By Dorothy Brooks
In a related development to the rollout of the CDC’s new “Impact Wellbeing” program, the American Medical Association (AMA) is warning that physician burnout is causing well-trained clinicians to leave their medical careers, leading to a physician shortage that is about to get much worse. Speaking to the National Press Club in Washington, DC, on October 25, Jesse M. Ehrenfeld, MD, MPH, AMA’s president, said that one in every five physicians surveyed during the pandemic said that they plan to leave medicine within the next five years, while one in three said they were going to cut back on their hours.
“Consider that nearly half of all practicing physicians in the United States today are over age 55, and while medical school applications are up, it can take a decade or more to educate and train a physician,” said Ehrenfeld. “It’s no wonder why the American Association of Medical Colleges projects a national physician shortfall of at least 37,000, and possibly well over 100,000, over the next decade.”
Ehrenfeld said “the insidious” problem of physician burnout has led to this crisis, but he also detailed several contributing factors, including:
- the fact that the average young physician leaves medical school with more than $250,000 in debt;
- an increasingly impersonal bureaucratic healthcare system that places enormous administrative burdens on physicians;
- shrinking Medicare reimbursement rates, with more cuts planned;
- legislative overreach that is criminalizing healthcare that has long been recognized as safe and backed by scientific evidence, such as laws restricting some obstetric services and gender-affirming care.
“Every physician I know has a friend or a colleague affected by burnout or has themselves confronted symptoms of emotional exhaustion or detachment from their work,” said Ehrenfeld. “Physicians, in fact, die by suicide at twice the rate of the general population — an alarming statistic.”
Ehrenfeld emphasized that not all feelings of professional burnout lead to thoughts of suicide, but he noted that the fallout still can have widespread and lasting repercussions for physicians and patients. “What’s worse is that physicians are often reluctant to seek help for their own mental health because of fears that will jeopardize their license or employment because of outdated, stigmatizing language on medical board and health system application forms that ask about a past diagnosis,” he said.
To address the looming physician shortage, Ehrenfeld called on policymakers to expand residency training options. While there has been concern among some emergency physician leaders that too many residency slots for emergency medicine physicians have been created in recent years, potentially resulting in an oversupply of emergency physicians down the road, Jonathan Fisher, MD, MPH, FACEP, the American College of Emergency Physicians’ (ACEP) senior director for workforce and emergency medicine practice, tells ED Management there is not a current surplus of emergency physicians, and ACEP supports a thoughtful consideration of all the factors that contribute to decisions about emergency medicine residency programs and slots.
“Healthcare workforce shortages are pronounced in rural and underserved areas throughout the country, and numerous barriers to providing equitable care in these communities persist,” explains Fisher. “Despite a 28% increase in emergency medicine residency positions over the past 10 years, there has been no corresponding increase in emergency medicine residency-trained or emergency medicine board-certified physicians working in rural EDs.”
Fisher also points to ACEP polling data showing that nearly 9 in 10 (89%) of U.S. adults say it is essential or should be a high priority to have 24/7 access to an ED. “Further, more than 9 in 10 (93%) trust an emergency physician to provide medical care at the ED,” he says. “In a crisis, there is no substitute for a licensed, residency-trained, board-certified emergency physician.”
Fisher does not say whether ACEP has observed that burnout is driving emergency physicians from their medical careers, but he states there are systemic challenges that require shared solutions. “Boarding is at crisis levels as staff shortages persist in many communities,” he observes. “At the same time, the corporatization of medicine is pouring fuel onto workforce challenges that make it harder for emergency physicians to do their jobs.”
In his speech to the National Press Club, Ehrenfeld outlined a five-step solution to address the physician shortage, including the following:
- Pass meaningful Medicare payment reform.
- Reduce administrative burdens.
- Pass legislation to expand residency training, provide greater loan support, and facilitate pathways for foreign-trained physicians.
- End the criminalization of healthcare, such as laws restricting some obstetric services and gender-affirming care.
- Make sure physicians are not penalized for taking care of their mental health needs.
Editor’s note: Find more information about the AMA’s Recovery Plan for America’s Physicians at: https://www.ama-assn.org/amaone/ama-recovery-plan-america-s-physicians
In a related development to the rollout of the CDC’s new “Impact Wellbeing” program, the American Medical Association is warning that physician burnout is causing well-trained clinicians to leave their medical careers, leading to a physician shortage that is about to get much worse.
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