Physician Shortage in the United States

BY: Fozia Yousaf

Primary Care Provider Shortage

United States, one of the most industrialized nations has a great shortage of primary care physicians recent survey discovered about 16% of U.S adults who need primary care

physician have to wait a week or more to see a doctor (Sandeep, Battinelli, 2014)

Because primary care physicians are paid the least from all the medical specialties. (Sandeep, Battinelli, 2014)

Students have a decreased interest in medicine Students do not want to spend long years in medical school and the tuition

rates are too high for them A lot of people are not willing to be committed in the medical field because

it requires a lot of time and dedication. (Sandeep, Battinelli, 2014) The U.S. needs new providers so the patients be treated so their health

needs can be met. A recent report says, “A shortage of as many as 44,000 primary care physicians by 2025” (Sandeep, Battinelli, 2014)

International Medical Education The U.S. needs new providers so the patients be treated so their health

needs can be met A recent report says, “A shortage of as many as 44,000 primary care

physicians by 2025” (Sandeep, Battinelli, 2014) Insufficient number of health professionals who cannot give the medical

care This is a human resource crisis due to this shortage World Health Organization is proposing to increase the production of

community health workers, non-physicians, and clinicians. Educating the number of doctors and the capacity of medical education

programmers should help in physician shortage

Distribution Analysis of International Medical Schools

The physician shortages across the world makes it harder when there is a low supply of medical schools

The countries with the fewest medical schools are Nigeria, with 32 (1.2% of all medical schools), Argentina 36 (1.4%), Germany with 36 (1.4%). (Duviver, Opalek, Zanten, and Norecini, 2014)

The study shows under developed countries are short on medical schools have the highest risk of the physician shortage the medical schools in the African continent is skewed. Eastern and southern Africa have

very low numbers of medical schools. It indicates that Cape Verde has no medical school and eight other counties in West Africa only have one medical school. (Duviver, Opalek, Zanten, and Norecini, 2014)

Asia scored the highest with a grand total of 1,188 medical schools This is because more than 60 percent of the world population lives in Asia, along with 46

percent of the medical schools are located there.

Distribution Analysis of International Medical Schools

Many countries have physicians in the institutions in the Caribbean to be trained “for the international rather than the national labor market” (Duviver, Opalek, Zanten, and Norecini, 2014)

Another reason that some countries have physician shortage is because they are trained for international countries and leave their country after completion of their degree

The country loses its graduates that migrate to the United States or other developed countries and it becomes an issue for the country that is already short on physicians

these countries have “low total number of schools with large class size or a high number of schools with large class size of or a high number of schools with a small class sizes” (Duviver, Opalek, Zanten, and Norecini, 2014)

government should play a strong role to fix this issue to the number, capacity, and quality of the training institutions

Physician Supply, Number of Medical Supply, Medical Education Programs

the relationship between physician supply and the number of medical supply which negatively affects the medical education programs. (Duviver, Opalek, Zanten, and Norecini, 2014)

The authors states “there is clear evidence of associations between the number of health workers and morbidity and mortality” (Duviver, Opalek, Zanten, and Norecini, 2014)

There is not enough physician training and quality is also poor in some countries

This makes it hard to produce the amount of physicians that are needed in healthcare

This affects the health system and the students’ clinical experience will be lacking which will make it difficult to practice in the real world of medicine

Physician Supply, Number of Medical Supply, Medical Education Programs Other reasons for physician shortage are “early retrenchment,

emigration, and retirement” (Duviver, Opalek, Zanten, and Norecini, 2014).

Other indicators of physician shortage is poor management which turns into “ suboptimal deployment, absenteeism, and ‘ghost workers” like “ physicians who appear on pay rolls while being registered as off-post” (Duviver, Opalek, Zanten, and Norecini, 2014)

The goal of this study was to give a summary of the world’s medical schools and present the issues on physician shortage, limited medical institutions, poor medical education, and lacking clinical experiences

The government should take a step to change this by giving more attention to these problems in the health industry.

General Practitioner Shortage in Europe

European countries are facing shortages of general practitioners that are referred to as physicians

These General Practitioners shortages are especially low in the rural areas.

