Academic leaders work to ease work force crisis

The profession's ranks are being hurt by rising medical school debt, lifestyle preferences and other issues.

By Kathleen Phalen Tomaselli amednews correspondent — Posted Aug. 25, 2008

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Current policies will not avert a U.S. health work force crisis, according to a report released in July by the Assn. of Academic Health Centers, a Washington, D.C.-based nonprofit group. Its report recommends developing a national planning body to unite efforts to stop work force shortages.

"We're at risk, our nation's health is at risk, our position as a global leader is at risk," AAHC President Steven A. Wartman, MD, PhD, said during a news conference on the report. "Projected shortages are not new, but as a nation, we lack a work force policy and without that, we will not be able to solve the looming shortage of health professionals."

The report, "Out of Order, Out of Time: The State of the Nation's Health Workforce," points to a long and growing list of challenges creating shortages in many areas. While projected shortages in primary care and nursing are not new, the demand for care is greater, due in part to the baby boomer wave of retiring physicians and increasing medical needs of the growing elderly population.

Other issues fueling shortages of health care workers: lifestyle preferences (medical students want regular hours and time home with families), economic disparities, rising medical school debt, a dwindling pool of medical school faculty, and fragmented health care work force policymaking, experts said.

The report recommends an integrated, comprehensive national health work force policy created by a unified planning group.

"We have had the different parts to the choir. But we've never attempted to get them to sing together from the same hymnbook," said Nancy W. Dickey, MD, president of Texas A&M University System Health Science Center in College Station.

Daniel W. Rahn, MD, president of the Medical College of Georgia in Augusta, who chaired the report's advisory committee, said "piecemeal, incremental policymaking is not sufficient to address challenges."

Fewer practicing doctors per capita

Dr. Rahn said the physician-to-patient ratio in Georgia is among the nation's worst, ranking 40th. Nonetheless, higher per capita rates do not always equal more available physicians for patients.

Consider Maryland, the state ranked second in physician-to-patient ratio. Of its 25,000 licensed physicians, 40% do not provide direct patient care, according to a January study by the Maryland Hospital Assn.

As a result, there are 176 clinical full-time physicians per 100,000 people, a rate 16% below the national average of 212 doctors per 100,000. Remove specialists from the equation, and parts of the state have 44 primary care physicians per 100,000 residents.

"Primary care is a dying specialty," said Sheldon M. Retchin, MD, CEO of Virginia Commonwealth University Health System in Richmond. "It's been estimated that by 2020, there will be a shortage of 1,500 physicians in Virginia and 22,000 nurses."

The AMA recognizes there is a physician shortage in many regions and specialties. To help alleviate shortages, medical education reforms are needed, including increasing medical school class sizes and allowing for additional residency slots to train physicians, specifically in needed specialties and regions, the AMA says.

Medical school tuition has outpaced income the last decade. The burden of school debt has grown 289% since 1987, approaching nearly $140,000 per student.

The National Resident Matching Program reported that family practice achieved a 91% fill rate for 2008 -- the best in more than a decade, according to the American Academy of Family Physicians.

But incomes for primary care physicians and specialists are rising at disparate levels: primary care incomes increased 9.9% while specialty incomes rose 15.8% in a four-year period from 2000 to 2004.

Such economic burdens, along with rising professional liability insurance premiums, are pushing many students to specialty care, experts said.

The work force shortage may be lessened by an increase in international medical students entering U.S. residency programs and a national push to build more medical schools. But experts agree that much more work needs to be done to have enough doctors to treat patients.

"We face many challenges," Dr. Dickey said. "Important in the primary care discussion are incentives, reimbursement [and] possible loan forgiveness."

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External links

"Out of Order, Out of Time: The State of the Nation's Health Workforce," Assn. of Academic Health Centers (link)

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