No, There Won’t Be a Doctor Shortage

By SCOTT GOTTLIEB and EZEKIEL J. EMANUEL,

In just over a decade the United States will need 130,000 more doctors than medical schools are producing. So says the Association of American Medical Colleges, which warns of a doctor shortage that will drive up wait times, shorten office visits and make it harder for Americans to access the care they need.

The road to Obamacare has seen its share of speed bumps, as well as big potholes. But a physician shortage is unlikely to be one of its roadblocks.

Shortage forecasters point to two major factors. One is an aging population. The proportion of Americans who are 65 and older will increase to 19 percent in 2030 from 12.9 percent today, according to federal projections. Second, Obamacare will insure 30 million more Americans by the end of the decade, dramatically increasing demand for physicians. Extrapolating forward from today’s 2.4 physicians per 1,000 Americans would mean we will need at least 90,000 more physicians by 2020, or so the reasoning goes.

Regardless of your political views, there are good reasons to be skeptical of these predictions. Take Massachusetts, where Obamacare-style reforms were implemented beginning in 2006, adding nearly 400,000 people to the insurance rolls. Appointment wait times for family physicians, internists, pediatricians, obstetricians and gynecologists, and even specialists like cardiologists, have bounced around since but have not appreciably increased overall, according to a Massachusetts Medical Society survey. Massachusetts’s experience may differ from other areas, particularly rural regions, but the results of reform there suggest shortage fears are exaggerated.

Today, more patients can be cared for in subacute settings rather than in hospitals. And new technologies are turning the treatment of many medical conditions into less resource-intensive endeavors, requiring fewer doctors to manage each episode of illness.

Innovations, such as sensors that enable remote monitoring of disease and more timely interventions, can help pre-empt the need for inpatient treatment. Drugs and devices can also obviate the need for more costly treatments. Minimally invasive procedures, like laparoscopic surgeries, can be done more quickly with faster recovery times and fewer physicians.

Other medical personnel can also expand the reach of physicians to care for a larger population. Nurse practitioners, health aides, pharmacists, dietitians, psychologists and others already care for patients in numerous ways, and their roles should expand in the future.

The opportunity exists to deliver more services and care with fewer physicians, but it’s not a foregone conclusion. Policy changes will be necessary to reach the full potential of team care.

That means expanding the scope of practice laws for nurse practitioners and pharmacists to allow them to provide comprehensive primary care; changing laws inhibiting telemedicine across state lines; and reforming medical malpractice laws that force providers to stick with inefficient practices simply to reduce liability risk.

Instead of building more medical schools and expanding our doctor pool, we should focus on increasing the productivity of existing physicians and other health care workers while incorporating new technologies and practices that make care more efficient. With doctors, as with drugs or surgery, more is not always better.

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