Monday, June 05, 2006

Is This One For Real?

The LA Times (free registration required) has an article on the possibility of a shortage of physicians in the USA:
Physician Shortage Looms, Risking a Crisis, as Demand for Care Explodes
An aging America needs more doctors, but supply isn't keeping up. Experts fear worsening quality and dangerously long waits for appointments.
By Lisa Girion, Times Staff Writer
June 4, 2006

A looming doctor shortage threatens to create a national healthcare crisis by further limiting access to physicians, jeopardizing quality and accelerating cost increases.

Twelve states — including California, Texas and Florida — report some physician shortages now or expect them within a few years. Across the country, patients are experiencing or soon will face shortages in at least a dozen physician specialties, including cardiology and radiology and several pediatric and surgical subspecialties.

The shortages are putting pressure on medical schools to boost enrollment, and on lawmakers to lift a cap on funding for physician training and to ease limits on immigration of foreign physicians, who already constitute 25% of the white-coated workforce.

But it may be too late to head off havoc for at least the next decade, experts say, given the long lead time to train surgeons and other specialists. [...]
The biggest issue there is the funding for medical training.  It is incredibly expensive to train physicians.  I recall that when I was in medical school, and students were complaining about double-digit increases in tuition, one of the administrators told us that our tuition only covered about one-third of the actual cost of training.  As an historical aside:
First UM Medical buildingWhen the Medical School first opened in 1850, students paid only a $10 registration or matriculation fee.

By 1891, the matriculation fee was $10 for Michigan residents and $25 for students from out of state. Over the next 50 years, tuition rose slowly until it was $250 in 1940. In the early part of the twentieth century, students were required to pay laboratory and demonstration fees totaling $136 over the four years. None of this takes into account room and board. The average cost of room and board in 1893 was $3-$5 a week; 1931: $12-15 a week. In 2003, tuition and fees for Michigan residents were $20,526 (out of state, $31,526) and estimated living expenses were $20,300 a year. Currently, the average student debt for someone receiving an M.D. degree from the University of Michigan is close to $100,000.
Medical schools are allowed to charge more for services, based upon the recognition of the fact that training costs are high.  But the federal government has balked at these higher fees, so there have been caps.  This debatable policy has made it more difficult for medical schools to expand enrollment.

There have been dire warnings of physician shortages before, but this time it seems more credible to me.  The key factor is the fact that the average age of the US population is increasing.  Obviously, older people require more doctoring than younger people.  But there is another factor:
At the same time, younger male physicians and women — who constitute half of all medical students — are less inclined to work the slavish hours that long typified the profession. As a result, the next generation of physicians is expected to be 10% less productive, Edward Salsberg, director of the Assn. of American Medical Colleges' Center for Workforce Studies, told a congressional committee in May.
I expect that the trend toward fewer work hours will bring up some controversy, and possibly some resentment.  Some physicians will be negatively judgmental about those who choose to work fewer hours.  Others will face pressures to delay their retirement.  At the same time, it will be increasingly difficult for physicians to keep up-to-date with their skills and knowledge base.  Every hour spent on continuing education is an hour that is not devoted to patient care.  There is a risk that the demand for more patient-care hours could lead to doctors devoting less time to continuing education, which obviously would have a detrimental effect on quality.

It seems likely that the prediction of a shortage of physicians is accurate.  That will pose new challenges for physicians, in terms of managing stress.  It occurs to me as I write this, that it may be desirable to make a point of educating medical students about these pressures, and how to deal with them.  As soon as I figure out how to deal with them, I will post that information here.