Where Have All the Doctors Gone?

Dr. Thomas E. Williams/photo Mitchel Zoler

Dr. Thomas E. Williams/photo Mitchel Zoler

from the annual meeting of the American Association for Thoracic Surgery in Boston

During today’s sessions, a report from a team of thoracic surgeons at Ohio State University documented a dire prediction for the future of U.S. thoracic surgery, and for the American public. Unless there is a dramatic shift in numbers, within the next two decades the number of U.S. thoracic surgeons will be about 40% below the number needed to maintain current thoracic surgery coverage, said Dr. Thomas E. Williams.

But that’s just the tip of the iceberg. Dr. Williams cited an analysis published 4.5 years ago that projected an overall U.S. physician shortage of 200,000 by 2020-2025. Dr. Williams said today that he and his associates have updated this global-physician analysis, and their numbers forecast a 300,000-physician deficit by 2030, and a 500,000 shortage by 2050 if current trends remain unchanged. 

Concern about this impending physcian-deficient is growing. A few weeks ago, at the annual meeting of the American College of Physicians (ACP), officials of that organization announced their plan for boosting America’s dwindling supply of primary-care physicians. The Association of American Medical Colleges (AAMC) has also recognized the crisis and has taken recent steps to boost medical school enrollments, which included opening  four new U.S. medical schools in 2009.  

What seems poorly explained is why this is happening. The ACP cited the economic disincentives in place for primary care. Dr. Williams noted a failure to promote thoracic surgery as an attractive option to medical-school students and inadequate numbers of training positions. The AAMC focused on the retirement of physicians coupled to increased demand from a growing and aging U.S. population. But a more fundamental issue is why a smaller proportion of American college graduates have recently entered the medical profession.

Perhaps a study has been published that addresses this that I don’t know about, but lacking that here is my guess: I always thought the best reason for young adults to go to medical school was because they had a sincere passion about caring for sick people. But I also suspect that in the past many instead did it because it was a reliable path to a good income and an upper-middle class life. Starting a generation or so ago a lot of competition emerged from careers in finance, and medicine’s reputation as a cash-cow occupation got tarnished by restrictions imposed by Medicare and managed care.

Sad but seemingly true. 

—Mitchel Zoler (on Twitter @mitchelzoler)

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Filed under Cardiovascular Medicine, Family Medicine, Geriatric Medicine, Internal Medicine, Practice Trends, Surgery, Thoracic Surgery, Transplant Medicine and Surgery

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