Supply of new physicians stagnant; widespread shortages uncertain – Point Of View
PCR interviewed Michael Whitcomb, M.D., senior vice president for medical education at the Association for American Medical Colleges (AAMC), about the supply of residency graduates and the potential for physician shortages.
What direction has the number of residents in U.S. teaching programs taken in the last few years? It has been roughly stable. AAMC and AMA jointly conduct a survey every year of all residency programs, and the results of the 2001-02 survey were published in the Sept. 4, 2002, Journal of the American Medical Association. (JAMA indicates that in the five years from 1996-97 to 2001-02, the number of residents declined about 2% from 98,076 to 96,410. Most of that decline was in the last two years.) This year, 2002-03, is roughly the same, and the prospects for the next several years are similar.
Some fields with very high demand and rapidly increasing pay scales, like radiology and anesthesiology, have attracted sizable increases in numbers of residents. Have some other fields, particularly primary care, lost residents? Yes, primary care has lost residents, and the losses are concentrated in family practice. But the two fields you mention don’t have enough physicians to make a big difference in supply in other specialties.
Why the decline in family practice? Because once you start there, you’re committed to primary care. If you do internal medicine, you have the option of going on to specialties such as cardiology when you finish residency. Pediatrics training is separate from the other two main fields, and many residency grads in that field are subspecializing.
So there’s basically a flat overall supply, with some specialties gaining at the expense of others. Certainly overall demand for physician services is increasing. Do you foresee widespread shortages developing? AAMC is unsure. There’s insufficient data on whether there’s an excess or shortage of physicians, and much better studies need to be done. In the summer of 2002, AAMC issued a statement on the physician work force saying as much, and withdrawing our former view that there is an excess of physicians and steps should be taken to cut the numbers entering the field.
What about the practice managers reporting great difficulty recruiting in some fields, and recruiters reporting inflationary sellers’ markets? We don’t deny what they’re experiencing. But it could be a bubble due to the earlier retirements taking place today in comparison with 20 years ago. Once the number of retirements stabilizes, we could be in equilibrium again.
Why have retirements gotten so much earlier? I think the biggest reason is the much greater complexity of clinical medicine compared to 10 or 20 years ago, which leaves many people trained before then feeling more and more uncomfortable in practice. Lay people often think medicine is a relatively static occupation in technique. Nothing could be further from the truth. Over 30 or 35 years, there’s been a tremendous amount of change. For instance, general surgery has almost entirely shifted to laparoscopic techniques. Thirty years ago, residents were trained on scalpels. And it’s true in every discipline. There’s also the incredible administrative complexity of medicine in comparison with 10 or more years ago.
Probably the second key reason is that there are much more effective ways to save for retirement, such as 401(k) plans.
Do you think retirements will stabilize soon? There’s no way to tell. There simply are no good data on physician retirements. AMA’s data are not detailed enough. Many retired physicians keep renewing their licenses. Many go into semi-retirement first. (See article on part-time physicians, p. 1.)
Is there any way to “pump out” significantly more residency grads over the next five or six years in fields that seem to need them like cardiology? In a word, no. The training pipeline is too long. Also, it’s too hard to start a program in a specialty in a teaching hospital for there to be dramatically more than exist today in any given field, or dramatically larger programs. Medical schools and teaching hospitals are coping with funding cutbacks, not bulging with money to start new programs.
What is the situation in U.S. medical schools? Roughly similar to that of teaching hospitals–generally a static output with very few new programs.
Isn’t there a reduction in the number of med school applicants? Yes, but that hasn’t led to a reduction in the number of medical school entrants or students. Nor has it led to a reduction in student quality.
Contact Whitcomb at (202) 828-0505 or mwhitcomb@aamc.org.
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