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The Doctor Shortage

By: David L. Barnes, MD

The Doctor shortage seems to be an issue that hits the front pages of our papers or on-line magazines from time to time, and then quickly gets pushed aside as a multitude of other healthcare issues take its place. And when you hear Doctor Shortage the only thing the press has time to mention is the shortage of Primary Care Physicians. But as the NEJM reported back in 2011, there is much more to this story than just Primary Care.

“In its June 2010 report on non-primary care specialty shortages, the AAMC’s (Association of American Medical Colleges) Center for Workforce Studies ventured a dire prediction for the decade ahead: a current deficit of 33 percent in surgical specialties, and an undersupply of 33,100 surgeons and other specialists by 2015, increasing to 46,100 by 2020. The AAMC expects the primary care physician shortage to top 45,000 by 2020. The forecast from the Health Resources and Services Administration is even more unsettling. The government agency calls for a shortage of 62,400 in the non-primary care specialties by 2020. In addition, one third of U.S. practicing physicians are expected to retire over the next decade.” In oncology, the worsening shortage, predicted to top 4,000 by 2020 and fueled by retiring baby boomers, is hitting hard in rural areas. On a national level, large recruiting firms are finding specialist recruiting tough going for reasons beyond the undersupply and the limited training slots. Pent-up demand is exacerbating the situation. For Merritt Hawkins Associates the surgical specialties, especially general surgery, are the most challenging and fast-rising search areas now. And psychiatry searches, especially those for rural practice, opportunities are through the roof”.

When I first came to Ouachita Parish 30 years ago I had no problem getting my patients in to see a needed local specialist.

We usually had shortages of some pediatric subspecialties, and some medical and surgical subspecialties but that was expected due to the size of our population in Northeast Louisiana. But about 10 years ago warning signs began to appear as some medical and surgical specialty physicians moved out of the area and others became employed and less accessible. Our local medical community initially was able to compensate for this shortage with longer work days and heavier work loads. But with older local physicians now retiring those warning signs have now become a reality. Other factors are now accelerating the shortages of both Primary Care and Specialists, including physician burnout from over-regulation by insurance companies and the Government, the rise of the hospitalist concept in patient care, the employment of physicians by hospitals and insurance companies, and the continued trend toward subspecialization. As we begin to see shortages in all doctor specialties all you have to do is look at the horizon, where you see storm clouds gathering.

Nearly half of us (830,000 doctors in the U.S.) are over 50 and with the stress of the implementation of Electronic Medical Records and changing work habits we are seeing fewer patients.

This storm will probably make landfall in January if the prediction of 30 million additional people, through the Affordable Care Act, materialize in doctor’s offices across the country. Just recently our Government has postponed the employer mandate until 2015.

Some of this shortage can be alleviated by the addition of mid-level practitioners, i.e. nurse practitioners and physician assistants, and many physicians have added them to their practices. But with the vast difference in clinical training hours 12,000 to 18,000 for Residency Trained Physicians and 500 to 1500 hrs for nurse practitioners one can see that these groups are not the final solution. Doctors in almost all specialties are being heavily recruited by hospitals, large medical groups, and emerging new medical entities.

In this issue of the Hippocratist we give you the perspectives of a few of our members. We start with Dr. Robert Marx, a local Urologist whose specialty has been hit hard locally by retirements in the past several years, then two general surgeons. Dr. Bill Ferguson looks back over 50 years of medicine and the winding road that returned him to his home parish, and the other, Dr. Bart Liles, the son of Dr. Arthur Liles, gives us a current view of the process that returned him to his hometown.

We again would like to thank our sponsors of this edition of The Hippocratist. The Doctor Shortage begins now….read on.
David L. Barnes, M.D.
President OMS