Health Reform and the Physician Shortage

A recent study published in the Journal of the American Medical Association indicates that the average number of hours physicians work already is in decline. The study showed that average hours worked by physicians per week dropped from 55 between 1977 to 1997 to 51 between 1996 and 2008, a 7.2% decrease.

The study’s authors project that this is equivalent to eliminating 36,000 physicians from the workforce. They also note a strong correlation between the decline in average physician hours worked per week and the decline in inflation-adjusted physician fees, suggesting that doctors work less the less they are rewarded. Health reform did nothing to address Medicare’s physician reimbursement formula (SGR), and any significant upward spike in physician reimbursement is unlikely (though reform did provide some primary care doctors with a temporary fee bump).

Cost savings through health reform will not be achieved by limiting access to health insurance (indeed, reform does just the opposite). Savings therefore will have to come from reduced fees to doctors and other providers, leading to an increasingly less independent, less engaged physician workforce that works fewer hours per capita. This workforce will be relied upon to care for our growing, aging population and the tens of millions of patients newly insured through health reform.

Clearly, there is a profound disconnect between the supply of physicians and demand for their services that will need to be addressed if the new system is to work. One key is to train more physicians—limiting physician training to a ceiling set in 1997 is not sustainable.

However, the conditions under which physicians practice also must be changed to ensure a physician workforce that is motivated and robust. Standardized reimbursement processes, reduced educational debt, tort reform, increased clinical autonomy—in short, a paradigm shift in the medical practice environment is needed to stimulate the most productivity from today’s physicians and to attract new doctors who are ready, willing and able to provide patient care in the era of health reform.