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Doctor shortage facing U.S.
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Several issues serve as sources of debate regarding the potential physician shortage and a tendency or lack of subspeciality training.
Concern over the physician shortage is a crucial issue because expanding the physician pool by enlarging medical training programs would involve a large cost for taxpayers.
However, the prevalent opinion is that the current supply of physicians is inadequate given the population.
A new study by Johnathan Weiner, a professor in health policy and management at the Bloomberg School of Public Health questions the idea that there is an impending physician shortage in the United States.
Weiner states that analysis of doctors currently involved in HMOs refutes the contention that enough specialist doctors are not in the nation's medical training programs.
PGPs or prepaid group practices, are multispecialty groups that receive reimbursements for treating HMO patients.
The study included PGPs from Kaiser Permanente, which is based in California; the Group Health Cooperative of Puget Sound; and HealthPartners in Minnesota.
The results of the study showed that HMOs have one physician per 600 patients while overall in the United States, there is one physician for every 400 patients.
Although the study showed that the HMO groups used primary care physicians more than specialty physicians, the study also showed that specialist care increased at a faster rate than general care over the past 20 years.
Dr. Weiner states that the results of the study demonstrate that the HMO groups were able to provide care to a greater proportion of patients with a fewer number of physicians.
He further states that the proportion of specialists with respect to the patient population was less than that of general care physicians. In conclusion, he says that this provides evidence that there is no shortage of doctors, particularly specialists, in the U.S.
Therefore, he states that since the HMO groups functioned with such proportions that "policymakers should deliberate carefully before concluding that expansion of medical training programs is warranted, especially given the huge taxpayer subsidy associated with supporting the training of each new medical professional."
However, it is debatable what physician-to-patient or specialist-to-patient ratio is adequate. According to Luis Martin in "Cuba: Issues and Answers," Cuba has the highest doctor to patient ratio, about one physician per 190 patients, of all of the countries in the world.
An article by the American Medical Association in its newspaper from Jan. 5, 2004 claims that currently there is a physician shortage and that it is likely to spread. The article cites that U.S. medical schools have been churning out 15,000 to 16,000 doctors a year since 1980, according to the Department of Health and Human Services, but census data shows the population has increased 24 percent, from more than 226 million to more than 281 million people.
The article also points to a growing proportion of elderly in the U.S. population since Americans are living longer as a reason for increased training of specialists in areas that deal with issues in elderly health.
It also points to the problem of physician shortage not necessarily as a lack of physicians in general but an unequal distribution. The article points to the fact that financial factors influence medical student choice of speciality.
Furthermore, trends in urbanization lead to the asymmetric distribution of physicians. The article cites that lack of appeal in certain regions of the country as well as the inability of disadvantaged communities to support specialist care monetarily lead to a tendency for physicians to conglomerate in major cities.
However, as with the study from the School of Public Health, the American Medical Association heeds caution in the expansion of medical programs as well due to the financial cost and the possibility of creating more physicians than necessary for the future.
In a Dec. 10, 2003 report in the Journal of the American Medical Association, researchers from the Medical College of Wisconsin indicated not only that there is an impending physician shortage but also that there is a persistent lack of physicians in the fields of anesthesiology, cardiology, gastroenterology, geriatrics, radiology and general surgery.
The lack of practitioners in specific fields incites the perpetual debate about whether increased specialist training should resolve the physician shortage or whether there too many specialists are leading to a lack of general care physicians.
Sarvenaz Nouri, a pre-med and neuroscience major at Johns Hopkins University highlights an underlying issue inherent in this debate. She feels that, "Specialist training enables people to expand knowledge in particular field and thus better contribute to the overall development of the field of medicine with a significant contribution in a specific area rather than focusing on general practice."
The development of new techniques and practices in subspecialty fields, along with the increased elderly population are indicating a lack in specialist physicians.
Senator Harry Reid, D-Nev., says, "The vast majority of our health care providers are not yet prepared to meet the challenges associated with caring for the elderly," in a hearing in which a Las Vegas man died after suffering a seizure following misdiagnosis due to the lack of geriatricians in the area.
Although there is undoubtedly a lack of physicians, particularly specialists in certain areas of the U.S., it is questionable whether expanding medical training programs would resolve this problem. If, as indicated by various studies, the current physician shortage associated problems are related to physicians clustering in metropolitan areas, then training more physicians would only heighten this disparity. There is a shortage in specialist care in the U.S., but it is most likely the consequence of geographic factors.
