Doctor Shortage in U.S.
(Dec. 16) -- The nation is short of thousands of primary-care doctors. Medical schools plan to add 3,000 first-year students by 2018, but that won't be enough to meet the need, according to a report from Bloomberg.com.
Though schools plan to educate more doctors, the demand for physicians is expected to soar if Congress passes a health care reform plan aimed at getting insurance to 31 million more Americans. The bill is being debated at a time when government-funded training for doctors has been frozen for 12 years, Bloomberg reported.
Medical colleges have added 1,500 seats since 2005 and plan to add 3,000 more by 2018.
"Do the math," said Steven Safyer, president and chief executive officer at New York's Montefiore Medical Center. "You give millions more people insurance, and it adds up to a much worse shortage."
Ed Salsberg, an official with the American Association of Medical Colleges, told the news service that the nation may be short of 159,300 doctors across all practice areas by 2025.
How should the shortage be resolved? Medical school officials have differing opinions. Read about them at Bloomberg.com.
Dec. 16 (Bloomberg) -- To combat a nationwide shortage of doctors, medical schools in the U.S. plan to add 3,000 first- year students by 2018. It won’t be enough.
The expansion, pushed for by the Association of American Medical Colleges, is being undercut by a U.S. health-care overhaul designed to supply medical insurance to an additional 31 million Americans and a cap on government-funded physician training programs that’s been frozen in place for 12 years, said Steven Safyer, of Montefiore Medical Center.
Last year, there were 16,721 fewer primary-care doctors than needed in inner city and rural areas, according to the U.S. Health and Human Services Department. Residencies, the hospital based-training doctors undergo before they can practice medicine on their own, have been capped by Congress at about 90,000 since 1997 as a way to curb rising medical costs.
“Do the math,” said Safyer, president and chief executive officer at the New York hospital, in a telephone interview. “You give millions more people insurance, and it adds up to a much worse shortage.”
The doctor crunch is a result of an aging population and a rising demand for specialists, according to the federal health department. By 2025, the nation as a whole will confront a shortfall of as many as 159,300 doctors of all varieties, said Ed Salsberg, director of the Center for Workforce Studies at the Washington-based medical college association.
Tufts, Dartmouth
Medical colleges have added 1,500 seats since 2005 to address the doctor shortage, Salsberg said. Tufts University in Medford, Massachusetts, increased its first-year enrollment by 12 percent this year, according to data from the association. Dartmouth College in Hanover, New Hampshire, increased theirs by 7.7 percent, and the University of Tennessee in Memphis was up 10 percent, the data shows.
Still, “it takes years to produce doctors,” said Steven Lipstein, president and chief executive officer of the 13- hospital BJC HealthCare in St. Louis, that trains residents from Washington University. “It’s a very long pipeline and right now it doesn’t have enough in it to meet our needs.”
To reduce the shortfall, federal officials need to follow up on the commitment medical schools have made to growth and raise the number of residencies available to students, said Robert Feinstein, senior associate dean for education at the University of Colorado medical school in Denver. The cap, instituted to curb Medicare costs, affects all but about 20,000 of the 110,000 residencies at U.S. hospitals, according to the medical college association.
‘Nowhere Near’
“The number of residencies nowhere near meets the demand from the number of students who will be in the pipeline in the coming years, or the need the nation has for doctors,” Feinstein said.
Medicare, the federal insurance plan for those 65 and over and the disabled, pays about $100,000 a year for each residency, at a total cost to the program of about $9 billion, according to a report filed by the Medicare Payment Advisory Commission in June. Medicare reimbursements for service also take into account the number of residencies each institution maintains.
The funding mechanism was set up in 1965 when the U.S. was about to extend government health coverage to 19 million elderly Americans. As Medicare’s ranks grew -- to 45 million people as of the end of last year, according to the advisory commission -- the number of residencies was limited to contain spending.
The number, though, may change as a direct result of the health-system overhaul being debated in Congress.
Medicare Amendment
On Dec. 5, Democratic Majority Leader Harry Reid, along with Senators Charles Schumer of New York, Bill Nelson of Florida and other sponsors, submitted an amendment to the health-care legislation that would add 15,000 residencies at a cost to Medicare of about $1.5 billion, according to Atul Grover, a lobbyist with the medical college association.
Because Congress is looking to keep costs of the legislation down, that proposal may be cut or even eliminated during the debate, Grover said.
Even with the push for more residencies, about 1,500 have gone unused for the last three years, the medical school group’s Salsberg said. This is because some hospitals find they no longer can provide supervision or hands-on experience necessary to educate all the residents they’ve been allocated, he said.
The Senate and House health-care overhaul bills call for taking these unused residencies and redistributing a portion of them to other teaching hospitals to train primary care and general surgery residents. That translates into producing 243 to 400 more physicians a year, depending on which version of the legislation survives, Salsberg said.
Another Solution
Not all educators agree that more medical students, more residencies or even more doctors are the best solution for the doctor shortage.
Harvard Medical School in Boston, for instance, hasn’t added to its enrollment, choosing instead to train doctors to depend on advanced-practice nurses, physician assistants, nutritionists and pharmacologists to fill gaps in patient care, Jules Dienstag, dean for medical education, said in an e-mail.
“We need to focus on preparing our graduates for a future in which they will work on solutions to the doctor shortage,” he wrote.
Johns Hopkins University in Baltimore and Duke University in Durham, North Carolina, have chosen similar approaches where curriculum exposes medical students to community clinics and situations in hospitals where they work in teams.
“We are ending up with a population suffering from a variety of chronic diseases like diabetes and hypertension,” said Edward Buckley, vice dean for medical education at Duke. “But you don’t need doctors for much of this chronic health care. You need people who can talk with the patient and visit the patient in their home.”
Source: AOL
Date posted: December 20th, 2009
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