All hands on deck needed to confront physician shortage crisis

Tanya Albert Henry , Contributing News Writer

AMA News Wire

All hands on deck needed to confront physician shortage crisis

Jun 10, 2024

About 83 million Americans live in areas that don’t have sufficient access to a primary care physician.

In large parts of Mississippi and Idaho, pregnant women can’t find obstetricians.

Across the nation, 90% of counties don’t have a pediatric ophthalmologist; 80% of counties don’t have an infectious disease specialist.

More than one-third of Black Americans live in a cardiology desert.

“The physician shortage that we have long feared and warned was on the horizon—it’s already here and it’s hitting every corner of this country, urban and rural, with the most direct impact hitting families with the highest needs and the most limited means. While the physician shortage is a crisis today, there is reason to believe it’s going to get a lot worse unless we take immediate actions to address it,” AMA President Jesse M. Ehrenfeld, MD, MPH, said during an AMA webinar about what’s exacerbating the physician shortage crisis and what’s needed to fix it.

The United States will be short by as many as 86,000 physicians by 2036, according the Association of American Medical Colleges’ estimates.

Solutions to the problem are more nuanced than just increasing the number of physicians that are being trained.

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A confluence of factors are shaping the physician shortage. Consider that:

  • Roughly two in three doctors experienced burnout during the pandemic.
  • Nearly half of all practicing physicians are older than 55 and getting close to retirement.
  • Even as new medical schools open and applications rise, they won’t be seeing patients tomorrow or even next year. It can take a decade or more to educate and train a physician.

“And when you think about physicians—in large number who are already reducing their hours— contemplating leaving the profession altogether, there’s trouble ahead,” Dr. Ehrenfeld said.

The AMA’s president also brought this message to cable TV news.

“We need to support physicians and a big piece of that are underlying policy decisions, like how do we pay physicians through the Medicare program, how do we provide resources when there is a cyberattack so that things can keep going? How do we get rid of these really, really irritating problems like overused prior authorization?” Dr. Ehrenfeld said during an appearance on MSNBC’s “Morning Joe.”

With so many factors contributing to the physician shortage, there’s not just one answer to the problem. The AMA is working on many fronts to offer solutions to the complex puzzle.

Payment reform. Congress needs to pass the Strengthening Medicare for Patients and Providers Act, which would give physicians an annual payment update to account for practice cost inflations as reflected in the Medicare Economic Index. Budget-neutrality reform through the Provider Reimbursement Stability Act would also help physicians keep their doors open. And the AMA is working with members of Congress who are close to unveiling legislation to help reform the Medicare Merit-based Incentive Payment System (MIPS).

“We need Congress to pass legislation that’s going to enact comprehensive payment reform. We need to keep as many of those physicians who are currently practicing to stay in practice. And how do we do that? We need to make some real targeted improvements to the physician payment system,” said Christopher Sherin, assistant director in the AMA’s Division of Congressional Affairs.

The AMA is leading the charge to reform the Medicare payment system and has achieved recent wins in five critical areas (PDF) for physicians.

Fewer administrative burdens, including the overused, inefficient prior authorization process. The Improving Seniors’ Timely Access to Care Act would expand prior authorization reforms that the Centers for Medicare & Medicaid Services finalized. State legislatures also have the power to reform.

The AMA is fixing prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles.

Smoother pathways for foreign-trained physicians. More than 12,000 physicians from other nations are in U.S. residency and fellowship training. These physicians are more likely than American-born physicians to practice in lower income and disadvantaged areas. Yet, fluctuating immigration laws make it difficult for them to stay in the U.S. The Conrad State 30 and the Physician Access Reauthorization Act could help ease this challenge and keep foreign-born physicians in the U.S. workforce.

Visit AMA Advocacy in Action to find out what’s at stake in clearing IMGs' route to practice and other advocacy priorities the AMA is actively working on.

Expanded residency-training options. There’s been a 52% rise in medical school enrollment since 2002, but residency positions haven’t increased at that rate. The average medical school graduate in 2021 submitted 73 residency applications—a 24% jump since 2017—with each residency slot receiving an average of more than 60 applications.

The 2021 and 2023 Consolidated Appropriations Act helped add 1,200 new Medicare-supported graduate medical education positions for the first time in nearly 30 years. But more needs to be done. That includes passing the Resident Physician Shortage Reduction Act.

“It is vital that more Medicare residency positions are added so that every physician can obtain a residency slot so that patients can have access to the health care they really need,” said Alexis Pierce, senior attorney in the AMA Division of Legislative Counsel. 

But simply training more obstetricians won’t solve the shortage in Idaho and Mississippi. New physicians won’t necessarily choose to practice in those states. The primary care shortage in rural areas won’t be solved by creating residencies in large urban academic medical centers.

“There really is a need to match our physician workforce to the needs of the population and one of the real critical issues that we need is some sort of central workforce strategy that acknowledges what those needs are and helps us understand how to train physicians to meet those needs, both in terms of capacity, but in terms of distribution of the specialty and geographic basis as well,” John Andrews, MD, the AMA’s vice president of graduate medical education innovations, said during the webinar.

Learn more about AMA's efforts for improving GME with the Compendium of Graduate Medical Education Initiatives Report (PDF).