Conference seeks solutions to pending physician shortage

Washington -- The number of physicians, especially primary care physicians, in the pipeline is not sufficient to keep pace with the needs of a growing and aging population, warned presenters at an August Health Resources and Services Administration meeting.

The problem is not that the supply of physicians, including those in primary care, isn't growing -- because it is, said Edward Salsberg, director of the Assn. of American Medical College's Center for Workforce Studies. It's just not growing fast enough.

Physicians, like the rest of the population, are reaching retirement age in large numbers. In 2017, more than 24,000 will turn 63, said Salsberg. The number of new physicians entering practice each year is about 26,000, he said, just about enough to maintain the status quo.

If there is a positive side to the recession, it's that more physicians have stayed on the job, he said. "If suddenly, 20,000 to 60,000 more doctors retire because the stock market is back up, we will be in trouble."

Finding ways to turn the situation around was the aim of HRSA's conference, The Health Care Workforce Crisis: A Summit on the Future of Primary Care in Rural and Urban America. The problem has been highlighted by efforts at health system reform that, if successful, likely will require additional primary care physicians.

Among the steps Salsberg and others suggested to bolster the supply is to increase graduate medical education slots and to expand the use of support staff, including physician assistants and nurse practitioners, where numbers of new graduates are soaring.

Others at the conference described another method -- reach out to students early, expose them to the health professions and "nurture the heck out of them," one participant said. This approach has been under way for several years in rural areas and areas with high concentrations of minorities -- parts of the nation that have long faced a dearth of health care professionals.

Nurturing future physicians

Starting early is key, said Katherine Flores, MD, director of the Latino Center for Medical Education and Research in Fresno, Calif. "Our feeling is if you don't work with the kids one-on-one by their freshman year of high school, you are going to lose them."

The center was founded in 1996 with funding from the University of California, San Francisco, School of Medicine and others. Its goal is "to enrich the pipeline so kids have the opportunity to go to college and then to health professional school," said Dr. Flores, a family physician and the daughter of Mexican farm workers.

The center runs "Doctors Academy" programs for students in local middle and high schools and provides fellowships for physicians. All programs seek to increase the quality and quantity of underrepresented minorities in the health professions, Dr. Flores said.

The programs nurture children who are not necessarily straight-A students and who are not likely to consider college.

So far the 10-year-old program has had a 100% high school graduation rate, and all students have been accepted into colleges. One Doctors Academy graduate is now in his second year of medical school and plans to practice medicine in the Fresno area. Another student plans to apply to medical school next year.

Similar programs to encourage children from rural areas to consider careers in health care are offered by the 15-year-old Northwest Pennsylvania Area Health Education Center in Erie, said Linda Kanzleiter, DEd, co-director of the center and an associate professor of family and community medicine at Pennsylvania State University College of Medicine.

The center runs programs that begin in elementary school and recognizes that, "if you come from a rural area, you will practice in a rural area," Kanzleiter said.

Middle and high school students are offered the opportunity to meet and work with physicians and conduct research projects under the guidance of mentors. During the past eight years, the program has produced 103 physicians who practice in underserved areas, Kanzleiter said.