The Doctors Shortage, a Crisis Within a Crisis

Talk to almost anyone in the medical profession and you'll hear the same concern: the current doctors shortage -- a subject in the news a lot these days -- is a crisis that's only going to get worse.

At the moment, the United States is believed to be short between 15,000 and 20,000 primary care doctors, meaning more than 50 million people have no doctor or have trouble finding one. Experts have been warning about the problem for some time. "We anticipate a deficiency of at least 125,000 physicians by 2025," Cecil B. Wilson, president of the American Medical Association, wrote in January 2011 before noting that, even then, 22 states were reporting shortages of doctors. "There is [today] a primary care shortage."

Because of this, some experts suggest that 20 percent of Americans -- perhaps even more -- do not have ready access to a primary-care doctor, a fact that puts an enormous strain on the doctors who are in practice. "A survey [from] The Physicians Foundation," the Associated Press noted, "found that 81 percent of doctors describe themselves as either over-extended or at full capacity, and 44 percent said they planned to cut back on the number of patients they see, retire, work part-time, or close their practice to new patients."

Some critics even blame the doctors shortage for the recent scandal at the Veterans Administration hospitals, where records were falsified and at least 40 veterans died in Phoenix while waiting for medical treatment. "At the heart of the falsified data in Phoenix," The New York Times reported, "and possibly many other veterans hospitals, is an acute shortage of [primary-care] doctors." As of the summer, the VA was still short 400 primary-care doctors. "The doctors [at the VA] are good," The Times quoted Senator Richard Blumenthal of Connecticut as saying, "but they are overworked, and they feel inadequate in the face of the inordinate demands made on them."

Nationwide, the doctors shortage will continue to grow as aging Baby Boomers sign up for Medicare in historic numbers, as the doctor population itself becomes older, and as Obamacare begins to provide coverage to the 32 million or more previously uninsured Americans. Not surprisingly, the medical community is feeling pressure to address the crisis. Some medical schools have expanded enrollment; others will soon. Over the next several years, the medical school student population is expected to increase by 30 percent.

Even so, the real problem -- a severe lack of residency positions -- may remain unchanged. In 2001, there were 96,000 positions; 10 years later, there were 113,000. Most residencies are funded through Medicare at an annual expense of $10.1 billion. That funding -- and the number of residency positions -- has remained virtually unchanged since the United States Congress froze the number in 1997 as part of the Balanced Budget Act. Until this issue is addressed, the medical community will continue to produce too few doctors.

If the situation weren't bad enough, within this crisis there is a second crisis: a critical shortage of minority doctors. The numbers are daunting. "While one in eight Americans is African-American, only one in 15 doctors is," an industry publication recently noted. "And though one in six Americans identifies as Hispanic [or] Latino only one in 20 doctors does." Since many physicians return to their community of origin to practice, this means minority neighborhoods across the country are being especially hard hit by the doctors shortage.

For decades, American medical schools admitted a disproportionate number of white male students. In the 1970s, the advent of affirmative action forced schools to admit more minority students. The result has been anything but impressive. As of 2006, despite affirmative action, minority students comprised a mere 6.4 percent of doctors graduating from U.S. medical schools. Moreover, minority populations in the country may have increased over the last two decades, but the number of minority students in medical school has not. For the 2012-13 academic year, 45,000 people applied for medical school out of which about half were accepted. Of that number, 8.7 percent were Hispanic and 6.5 percent African American.

That is not the case in some international medical schools. The American University of Antigua Medical School, featuring a large minority student population, has a white enrollment of only 17 percent, while the traditional white enrollment at Ross University Medical School is 28 percent. Many of these minority students are Americans who return to the U.S. to practice.

Obviously, the demand for minority doctors, produced by either domestic or international medical schools, will increase in the future. As the AMA's Cecil Wilson observed: "Underrepresented minorities in the ranks of physicians -- only 6 percent compared with 30 percent of the overall population -- is [a] problem that will only grow as our current minority groups swell to dominate the population by 2050."