This is a problem in the health system because it will cause conflict in providing the healthcare for those people who are close to doctors especially for the growing aging population that cannot drive to receive their regular checkups

It would be nice to have their doctor close by their homes so there is less traveling which will make it easier for the elderly population

Strategies to improve General Pracitioners in EuropeCoercive Utilitarian Normative

Coercive Strategy

One example of coercive strategy is “restricting the entry to a particular health care delivery area” (Steinhaeuser, 2014)

This strategy will help to distribute doctors among all areas such as the urban, rural, and semi-rural

Utilitarian Strategy

The concept of providing scholarships, educational loan payments in return for service in underserved areas

Normative Strategy

when people incorporate the concept of education that will provide doctors the training that will help them working in the underserved areas

It is important to define “rural” because each country has its own definition (Steinhaeuser, 2014)

Rurality was defined in various ways, sometimes by the “cost or time to travel” such as going to a hospital. (Steinhaeuser, 2014)

Perspectives of young Doctors in Rural Areas

Sometimes young doctors in the rural area may have a negative perspective about the type of a health care delivery

This can influence the doctors or give false perceptions about General Practitioners that work in rural areas in Germany which has more working hours and less opportunity to become specialists

New-Zealand has strategies for the young doctors to work in the rural areas by giving them financial incentives

Australia Rural Doctor Association

Australia’s Rural Doctors Association has given a warning on the issue of low rural medical workforce shortage (Minor, 2014)

The association announced this when the records of physician shortage demonstrated a need to increase doctors in the rural areas. The data came from the Australian Institute of Health and Welfare

Ian Kamerman, President of Rural Doctors Australia Association, informed that the rural practitioner workforce was facing a decline and major attention is required to fix the issue

The association announced that doctors in rural areas are working extremely long hours and it would be helpful to increase the number of doctors

Solutions by Ian Kamerman (President of Rural Doctors Australia Association) Want doctors to possess skills that will provide the right medical care Want government & the policy makers to consider these things want the upcoming practitioners to have access to the rural training programs,

support the people, and provide incentives to work in the rural setting (Minor, 2014)

“rural pipeline for training medical graduates through rural clinical school” and offer the students the specialists training in the community (Miner, 2014)

The Pipeline model includes training programs that will create incentives for people “to go rural” after completing the pipeline model (Miner, 2014)

This program will train medical graduates by incorporating clinical schools in the rural areas based on specialist training and then placing them in the community to serve the people (Miner, 2014)

Alzheimer’s disease lacks Physicians The adults with Alzheimer’s disease & related dementia in the United

States is a major issue One in nine people who are 65 and older and one-third of the

population group that is 85 and older have Alzheimer’s disease (Gregg 2014)

By 2050, the people with Alzheimer’s disease will triple from 5.0 million to 13.8 million(Gregg 2014)

The health care system is facing problems because the supply of physicians is not enough

There is lack of dementia care and chronic disease management, under appreciation, law investment in primary care and long term services, and a shortage of other health care workers (Gregg, 2014)

Gregg defines Alzheimer’s disease as “a chronic, progressive illness with median duration of seven to ten years” (Gregg, 2014)

Alzheimer’s disease lacks Physicians Continued…

The disease of dementia is first diagnosed by the primary care physician providers and these people also complete the evaluation after several visits(Gregg, 2014)

The primary care physician will refer these patients to a neurologist, or psychiatrist. The United States is short of primary care physicians and these patients need the initial help for evaluating their health conditions

The primary care physicians’ role is to diagnose the patients and give the patient’s family feedback, and refer the patient to where the medical treatment can start(Gregg 2014)

Alzheimer disease is a serious disease and patients need all the medical care there is to slow down the disease process

People start developing this disease late in life and primary care physicians are needed for all stages of the disease. (Gregg, 2014)

In the early disease stage, the primary care physician provides the diagnosis, initial plan of care, referral for long-term service, and primary management with 2-3 routine visits per year or hospital care as needed(Gregg, 2014)

In the middle disease stage, primary care practitioners provide primary management and referral for long term service, maintaining general health of patient, and monitor for patient safety and caregiver stress. (Gregg 2014)

In the late disease stage, primary care physicians provide primary management and palliative care, monitor for patient safety, and assist with planning for end of life care. (Gregg 2014)

Alzheimer’s disease lacks Physicians Continued… The primary care provider’s job is to give the “comprehensive care” for

the patients who have Alzheimer’s disease and the United States needs many primary care physicians for these older people by 2025. (Gregg 2014)

The Alzheimer’s population is supposed to grow by “15.2 percent from 2010 to 2025” (Gregg, 2014)

The age group of 65 and older is expected to grow and 60% of these people will develop Alzheimer’s disease. (Gregg 2014)

Difficulty Entrance to Medical School Statistics shows in 2009 that only 19,332 of the 42,269 students who

applied to 129 medical schools in the United States were accepted. (Feldstein, 2011)

There are many qualified students who are not accepted each year for medical school because the schools did not have enough space for these people. (Feldstein, 2011)

Other reasons could be that there is not enough medical equipment to practice for lab work, having low faculty number, and classroom size is not large enough

Some excellent students are rejected because the people completed medical education from other countries such as Mexico (Feldstein, 2011)

Students who complete medical school overseas have to pay a higher tuition in the Unites States and have a longer training period than the U.S medical schools.

