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The Difficulty of Predicting Physician Shortages


 

Much of the criticism directed at the IOM’s proposed revamping of federal GME funding stems from the idea that a graying population will place additional strains on a healthcare system that already is facing a significant doctor shortage.

“Number one, they came out and said, ‘We don’t know that there’s a shortage of physicians and we’re, if anything, going to remove money from the training system rather than putting in additional resources,” says Atul Grover, MD, PhD, FACP, FCCP, chief public policy officer for the Association of American Medical Colleges. “So we found that problematic, given all the evidence we have of the growing, aging population.”

Census figures indeed suggest a rapidly growing population of seniors: By 2030, one in five U.S. residents will be at least 65 years old. The estimated size of a future doctor shortage, however, has proven far more contentious.

Vikas I. Parekh, MD, FACP, SFHM, chair of the SHM Academic Hospitalist Committee, says most observers agree on a few basic points: that the pool of U.S. physicians leans more toward specialty than primary care and that significant workforce gaps exist in certain geographic locations—both in primary care and in other specialties.

Dr. Grover says the uneven distribution and an overall shortfall are both problematic; the AAMC has projected a shortage of up to 90,000 doctors by 2025. But Dr. Parekh says predicting future workforce numbers has always been a challenge.

“We concluded that attempts to forecast physician supply and demand, both in the aggregate and by broad specialty types, have been singularly unsuccessful in the past. In fact, past projections have not always been even directionally correct.”
–Gail Wilensky, PhD

“Historically, the projections of what the shortages might be have not been reliable or accurate,” he says.

In a recent outlook published by the National Institute of Healthcare Management, IOM committee co-chair Gail Wilensky, PhD, a senior fellow at Project HOPE and former Medicare administrator, goes a step farther. “We concluded that attempts to forecast physician supply and demand, both in the aggregate and by broad specialty types, have been singularly unsuccessful in the past,” she writes. “In fact, past projections have not always been even directionally correct.”

Deborah Powell, MD, dean emerita of the University of Minnesota Medical School and another IOM committee member, likewise defended the report’s analysis.

“I have had physicians tell me that they do not understand why our report said that there was not a physician shortage, and I try to point out that we did NOT say that,” she writes in an e-mail to The Hospitalist. “Rather, the report [and the committee] said that we could not find compelling evidence of an impending physician shortage and that physician workforce projections had been and are quite unreliable.

“However, we were agreed, and stated multiple times, that there were and are striking physician shortages by geography and specialty in multiple areas of the country, and we suggested a specific system change aimed at beginning to address these geographic and specialty shortages.”

The committee members decided against the “one size fits all” solution of simply expanding the current system, she says, because they believed the existing structure had contributed to the disparities in the first place.

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