The Association of American Medical Colleges predicts this country will be short 91,000 physicians by 2020 – half of
which are needed in primary care specialties.
However, there is little consensus amongst experts in political
healthcare circles that a physician shortage will materialize. The Institute of Medicine, a nonprofit think
tank, hypothesizes the inefficiency in healthcare is more to blame, casting
doubt on an impending scarcity.
Academic economists insist the solution is to flood the workforce with
mid-level providers and automate medicine further.
According to the Kaiser Family Foundation, there are approximately
968,743 doctors practicing in the United States. Taken at face value, that number seems
adequate, however there are a couple of caveats. Data shows that the average age of physicians
is continuing to climb. Nationally, 1 in
3 physicians are over 50 years old and 1 in 4 are over sixty. That means at
least 25 percent of the physician work force could retire soon, translating to
a loss of more than 223,000 doctors. Also,
most experts agree that physicians prefer living in major metropolitan areas to
rural locales. To make matters worse, Medicare
reimburses more in places where the cost of living is higher, a lopsided scheme
which further disincentivizes physicians from migrating to rural areas.
The aging of the physician population and a definitive
preference for urban centers has resulted in a problem of physician
maldistribution, which according to a recently released report from the Office of Financial Management/ Health Care Research
Center, is getting worse. In Washington
State, there are currently 18,730 practicing physicians. About
37 percent, or 6,885 physicians, work in primary care fields, including family
medicine, internal medicine and pediatrics.
To put the physician maldistribution problem in perspective, the five
most populous counties – King, Pierce, Spokane, Snohomish, and Clark -- are
home to 73 percent of the state’s physicians while they account for just 65
percent of the population.
Only 6% of physicians practice in rural areas, yet
they serve 16% of the population. Kitsap
County has 443 physicians, equivalent to 2.4% of the state total and is one county
experiencing a shortage of primary care physicians. Kitsap County falls below the state average
in every primary care specialty across the board.
For the purposes of the OFM report, figures are
expressed as a ratio of physician number per 100,000 population. For the family medicine specialty, the state
average is 41 per 100,000 people, yet Kitsap has just 36 to serve 100,000. In internal medicine, the state average is 38
physicians per 100,000 and Kitsap significantly lags behind with merely 25. The outlook for rural pediatricians appears
even bleaker; the state average is 12 per 100,000 and Kitsap survives on half
that number, with just 6.
Americans–
especially vulnerable populations, like children -- will be affected most when
they cannot get the care they need, but the trend will grow to affect us all in
time. Effective solutions to the fact that patient
demand is outgrowing physician supply, have remained elusive. In our society, it is not exactly a good time
to be a physician. According to a 2012 JAMA
Internal Medicine Mayo Clinic study, 46% of all U.S. physicians are
emotionally exhausted, feel cynical about work, or have lost their sense of
personal accomplishment … or suffer from all three. A
2012 study of 5000 physicians showed that 89% of practicing physicians would
not recommend medicine as a profession to their children or other family
members. Doctors have the highest
suicide rate of all professions. We are
losing our most compassionate people to careers with less stress and a flexible
lifestyle.
We must entice our best
and brightest to enter medicine. And in
order to accomplish that, our healthcare system must change.
The report released by
the Office of Financial Management is a clear warning sign that the physician
shortage is already impacting Kitsap County residents. As physicians, we should educate the public
and try to find ways to better incentivize other physicians to choose rural
areas in which to live and work. Until then, find a primary care physician you can
trust as they are worth their weight in gold.
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