Schooled Reporting on education

Doctors in demand

Education | Medical schools are graduating more new physicians than ever, but America still faces a growing physician shortage
by Leigh Jones
Posted 9/05/18, 04:28 pm

Finding a family doctor could get a lot more difficult in the next 10 years.

The United States already has a physician shortage—fewer doctors than are necessary to meet patient demand in a reasonable amount of time. But it’s about to get a lot worse. By 2030, the U.S. medical system will be short as many as 121,500 doctors, according to a recent estimate by the Association of American Medical Colleges.

Some medical schools have framed the problem in financial terms: Last month New York University announced a plan to offer free tuition to help reduce future doctors’ debt loads. It’s the first medical school to offer such a deal, but it probably won’t be the last. NYU’s associate dean for admissions and financial aid, Rafael Rivera, said medical schools have a “moral imperative” to remove potential obstacles, especially for doctors who might choose less lucrative fields, like primary care, if they didn’t have so much debt.

But is the prospect of mountainous student loans really keeping America’s best and brightest from choosing a career in medicine?

The number of students applying to medical school suggests it’s not. Medical schools have increased enrollment by 30 percent since 2002, and the number of applicants has grown by 50 percent. To help accommodate all the physician hopefuls, 22 new medical schools have opened since 2007.

If so many students want to become doctors, why do we have a projected shortage?

Demographics play a significant role. The number of Americans aged 65 or older is expected to grow by 50 percent between 2016 and 2030. By contrast, the population under 18 is expected to grow by only 3 percent. Older people need more medical care.

And while medical schools are turning out new doctors, they’re not enough to replace the ones hanging up their stethoscopes. More than one-third of all active physicians will be 65 or older within the next decade.

Another problem: Younger doctors are working less. According to the Association of American Medical Colleges, if the trend of physicians working part time continues at current levels, we will have 32,500 fewer doctors working full time in 2030—about one-quarter of the overall projected shortage.

David Stevens, CEO of the Christian Medical and Dental Association, blames the increase in part-time doctors on burnout. Younger doctors, especially millennials, have a different view of work-life balance. They want more time at home with their families and are willing to work less and make less to have a better quality of life, Stevens told me.

But the medical profession’s industrialization has pushed doctors of all ages to consider cutting back. Most doctors now work as employees for large healthcare networks that are more focused on the bottom line than on building patient relationships.

“It used to be a profession where you as an individual have a covenant relationship with the patient, you’re running your own practice, you had control,” Stevens said. “Healthcare professionals feel like they have very little control or say in what happens and they’ve become units of production.”

And while many doctors struggle with disillusionment over changes to their profession, Stevens finds the problem particularly acute among Christian physicians: “People get a few years of practice and they think, ‘Wow, is my life going to be like this for the rest of my life? I want to have ministry. I want to build myself into people's lives. I want to provide them spiritual and physical healing, and I’m not having the opportunity to do that like I hoped.’”

Associated Press/Photo by Damian Dovarganes Associated Press/Photo by Damian Dovarganes Students in Los Angeles walk out of school in April to protest gun violence.

Digging into data on school shootings

Advocates for stricter gun laws insist tighter controls are necessary to stem an epidemic of school shootings. Activists in Boston recently staged a mock back-to-school fashion show that featured bulletproof vests, helmets, and gas masks. The not-so-subtle message: American schools are dangerous places.

Two horrific shootings during the last school year would seem to back that assertion. Statistics quoted in many media stories also paint a dire picture: Everytown for Gun Safety has logged at least 57 incidents of gunfire on campus so far in 2018. Government statistics are even worse. A U.S. Department of Education report released this spring claimed 235 schools reported at least one incident involving a gun during the 2015-16 school year.

But most of those incidents never happened, according to an analysis by NPR. Reporters managed to confirm just 11 incidents from the government data. The rest? Reporting errors. Some of them are blatantly obvious: Cleveland schools reported 37 shootings, but that number was actually entered on the wrong line of the spreadsheet. The real number of shootings in Cleveland schools? Zero.

Legislators are spending millions on school safety measures across the country. If school shootings aren’t really a widespread problem, is that money well spent? —L.J.