There are very qualified students, but the requirements for medical schools are competitive and demands for the best ones should be admitted in medical schools.

Medical Schools for African Americans The shortage of physician has many causes and John Issac talked about

race being one of the factors which is a healthcare disparity in the United States

The number one nationality is African Americans who do not receive equal access to medical education, and do not receive acceptance for high level health jobs

Issac says, “Cultural competence and makeup of this workforce will either reduce or perpetuate the health disparities in the coming years” (Issac, 2014).

The Association of American Medical Colleges has published the data which states that there is evidence unequal access for minorities to medical school and the medical profession

African American males had the lowest acceptance percentage rate for medical schools in 2012.

African American females had the lowest acceptance rate of 36% of any female group applicants.

Health Policies Medical Education Department Assistance Program American Medical Association 5-year Strategic Plan American Medical Association Evercare Loan-forgiveness Program Reducing Medical School Subsidies Nurse Led Program Diversity in Healthcare

Medical Education Department Assistance Program

The Medical Education Department Assistance Program helps the medical residents to fill the vacancies in the hospital which will create more doctors to practice in the facility.

This program will assist the international students and other medical students who will start the residency programs at the hospitals

The American Medical Association (AMA) is committed to ensuring that physicians-in-training are successful as they advance through their education cycle” (American Medical Association).

It offers the most complete, up-to-date information regarding graduate medical education (GME) for medical students, residents, educators, academic physicians, and residency/fellowship program directors

Guides students in the right direction The Medical Education Department is designed for medical students who need to complete residency at

their hospitals The department makes an effort so medical students can start their residency program and provide the

students their medical residency orientation The Graduate Medical Education is known for setting standards, monitoring, accrediting medical residency

programs in the United States. (American Medical Association)

American Medical Association 5-year Strategic Plan

The senior management team came up with a 5-year strategic plan with having focus and impact, research, education, and advocacy are involved.

The AMA engagement will make a difference in physician shortage by incorporating a strategic plan that will bring positive changes in the healthcare systems

The AMA is trying to improve health outcomes, accelerate change in medical education, and shape delivery and payment models that will demonstrate high quality care and value while enhancing physician satisfaction and practice sustainability(AMA Foundation)

American Medical Association American Medical Association offers financial assistance by giving medical students

scholarships, grants, and awards to the top medical students and residents in the world (AMA Foundation)

First, health outcomes are important because American Medical Association has leadership that will help establish quality and performance measures.

coming up with ways to change the physician education in the U.S that will motivate more people in the medical field

The AMA wants to create an accelerating bold innovation in medical education aim is to transform the medical education and the historic leadership at all levels. AMA intends to develop a strategic way to bring change, better education outcomes with

the changing needs of the healthcare system (AMA Foundation) Since physicians are needed in healthcare, the organization is trying to create methods

that will help them receive the best education and develop leadership skills for physicians that will keep them together as a team in healthcare.

American Medical Association Continued… American Medical Association is trying to shape delivery and payment models that demonstrate high

quality care and value while enhancing physician satisfaction and practice sustainability (AMA Foundation) There will be federal and state legislative advocacy that will help make improvements in the delivery

systems in healthcare Physicians will like to practice in a good environment and this is a way to keep the supply of physician at a

good level. The past and current health models are willing to make efforts to do this task with making sure doctors are satisfied so there will be successful outcomes

The AMA is coming with research activities and making partnerships “individual physicians, integrated physician organizations, and others to help identify effective delivery models that provide both high quality patient care and physician satisfaction” (AMA Foundation)

In order to keep physicians in healthcare the AMA will help the doctors in providing them with the sources they need to make valid decisions about their future practice environments

The organization will guide in implementing changes in their practice. This will make doctors satisfied to continuing their careers to give good quality care for their patients

The AMA will use these key ideas to drive and make changes in the practice by demonstrating delivery and payment models that will show “high quality and value while preserving, restoring and enhancing professional satisfaction for physicians” (AMA Foundation) .

