Shortage of physicians, APNs and PAs could double by 2025

The nation's supply of physicians, advanced practice nurses and physician assistants can't keep pace with growing demand as the country expands insurance coverage under the health system reform law, says a study in the Journal of the American College of Surgeons.

Significant work force shortages would persist even with aggressive training initiatives.

"The most likely scenario is one of flat supply in the face of rising demand, leading to long-term shortages of advanced clinicians of approximately 15% [by 2025], double the current level," said the June study (link).

If training programs for APNs and PAs grow 3% to 5% annually as projected, but there is no expansion of physician residency programs, the supply of advanced clinicians would be 20% less than demand by 2025. That would mean an undersupply of 214,000 physicians.

Adding 500 first-year residency positions annually beginning in 2012 would narrow the gap to 18% or 178,000 physicians, and adding 1,000 positions annually would mean a 14% shortage of 138,000 physicians.

Researchers estimated future health care demand based on projected gross domestic product growth and goals for decreased health spending under the reform law.

Meeting future demands would require redesigning medical practice and the delegation of more tasks to other health professionals, said Richard Cooper, MD, study co-author, emeritus professor at the University of Pennsylvania School of Medicine and senior fellow in the university's Leonard Davis Institute of Health Economics in Philadelphia.

"It means giving up some old models and accepting the reality that we're going to have a continuing shortage of physicians and how do we deploy them," Dr. Cooper said.

Though supplies of APNs and PAs are rising steadily, their growth is limited by factors such as the supply of qualified instructors to train them. "There is this idea that you can sprinkle a little fairy dust and get more nurses and PAs, but there is in fact a limit to how fast you can expand," he said.

A broader spectrum of health care workers will have to be trained to provide certain aspects of patient care, said Michael Sargen, lead study author and an MD candidate at the University of Pennsylvania. "It will not be possible for physician assistants and advance practice nurses to fill the void, even with the increases in supply that we have projected," he said in a statement.