Dr. Kevin Most: Doctor Shortage
We have talked in the past about the looming shortage of physicians that we expect in this country. Those estimates have been outlined by many agencies and associations, one thing is clear, we will not have a surplus of physicians. The estimates of the physician shortfall can range from 60,000- 120,000 by 2030. One area of most concern is in the specialty of primary care physicians. Historically they are the lowest paid physicians and often medical schools will steer their students to other more high paying specialties.
What are we doing about this need? Well some schools are increasing their class size but this is not as easy as it sounds. Class sizes are not determined by how many chairs do we have in the teaching auditorium, it is based more on the clinical exposure the students will have opportunity to see. For the simple basics, the first 2 years of medical school are heavily weighted to classroom didactic teaching. During the first 2 years the student is gradually exposed to patients. The third and fourth year of medical school, the student is expected to apply the learnings from the first two years in an active clinical setting. The student in those years actually touch patients, assist in procedures, again learning on real patients what they were taught in the classroom earlier.
Residency is then the years spent after medical school and before actually practicing, this can vary from 3 – 15 years. The vast majority of this time is spent in the hospital caring for sick patients. There is some office exposure as well but the focus is clearly on hospital based care. One of the big changes we are seeing is there is a need to train physicians for a better focus on care of the outpatient, working much more in the office and less in the hospital as many doctors no longer go to the hospital to treat patients.
The reason I bring this up is there is a bill in front of Congress that may impact those physicians who are being trained to only practice primary care in the office and more importantly are being trained in underserved communities, areas where there is minimal or no primary care access. This current program is training close to 800 doctors at 57 sites across 24 states. Almost all are located in underserved or rural communities. The funding for this program may go away at the end of this month if not extended by congress.
This program is the “Teaching Health Center Graduate Medical Education Program” This program focuses on treating patients in an outpatient setting in areas that are underserved, many of these programs are set in an urban setting in areas where medical offices are not found. There are neighborhoods in many cities where basic primary care is not available. Many individuals in these areas rely on public transportation, making it even more difficult to receive care. We have talked about neighborhoods in this country where the ability to buy fresh fruit and healthy foods is not present, many of the clinics that are supporting this teaching program are in those neighborhoods.
Young physicians who sign up for their training in these programs are individual who are drawn to help the underserved and many will stay in the area and practice. Removing the funding for this program will impact the health of these very vulnerable communities in the short run by removing these training docs but more importantly in the long run as often see physicians staying in the area that they trained.
Call your congressman and ask him to support the “Teaching Health center Graduate Medical Education Program”