The Doctor Shortage in the US: Is It a Real Thing?

Many people have to wait too long to see a doctor. And it could get worse. If, as many people believe, we have a shortage of doctors in the United States, then it follows that we can fix this only by training and hiring more physicians.

As with almost everything in our health care system, though, it's complicated. Some people think there's no shortage at all - just a poor distribution of the doctors we have.

That's the topic of this week's Healthcare Triage.


John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics

And the housekeeping:

[emilyrose]

I was a science major and 90% of the incoming freshman wanted to become doctors. By senior year only about 2% still wanted to be a doctor. Most people (me included) decided it wasn't worth it by the time we graduated. Not only was it insanely competitive (even for 4.0 students) but it also required another 5-8 years of training and hundreds of dollars of student loans. To make matters worse, the salary isn't often worth it for the price of becoming one. Therefore most of the students went on to different careers that paid well but did not require you to throw away your life or your chance of retiring at 60. Right now my peers and I are becoming nurses, PA's, genetic counselors, physician assistants, world health specialists, etc. From my perspective the individuals who are going into medical school are 1) from cultures that see being a doctor as the only option to be successful 2) students from wealthy families who didn't have any undergraduate loans and had the funds to travel on humanitarian missions in the summer

[biophile]

I own a federally designated rural health clinic. I'm a board certified family doctor. At the end of this week I am closing my business. Revenue couldn't keep up with expenses with the biggest factor being the difficulty recruiting physicians. I, the doctor who works for me, and essentially all of my employees have been hired by the local Federally Qualified Health Center so services will continue in the community but we will not be in a better position to fill the need.

[tonycns]

America: We have a shortage of doctors
Medical school: Oh, you want to be a doctor? That'll be $300k

[HermannTheGreat]

Med School has too high a bar of entry, to high a cost of education, and the length of requirement for school is too long. The fact that Physicians Assistants and Nurse Practitioners are doing much of what general practitioners do for only 2 years of graduate school and half the cost of medical school shows that Med school is too long and too expensive. Secondary settings need specialized doctors with extra schooling, but that education shouldn't cost $500, 000 because it's created situations where those in need have to wait a month and the costs are expensive.

[Praisethesunson]

Making medical school cheaper might help.

[kennyc]

A potential solution is to allow for MDs without a residency have a less painful pathway to become a mid-level practitioner such as a PA. Annually there are over 30 thousand MD applicants in the NRMP match that do not match each year. Even if you assume only half of these people are qualified, that still gives us a substantial number of people who can go into that pathway. Currently there is no real pathway for that. You have to go through a PA program (which is additional time and money investments) to be able to qualify to be a mid-level practitioner. That's a ridiculous proposition to make for anybody who's passed at minimum the USMLE step 2.

[cjrosse]

Im a Canadian training to be a doctor in the US (attending a US medical school). I agreed with everything he said except implying midlevels should get more power.

I've worked with many midlevels. PAs (physician assistants) and NPs (Nurse Practitioners). They absolutely play SOME role in primary care, but giving them more power is dangerous to patients. They undergo substantially less training than physicians and it shows. I'm about to graduate medical school and I haven't even started residency yet (which will be another 4+ years of training) and I continually catch mistakes from PAs and NPs. You cannot cram medicine into 2 years (PA education). There is simply way too much physiology, pharmacology, and pathology to learn. NPs at least require a BSN then a masters degree. Oh did I mention NP and PA programs are available online. People in charge of your lives can get education online! That's not sketchy.

Midlevels are great for dealing with non-complicated patients. Sore throats. Coughs. Basic diabetic stuff. As soon as the patient gets complicated, they are more of a risk to patients. This shouldn't be an issue. Simply refer that patient to a physician. However, ego gets in the way. Too many midlevels think they can manage these patients when they can't. Giving prescribing rights to providers who learn the very basics of pharmacology is dangerous.

These people want to be doctors, but don't want to put in the time for the appropriate training. They have the potential to significantly decrease spending/resources, the issue becomes regulating their scope of practice, which should be limited given limited training

[LikelyToBeEatenByAGrue]

We may need more doctors graduating med school, but what we really need is more residencies for them when they do. ~30k doctors don't get residencies and basically can't practice.

[FuzzCutieNerd]

I live in Boston and we have some of the best hospitals in the country (and very many). There are thousands of doctors within easy driving distance of me, but between not very good insurance and a number of personal factors that restrict the pool of availability, I can't find a primary care doctor. And the only specialist in the area who knows about one of my conditions and takes my insurance has an eight month waiting list for an appointment. For certain people, there is a shortage of available and competent practitioners, both generalists and specialists, and I agree from experience that the issue seems compounded by insurance issues.

[brittneyrajewski]

In my opinion we have a doctor shortage because people do not want to go to school for the long time that being a doctor requires. I am sure many people would love to be doctors but motivation is not there for them, they'd rather take the easy way out and become a nurse or physicians assistant. Also another reason might be because college is becoming more and more unaffordable. If students do not have a local college that they can go to the price is outstanding and many students do not want to go into that much debt for a degree, they will be paying student loans off for a while and that is something most people do not want to do. It is hard enough trying to support yourself but imagine having $100, 000+ in debt you have to pay off. I do not necessarily think we have a general doctor shortage but I do think we have a specialist shortage for the amount of people who need to see them in America. When you go to a specialist you wait forever because they have overloaded schedules with too many patients that they realistically cannot see in one day because they are the only specialist in the area.

[YoungTheFish]

I can't be the only one who misread this as Doctor Strange in the US

[mjdurst]

In the northern part of michigan there is a shortage of doctors because the DRS do not want to work in the upper part of the state why because thier wives dont like that they cant shop at bloomingdales because there are none in north part in mich you have to wait close to 6months to a year to see a specialist like an orthopedic or cancer surgeons which causes a poor continuity of care and patient is sicker mich has nine medical schools none come up to the city's above lansing mi this could be helped if the graduating drs Bill's for school are written off and they are given incentive to work in northern mi

[biophile]

You might mention what we family doctors refer to as "the deans' lie." Medical schools report on the number of their graduates going into residency in primary care specialties. In that number they include everyone going into residency for family medicine, internal medicine, and pediatrics. Of course a majority of internists and a large minority of pediatricians go on to sub specialize while the vast majority of family doctors enjoy careers in primary care.

[Fireclaws]

America should be more like the Uk. In the US, I heard paramedics can't do anything without asking a doctor first. Here, we have can have paramedics and nurses that can completely treat a problem on site and either get you to hospital or send you home.

Obviously, there needs to be a follow up doctor visit but that can be a local appointment rather than taking up more time at the hospital.

[peanut]

Since 1925 we have had a "doctor" shortage, Havard, Yale, Johns Hopkins want it this way.

[Hamletstwin]

Why not take a cue from he military. gov't pays for the medical school and then they own their ass for ~8 years where they work in places where services are needed. They get room and board and a modest salary. Grant grandfather options to existing medical people with similar terms.

[gervais]

This great information. As of 2019, what is the data saying now in regards to physician shortage, med levels, distribution in healthcare delivery? I would love to know! Keep it up!

[rs]

The doctor shortage will get much worse, it has to do with shrinking U.S. demographics and rising tuition costs. It's mathematically impossible to fill all the doctor slots being vacated by boomers. Add to this rampant discrimination against minorities and it only compounds the problem.

[humzahhassan]

We could make rural areas more appealing to doctors but that won’t happen

[aquaknight]

I would have also liked to see how many hrs per week do they work as it directly relates to the subject at hand. Comparing ourselves to other nation could be pointless as the systems might not be similar or compatible for conparison.