Doctor shortage: Why can't we just churn out more physicians?

Answers to your questions about the news.
June 27 2011 6:44 PM

We Need More Doctors, Stat!

Why is it taking so long to address the physician shortage?

A waiting room at a doctor's office. Click image to expand.
Why don't we have enough doctors in the U.S.?

The Obama administration is recruiting "mystery shoppers" to pose as patients, call doctors' offices, and see how hard it is to get an appointment, especially with government health insurance. Critics say the study is a waste of taxpayer money. One family physician told the New York Times, "Everybody with a brain knows we do not have enough doctors." If everyone knows we have a doctor shortage, why don't we make more?

Money, mostly. The fastest way to produce more doctors in the United States would be to expand the capacity of the country's residency programs—the three- to six-year training stint that medical school graduates must complete before becoming licensed to practice on their own. But there are several barriers to doing that, not least of which is money. The federal government gives hospitals about $100,000 per resident per year to subsidize salary and training but has (for the most part) frozen the number of positions eligible for that subsidy at 1996 levels. Hospitals have expanded their residency programs modestly in that time, especially in high-earning specialty fields such as dermatology and radiology. But they argue that they don't have the money to keep up with demand.

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Some economists suspect (PDF) there's something more nefarious going on than a simple lack of funds. In order for a hospital to take on more residents, it has to apply to the Residency Review Committee, a group comprised of 20 representatives of medical associations and one nonvoting government representative. Cynics claim that the groups deliberately restrict the flow of doctors so that demand for medical services will outstrip supply and salaries will remain high.

There's not much empirical evidence to support the claim, however. The Residency Review Committee insists that its job is to maintain the quality of education and that it permits hospitals to expand their residency programs if the institution has a solid track record and sufficient faculty mentors to shepherd the trainees through their apprenticeship. Also, in many fields, a resident can't graduate without performing a prescribed number of certain procedures. If a hospital doesn't have enough patients, it simply can't accommodate more residents.

Although residency programs aren't big enough to satisfy the nation's need for doctors, medical schools aren't even cranking out enough graduates to stock them. Today, nearly one-half of the doctors filling internal medicine, pediatric, and family practice residency programs come from abroad. That's because, anticipating a looming doctor surplus, medical schools stopped growing 30 years ago (PDF), and they aren't producing many more graduates today than they did in the early '80s.

Recently, medical schools started growing again, and they're now on track to increase the number of students 30 percent above the 2002 baseline by 2013. But since the new U.S. graduates will simply displace many graduates of foreign medical colleges (PDF), this expansion won't necessary result in a net gain in doctors. Besides, the increased number of spots at the med-school level doesn't represent a quick fix: It takes at least seven years between the day a fresh-faced idealist takes her seat at a medical school and the time she emerges from residency as a licensed, massively sleep-deprived physician.

Got a question about today's news? Ask the Explainer.

Explainer thanks Thomas Getzen of the International Health Economics Association and the Fox School of Business at Temple University, Atul Grover of the Association of American Medical Colleges *, Ellen Griffith of the Centers for Medicare and Medicaid Services, Julie Jacob of the Accreditation Council for Graduate Medical Education, and Sean Nicholson of Cornell University.
 
Correction, June 28, 2011: The original referred to the Association of American Medical Colleges as the American Association of Medical Colleges. (Return to the corrected sentence.).

Brian Palmer writes about science, medicine, and the environment for Slate and the Natural Resources Defense Council. Email him at explainerbrian@gmail.com. Follow him on Twitter.

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