Associated Press/Photo by Paul Sancya Associated Press/Photo by Paul Sancya Gardner Elementary School in Detroit

Busing in bottled water

Students heading back to school this week in Detroit won’t be racing to the water fountain after recess. Administrators at Detroit Public Schools announced last week they would shut off drinking water at all 106 schools after tests revealed elevated levels of lead and copper. The district’s 50,000 students will instead have access to bottled water—a switch expected to cost $200,000 for the first two months. Officials hope to negotiate a better deal for the rest of the school year. Detroit isn’t the first big school district to switch to bottled water. Schools in Portland, Ore., shut off their water fountains in 2016, and most schools in Baltimore cut their taps more than 10 years ago. The water crisis in Flint, Mich., revealed the dangers of aging water system infrastructure. Experts warn contaminated drinking water is a widespread problem, especially in older communities. —L.J.

Binge-drinking crackdown

The North-American Interfraternity Conference voted almost unanimously this week to ban hard liquor at U.S. and Canadian fraternities. If they want to serve anything other than beer or wine, fraternities must hire a licensed, third-party vendor to provide the drinks. That could help prevent minors from binge drinking, since vendors risk losing their licenses if they serve to anyone under 21. Several alcohol-related deaths following frat parties at U.S. universities during the last school year prompted the change. All those cases involved pledges or fraternity members too young to drink legally. —L.J.

Settlement in Piazza case

Timothy Piazza, a 19-year-old Penn State University student who died after a fraternity hazing ritual in 2017, became the face for the push to hold Greek organizations accountable for their booze-soaked soirees. This week, Beta Theta Pi’s national organization settled a lawsuit filed by Piazza’s parents. The family declined to disclose the financial terms but announced the fraternity agreed to adopt a 17-point safety program to prevent similar tragedies in the future. Jim and Evelyn Piazza have had limited success seeking justice for their son. A Pennsylvania judge dismissed the most serious charges against the fraternity members who didn’t get help for Piazza even after he fell down a flight of stairs and lay unconscious for hours. —L.J.

Leigh Jones

Leigh lives in Houston with her husband and daughter. She is the news editor for The World and Everything in It and reports on education for WORLD Digital.

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Comments

  • JOSEPH HOYLE
    Posted: Sat, 09/08/2018 08:24 pm

    Please note that the Association of American Medical Colleges has a conflict of interest in the projection regarding physician shortfall.  Although HRSA data is a little bit old (2013), HRSA projects the shortfall of family doctors can almost be made up with nurse practitioners and physician assistants, and that there are already a surplus of pediatricians.  The estimate is that the shortfall in 2020 would be 6,400 full time physicians for the entire nation.  "Nine states are projected to have 2025 shortages of both primary care physicians and PAs: Alabama, Arkansas, Indiana, Illinois, Louisiana, Mississippi, Missouri, New Jersey, and Ohio." 

    As a young family doctor who loves my job, I encourage medical students to choose primary care, and I agree that work-life balance can be achieved and appreciate guidance from CMDA.  

  • liannf
    Posted: Tue, 09/11/2018 03:09 pm

    I am not a family physician, but am married to one.  I have watched my husband go from a payback period of four years in the Navy to private practice to being a hospital-employed physician over the last 30 years.  He survived the Navy because he had to and he knew his time was short, but he hated that he was unable to do what was best for his patients because of the rules and procedures in place with the military.    He then went on to a private practice with another physician and worked hard, but was happy most of the time.  He did get frustrated as the years went on because of the amount of time and money required to get approval from insurance companies to do what was needed for his patients, but they were still dedicated to the relationship with and care of their patients.    But his problem was the "corporate practice of medicine" meaning that the medical decisions for his patients were being made by insurance companies and decreed from people who had no clue about medical care or the people that the doctor was dealing with. These decisions had medical consequences that kept his patients from receiving the care they needed.  After his partner died very unexpectedly, he turned over (they would not buy) his practice to the hospital.  He spent the next two years becoming more and more unhappy as he was relegated to just another cog in the wheel. He tried to help the practice do the best for his patients, but the hospital didn't value his experience or his desire for doing what was right. They ignored his offers of help even though he wanted no extra income.   The hospital set up many "physician extenders" in independent settings who theoretically had physician supervision required by law but rarely had any oversight. He does have respect for several of the extenders, but finds that many get in over their heads without knowing so. It is the difference between four years of medical school and three years of residency versus the two years post graduate work to become a physcian's assistant.  The prices that the hospital run clinic charged were much higher than the prices that his practice charged because they were allowed to do so and he lost many patients that way.  The hospital reduced the amount of staff in his office and wanted more people seen in less time, again reducing the care that the patients received.  After two years, he quit because he was tired of not being able to provide good care for his patients.  He is now working with another doctor in Direct Patient Care.  They can take as much time as needed with each patient and because they don't take insurance, they don't have to fight for medical care for the patient.  They can negociate prices for drugs and procedures and the patient is able to choose what he would like to do.  

