The latest physician supply and demand report from the Association of American Medical Colleges (AAMC) painted a bleaker picture of the growing physician shortage in the U.S., projecting a shortage of between 42,600 and 121,300 physicians by 2030.
The underlying causes haven’t changed: the population aged 65 and over is expected to grow by 50 percent by 2030, increasing demand for healthcare services. The physician population is also aging, with 13.5 percent of the active workforce already aged 65 and over and another 27.2 percent between the ages of 55 and 64. Exacerbating the shortage is the trend of physicians working fewer hours—across all generations, not just millennials, the report noted—meaning it may take more than one physician for hospitals and practices to replace the productivity of a single retiring physician.
“If this trend continues, then by 2030 there will be 32,500 fewer (full-time-equivalent) physicians in the national supply than if physician work hours remained similar to current patterns,” the report said.
Non-primary care specialties have the largest projected shortfall of between 33,800 and 72,700 physicians by 2030, including a shortfall of up to 30,500 surgical specialists. This category also includes “medical specialties,” such as cardiology, oncology and gastroenterology, which the report said may actually have a surplus of about 700 physicians to a shortfall of 9,600 physicians, though this finding isn’t broken down by subspecialty. Primary care is expected to face a shortage of between 14,800 and 49,300 physicians.
Population health will only increase demand for physicians in the long term. According to the report, a short-term decline from improvements in measures like reducing obesity and better management of high blood pressure and cholesterol would bounce back to increased demand by 2030.
“The demand for physicians would thus be 17,300 FTEs higher in 2030 relative to demand levels in the absence of achieving these goals,” the report said. “This finding suggests that although prevention efforts will probably reduce demand for some specialties, such as endocrinology, demand for other specialties, such as geriatric medicine, will increase.”
The report said it took into account the growing ranks of non-physician practitioners like advanced practice registered nurses (APRNs) and physician assistants (PAs) and demand for the retail clinics they staff. For both roles, the number of practitioners is expected to double by 2030 to 242,000 PAs and 449,000 APRNs—six times the rate of growth of demand for healthcare services overall.
Under one of the report’s scenarios, PAs and APRNs could reduce the demand for physicians by 50 percent in primary care, 60 percent in anesthesiology and by 108,600 physicians overall—covering the majority of the shortage. However, it also said there might be a “market saturation point” where those practitioners have trouble finding jobs. It also said there needed to be more research into whether PAs and APRNs can truly displace demand for physicians.
“APRN and PA supplies have grown rapidly over the past decade, and these clinicians fill important roles in care delivery,” the report said. “To what extent have APRNs and PAs reduced demand for physicians in some specialties, and to what extent are APRNs and PAs providing previously unfilled services and expanding access to care?”
Expanding the role of non-physician practitioners has also been actively opposed by groups representing doctors. The American Medical Association adopted a resolution in 2017 to active oppose state-level efforts to allow APRNs to practice independently without a physician’s supervision.
The AAMC’s recommend solutions to the shortage remain the same: continuing to train more doctors and getting help from Congress.
“To address the doctor shortage, medical schools have increased class sizes by nearly 30 percent since 2002. Now it’s time for Congress to do its part,” AAMC president and CEO Darrell Kirch, MD, said in a statement. “Funding for residency training has been frozen since 1997 and without an increase in federal support, there simply won’t be enough doctors to provide the care Americans need.”