My Turn: Crisis looms for next generation of doctors
Tomorrow, 90 soon-to-be doctors will graduate from the Geisel School of Medicine at Dartmouth, where I am a resident urologist.
For each of them, medical school graduation marks the culmination of years of preparation and effort, as well as the start of residency training in diverse specialties, from pediatrics to neurosurgery.
Every physician on the journey from graduation to independent practice undertakes three to 10 years of residency training. At my hospital, and at hospitals nationwide, the annual welcoming of new residents ensures a pipeline of trained doctors who will go on to serve our communities.
The pressure on this pipeline has never been greater. The U.S. population is aging at the fastest rate in recent generations: 10,000 baby boomers are joining the Medicare roster daily, and the Census Bureau predicts a one-third increase in the coming decade.
The impact of this on health care is tremendous. As the population ages, the demand for health care providers rises.
Seniors today are also living longer with chronic conditions such as cancer, heart disease and diabetes, treated by an array of specialists. Furthermore, the Affordable Care Act, the law behind Obamacare, is likely to compound the need as newly insured individuals put strain on expanded access to doctors.
But demand is only one side of the equation.
One in three of today’s practicing physicians is expected to retire in the next 15 years, so ensuring adequate supply to meet the needs of a larger, older population is increasingly problematic.
By most estimates, the assembly line isn’t turning out new goods quickly enough. Indeed, the Association of American Medical Colleges has projected a shortage of 91,000 physicians by 2020, half in non-primary care specialties.
Here in the Granite State, my colleagues in urology are already feeling the impact. The steady decline in the number of practicing urologists per capita has reached a 30-year low. But if the need for more urologists to take care of enlarged prostates and overactive bladders was foreseen years ago, why can’t we simply produce more urologists, or more doctors in general?
A big part of the answer will be evident at medical-school graduations this week. While 25 states have recently opened new medical campuses, the number of residency slots available to train graduates remains comparatively unchanged.
This year, more than 20,000 senior medical students and recent graduates of U.S. medical schools vied for 26,000 residency positions. But two years from now, when schools reach production capacity and 7,000 more graduates are expected, residency applicants will exceed available slots. My specialty has already reached the tipping point: one in three aspiring urologists was turned away from residency this year.
The bottleneck is troubling not just because thousands of new physicians will be unable to practice, but it also comes at a critical time when more Americans are seeking more health care.
The stagnation in the availability of residency positions is tied to Medicare funding for new training slots, which has been capped since 1997.
Legislative action is now being considered to lift the caps and preserve Americans’ future access to primary and specialty care.
Two bills, the Resident Physician Shortage Reduction Act and the Training Tomorrow’s Doctors Today Act, have proposed 15,000 additional residency slots over the next five years. The legislation, which has bipartisan sponsors and supporters in the House and Senate, recognizes the shortages for both primary and specialty providers.
The bills also link federal funding for residency training to performance standards that ensure trainees are prepared for 21st-century practice.
We should urge lawmakers to avoid a supply-and-demand crisis. Training enough physicians to care for the aging demographic of New Hampshire, and the country, underlies promoting health and preserving health care. Amid ongoing political chatter about insurance mandates and universal coverage, the reality is that, with respect to maintaining the physician workforce, accepting the status quo undermines the foundations of efficiency and access on which current reforms have been built.
(Kevin Koo lives in Lebanon.)