How to Ease the Coming Physician Shortage

Changing licensing restrictions and expanding services would help

The U.S. will face a shortage of 46,000 to 90,000 physicians by 2025, according to a report issued by the Association of American Medical Colleges. Meanwhile, the U.S. Department of Health and Human Services notes that the population of Americans age 65 and older will double between 2013 and 2040, swelling to 98 million. Older patients face complex health issues that require more frequent and intensive forms of treatment.

These trends suggest that if nothing is done to lower the high barriers to people seeking medical careers, it will only be a few years until patients will not be able to find the treatment they need.

The cartels that dominate medical professions make it extraordinarily difficult for individuals to enter the field. According to the American Medical Association, most doctors require 11 to 15 years of education and training before they are eligible for a state license to practice. This timespan includes four years of undergraduate study, four years of medical school, and, depending on the specialty, three to seven years of residency. Would-be physicians must then pass a series of exams before they obtain a license.

This process leaves the average new doctor with $169,601 in debt, plus roughly a decade in foregone earnings. And it’s not just the new docs who pick up the tab for their training: U.S taxpayers contribute around $15 billion each year to educating new doctors.

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Aside from the extraordinary financial cost and time required for medical training, another factor in the upcoming shortage is a cap on the number of residency slots. A medical residency is something like an apprenticeship, with new doctors prohibited from going into independent practice until they have served several years under the supervision of an already-licensed physician. While more medical schools have opened in recent years to meet the growing demand, there has not been a corresponding rise in residency positions.

Taxpayers pay for most residency positions through their Medicare and Medicaid dollars, but in 1997, Congress froze the number it funds at 100,000. The Association of American Medical Colleges has lobbied Congress to fund 15,000 more residencies, but in 2014, President Obama proposed to fund fewer, not more, positions. Consequently, medical students will begin to outnumber available residencies as early as next year.

The solution is not to demand that Congress fund more residencies. Instead, state-level policymakers should tear down the protectionist walls erected by professional associations that seek to keep salaries high by suppressing the number of new doctors, nurses, and medical technologists and limiting their abilities to serve patients.

These entrenched special interests use their power in state legislatures to maintain restrictive “scope of practice” regulations that, to cite one example, make it impossible in many places —including Michigan — to open low-cost clinics in Wal-Mart stores staffed by highly trained nurse practitioners. Expanding the scope of practice for midlevel professionals like nurse practitioners and physician assistants would expand the pool of quality health care services available in a state while lowering the cost to receive them.

Special interests also resist the adoption of retail and direct primary medicine. Retail medicine involves a medical professional setting up business in a store front, offering affordable, convenient treatment on an as-needed basis. Direct primary medicine offers a subscription-type model in which a patient pays a fixed monthly rate to a health care provider, encouraging more focus on prevention and maintenance of chronic conditions. States should encourage new models that cater to the needs of different types of patients.

It will take a combination of solutions to resolve the physician shortage, and their unifying theme should be “service.” The criteria for training good health care providers should focus on the needs of the patients — we should not prop up an ineffective model of health care delivery for the benefit of incumbent practitioners. As our population ages and advanced treatments allow patients with chronic illnesses to live longer, policymakers and industry professionals must work together to remove barriers to entry in the health care field, and to free the market to meet changing needs.


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