states with new medical schools, and hospitals in designated health professional shortage areas.
Despite the math, one positive sign is that the Centers for Medicare and Medicaid, the organization that allocates the slots, awarded 200 of the 1,000 slots to hospitals in designated health professional shortage areas. Three-quarters of those new residency slots will be in primary care and mental health specialties. However, there is no guarantee that placing residency slots in these areas will result in physicians staying in these areas over the long-term.
Additional Factors Impacting Access
There are factors imbedded in the healthcare environment that suggest a disconnect between the actual capacity of the healthcare system and provider shortages, according to Harvard Business Review. These include:
- Lack of affordability. As the population of uninsured rises, many people can’t afford to access care.
- Physician labor inefficiencies. Evidence suggests that physicians spend 20 to 30% of the time that could be spent taking care of patients performing recordkeeping and compliance-related tasks.
- Supply and demand mismatch. Research on healthcare deserts and physician shortage areas demonstrates that many regions can’t attract enough providers.
- Rigid care models. Substituting physicians assistants and nurse practitioners for primary care physicians could alleviate some of this shortage.
The pandemic demonstrated that telehealth can quickly and efficiently reach populations in need of care. Targeted expansion of telehealth along with other emerging technologies will likely be helpful in relieving these shortages. Digital healthcare coordination technology, for example, can guide patients to provider openings and immediately schedule them for the most appropriate care. Remote monitoring technologies can also facilitate the right patient healthcare information getting to the right primary healthcare provider.
A Final Word
These issues are interconnected and exist within a legislative, political, organizational, and reimbursement structure that makes change difficult. Over time, hopefully, changes will occur that will create more equitable access with fewer challenges.