Evercare Evercare is a Medicare managed care program where the patients receive special needs that

helps with intensive care and case management Model involves having health professionals and the physicians who will provide excellent

quality of care Improve patients who have chronically ill conditions Sometimes physicians are not available at the health settings, so the registered nurses can

substitute doctors so they can diagnose the patients who have various diseases Nurse practitioners and a social workers who work together with the primary care physician John Hopkins University created the Guided Care Program for families and friends. (Wenger,

2014) Nurses & primary care physicians plan to work together and help with caring of 50-60

patients with chronic illness This program was developed for the elderly population who required special needs plans

and extra specialized care Ever Care was one of the Medicare Advantage plan categories and it was established by the

Medicare Moderation Act of 2003 The Centers for Medicare and Medicaid service’s aim was to offer excellent quality care and

should have top priority on patient’s health status, manage chronic diseases, and decrease hospitalization

Loan-forgiveness Program

Will increase the number of primary care physicians and forgive many students’ loans from medical schools and this can attract young students to the health profession

The Association of American Medical Colleges and the American Colleges of Emergency Physicians and the Emergency Medicine Residents Association show concerns for students who have high loans after medical school

After hearing these organizations’ voices the Academic Affairs committee established the “Medical School Debt/Loan Repayment-Forgiveness.” (ACEP)

The purpose is to help pay for the high medical loans for medical students, residents, and the young physicians

The National Health Service Corps annual budget is at $125 million and these funds are used for loan-repayment of medical school. The NHSC also provides scholarships to the racial and ethnic minorities

Reducing Medical School Subsidies

Feldstein says “a decrease in state subsidies to medical schools would force medical schools to re-examine and reduce their costs of education

Physician shortage can be resolved by reducing the student’s educational costs which would be both benefit in supplying physicians in health care and motivate students to enter the medical field to become a physician

It will help the people who cannot afford the high cost of medical school and this will offer every qualified students the opportunity to become a doctor when the subsidies are decreased, and they care properly placed in a subsidy program that “must be available” (Feldstein, 2014)

The government should reduce medical school subsidies because it will make medical schools more efficient by decreasing the time for earning a medical degree as well as reducing the cost of medical education

The decreased tuition rates from reducing subsidies on medical education will have a positive effect on even the high-income families because students will graduate, and will enter into “one of the highest-income professions” (Feldstein, 2014)

This approach will invite many students to enter medicine and the subsidies will help many of the poor families who have qualified children who are able to get into medical school

Nurse Led Program

The nursing led programs for chronic disease management are successful. For example, England has used its “nurse-ran, protocol-driven clinics” for the management of diabetes and other chronic diseases. (Sandeep, Battinelli, 2014)

Positive results such as fewer hospital admissions, earlier follow-up after a person is hospitalized, receipt of receiving great patient-education, longer survival rates are due to the nurse-coordinated programs for patients with heart failure.

Sandeep and Battinelli (2014) says that the outpatient medicine is too hard for physicians to handle by themselves so “new models of primary care, and nurses” will be one of the main sources for this type of medicine (Sandeep, Battinelli, 2014).

“Recognizing that nurses-managed protocols work for common outpatient diseases may be one stop toward solving American’s primary care problem” (Sandeep & Battinelli, 2014).

Diversity in Healthcare

Science teaches us through molecular biology and numerous other fields that variance and diversity are strongly favored by nature” (Issac, 2014)

Physician shortage in the United States is a crucial issue and increasing the diverse group of physicians is one of the best ways to supply doctors because there will be better end results in patient satisfaction, good quality care, and the feeling of understanding one another

The joint Commission on Accreditation of Healthcare organization believes that having a diverse workforce will enhance health care quality (Scott, 2008)

The current percent of health professionals that fall in the minority category is low but its competition for their skills and knowledge has significantly increased as the benefits of having a diverse workforce is becoming more evident(Scott, 2008)

Diversity in Healthcare Continued… The Department of Health and Human Services office of Minority Health

came up with the culturally competent Nursing Modules which helps nurses “to increase awareness, knowledge, and skills in caring for a more diverse population” ( Scott, 2008)

Diversity is a healthy piece of a puzzle in healthcare because it helps doctors learn new ideas and makes a person more developed

Diversity helps to solve the issues on primary care physician shortages, because it will bring in a large and diverse group of people in the medical field which will increase doctors in hospitals and nursing homes

The doctors will have more time for their patients and the physician will also be self-satisfied with the care that the patient receives

There has been a public policy institute called Greenling which is working on effective recruitment strategies for the disparity between California’s medical schools

This program will help with training the under-representative minority physicians for University of California, Los Angeles. (Issac, 2014)

Diversity in Healthcare Continued…

Medical schools today will emphasize diversity in their curriculum to create “a stronger and more diverse health workforce tomorrow.”

Dr. Sinkford says, “Diversity does matter and it is evolving” (American Dental Education Association)

It is a passion and commitment and involves revising your thinking and energy you have to put into the various initiatives” (American Dental Education Association)

Dr. Mark Nivet, Chief Diversity officer says, “This is a defining moment for health reform, demographic shifts, continued economic woes and the projected worsening of physician shortage portend major upheaval for the health care enterprise in the near future.” (American Dental Education Association)