Physician Shortage Could Hit 90K by 2025

The Association of American Medical Colleges is calling on Congress to immediately fund an additional 3,000 medical residency slots each year in addition to the 27,000 to 29,000 residency slots already in place.

Under a best case scenario, the nation's graying and growing population will contend with a shortage of at least 46,000 physicians within 10 years, Association of American Medical Colleges projections show.

That shortfall could hit 90,000 by 2025 if the healthcare sector fails to aggressively embrace and promote the use of non-physician clinicians, and adopt more efficient care and payment models such as patient-centered medical homes and accountable care organizations, AAMC said.

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In addition, AAMC wants Congress to immediately fund an additional 3,000 residency slots each year, in addition to the 27,000 to 29,000 residency slots already in place. Graduate Medical Education has been capped for the past two decades. What was a supposed to be a temporary cap has become permanent.

"What we are suggesting is a modest increase in that cap right now," AAMC Chief Health Officer Janis M. Orlowski, MD, told reporters Tuesday. The estimated cost of the bill is $10 billion over 10 years. "This does not alleviate the physician shortage in any of the different scenarios that we are looking at. We see it as a multipronged approach," she said.

The AAMC projections include a shortfall of 12,500 to 31,100 primary care physicians, and between 28,200 and 63,700 subspecialists.

Orlowski says it's a simple case of supply and demand.

"Although physicians supply in the US is projected to increase modestly between 2013 and 2025 demand will grow more steeply," she says. "Specifically, total demand for physician services is projected to grow as much as 17%."

"The bottom line is that the physician shortage is real; it is significant. It's particularly serious for the kind of medical care our aging population will need, and it must be addressed today, in 2015, if patients are going to be able to get the care they need in 2025. The good news it is not too late to fix this. Congress needs to act now."

Residency training costs about $16 billion nationally, of which Medicare provides about $3 billion. It costs about $152,000 a year to train a physician, of which Medicaid pays $40,000. The average student debt after graduating from medical school is about $176,000 AAMC says.

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AAMC President/CEO Darrell G. Kirch, MD, told reporters "the onus is on Congress to lift the artificial cap that has been in place since the 1990s and do its share of contributing to the training."

"A large portion of the funding for residencies is already borne by teaching hospitals. Students already carry massive amounts of debt," Kirch says. "We need to make sure the federal support is aligned with those efforts."

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Kirch says AAMC is not in a position to recommend which states receive the new residency slots, or if existing slots should be moved to other states to account for demographic shifts.

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"It is not the role of the AAMC to tell which areas that they should start or stop individual residency programs," Kirch says. "That is a local decision that each hospital, each potential training site needs to make. Whether Congress would want to go in that direction is an issue for policy makers. The purpose of this analysis is to show the overall national landscape."

An AAMC study from 2013 shows that Northeastern states such as Massachusetts, New York, Connecticut and Pennsylvania have the highest ratios of residency slots per 100,000 population. These states also have the highest ratios of physicians per 100,000 population. For example, Massachusetts had 421 active physicians and 87 residency slots per 100,000 in 2011, while Florida had no more than 265 active physicians and fewer than 20 residency slots per 100,000.

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Last month, safety net hospitals and teaching hospitals in Florida projected a shortfall of 7,000 physicians and called for a shift in residency slot allotments, which they say unfairly rewards the physician-rich Northeast.

"We just passed New York as the third most-populous state," Jim Burkhart, president and CEO of Tampa General Hospital, and vice-chair of the Teaching Hospital Council of Florida, said in a recent interview.

"The number I heard today was that Florida is growing at the rate of 800 new residents per day. But we are 42nd in the number of residency slots we have per capita. That is a formula for disaster."

Kirch said Tuesday that "where a residency spot exists does not determine where a physician actually ends up practicing. So, there is no guarantee that putting residency spots in different locations is going to move physicians to that location. We live in a country where people are given free choices and after their training residents can choose where to practice."

Instead of shuffling residency slots, Kirch says states, local areas and health systems may be better served by recruiting new physicians with job perks such as debt forgiveness.