    From his standpoint, corporate America does not value or pay for primary care physicians because it is cheaper to pay for PAs or Nurse Practioners.  There is a loss of continuity in patient care since most people go to large clinics and see whoever is available.  The patients are paying the fees for seeing a physcian, but are usually seen by extenders.  And physicians are quitting because they are tired of the lack of respect from the administrators they deal with and the increased amount of work they are required to do that are not part of their training.  Is it the best use of resources to require physicians to do the work that secretaries and medical transcriptionists used to do?  He proudly claims that he is a dinosaur who wants to have relationships with his patients and continuity of care and doing what is right for them. 

  • JOSEPH HOYLE
    Posted: Tue, 09/11/2018 08:49 pm

    Thank you for the comments and I think DPC is an exciting model for some.  The model I follow is more based on an article on Finding Joy in Practice http://www.annfammed.org/content/11/3/272.full that certainly agrees that physicians should not be doing secretarial roles - and CMDA has also provided similar resources to membersx  I do think there is a role for PAs, NPs, and other physician extenders in the primary care system, like there is in the armed forces, and more should be done to leverage the differences in training and (nursing) philosophy to benefit patients through collaboration instead of equivalence in the eye of payers... but I think physicians may have suggest these types of models and in SC there seems to be more competition than collaboration at this time.  My point was mostly that the situation is probably not as dire as the Association suggests.  

  • jmw
    Posted: Wed, 09/12/2018 08:31 am

    Thank you Leigh Jones for this article.  It was intersting to me since I also, as liannf, have been married to a practicing family physician for 25 years.  A few points that would help explain the mess that our healthcare system is in:

    1. Ask how much time physicians spend on the computer compared to about 7 years ago.  A hospital administrator said to me a few years ago, "These new kids can't see as many patients as the old guys can."  These "new kids" don't know what life was like without all the data entry.  My husband's work day increased by about 2 hours/day once the ACA mandated that records be paperless.  It was unsustainable.  That drove him to retire from his 20 years of practice in rural Indiana and take a position with a healthcare company that has an on-site clinic at a manufacturing plant.  He does all their primary care and is seeing half the volume of his previous job.  He is now getting home at a decent time but he also left thousands of patients with whom he had formed valuable relationships.

    2.  Find out what an "RVU" is.  Many or maybe most, I'm not sure, physicians are paid via an RVU formula.  The more people you see, the higher you code, the more money you make.  The question at supper from my kids used to be, "how many people did you see today?"  A higher number of patients meant a higher paycheck that month.  It is maddening.  It seems to be a conflict of interest.  My husband always felt the pressure to "keep his numebrs up".  His new job is salaried.  He took a 10% paycut but it was worth it!   He now feels he can take more time with his patients and be a family doctor like he was trained to be.  I'm so thankful that he does not work under an RVU system anymore.  But I believe most physicians still do.

    My husband has said many times, "I just want to practice medicine."  He doesn't want to be entering data into the computer for hours each day nor does he want to be counting how many patients he sees each day.  Checkout the concept of RVU's and compare time on the computer with 7-8 years ago.  This might provide more insight into why there is so much physician burnout.

    Thanks for listening.

  • Brendan Bossard's picture
    Brendan Bossard
    Posted: Thu, 09/13/2018 01:14 pm

    I have worked in the medical records department of a psychiatric hospital for the past 10 years.  We still keep paper records, although we are transitioning (slowly) to electronic.  Regulatory and licensing requirements have caused our charts to double or even triple in size since I began.  Forms are much more complex.  Logging into computers to record notes, orders, and all the other ancillary stuff takes time.  These things roughly measure how much more work everyone--not just doctors--have to do in this field.

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