Is There a Doctor in the House?
December 1, 2023 5 minutes read
By Gary Evans
With high levels of physician burnout, demographic changes, and increasing demand for Medicare by an aging nation, the shortage of physicians may reach more than 100,000 in the next decade, the American Medical Association (AMA) reported.
“The physician shortage that we have long feared and warned was on the horizon is here,” said Jesse Ehrenfeld, MD, president of the AMA. “It’s an urgent crisis hitting every corner of this country. Urban [and] rural, with the most direct impact hitting families with high needs and limited means. Imagine [being] in desperate need of a physician’s care and finding no one there to take care of you. That’s what we’re up against.”1
Speaking at the National Press Club in Washington, DC — and uncoincidentally lobbying for Congressional action — Ehrenfeld said the current situation is limited access to care for millions of people.
“It’s about to get much worse,” Ehrenfeld predicted. “Consider that roughly two in three doctors admitted to experiencing burnout during the pandemic, according to a survey2 from the AMA, Mayo Clinic, and Stanford Medicine. That is the highest level of burnout ever recorded by the AMA. Consider that one in five physicians surveyed during the pandemic said that they planned to leave medicine within the next two years, while one in three said they were going to cut back on their hours.”
Ehrenfeld humanized his call to action with a series of personal anecdotes, including the suicide of a colleague that still “haunts” him. Many others may leave the field to save themselves, as the burnout toll is substantial.
“Just the other day I walked into the physician’s lounge at the Medical College of Wisconsin in Milwaukee where I’m an anesthesiologist,” Ehrenfeld recalled. “I saw an experienced colleague, who I know well, completely break down, so clearly exhausted and overwhelmed. This is a picture of our healthcare system in 2023. It’s not a happy or uplifting one.”
Echoing calls for reformed licensing credential requirements, Ehrenfeld said that physicians should not be punished for taking care of their own mental health needs. “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,” he said. “Physicians die by suicide at twice the rate of the general population.”
Yet physicians often are reluctant to seek help for their own mental health over fears it will jeopardize their license “because of outdated, stigmatizing language on medical board and health system application forms that ask about a past diagnosis,” Ehrenfeld said.
Specifically, the AMA is asking medical licensing boards to remove questions about a past diagnosis or counseling for mental illness or substance use disorder. The current situation with a provider’s health might still be fair game, but the AMA is trying to at least remove language that punishes someone for their past.
“We encourage boards and hospital systems to focus on whether a current health condition, such as depression, exists that — if left untreated — would affect patient safety,” Ehrenfeld said. “Seeking care for burnout, mental illness, or a substance use disorder is a sign of strength — an act that takes courage and deserves our health system’s unconditional support. In fact, the health of our patients, our nation, depends on physicians seeking mental health for their well-being before they abandon medicine altogether.”
A Bitter Divide, A Widening Desert
Social and political actions also play a role — particularly for physicians who provide care for LGBTQ+ patients or women seeking to end a pregnancy.
“Recently, another exceptional physician — a woman whom I personally recruited to lead the LGBTQ health clinic at Vanderbilt University Medical Center — abruptly quit the program,” Ehrenfeld recalled. “[She was] no longer able to cope with the political pressures, the distorted half-truths about the work she was doing. She packed up her family to move to another state to practice medicine unfettered by restrictive state laws.”
An ongoing attack on science is undermining trust in medical institutions, leading to threats and hostility toward healthcare workers.
“[This attack includes] government intrusion into healthcare decisions and aggressive efforts in many states to criminalize care that is supported by science and evidence,” Ehrenfeld said.
Fourteen states have enacted outright bans on abortion, and seven others have enacted partial bans. Twenty-two states have enacted laws restricting or banning gender-affirming care.
“Let me be clear: These efforts — fueled by misinformation in a heated attack on science and evidence-based care — have forced the government into the most intimate and difficult decisions a person can make,” Ehrenfeld said. “They have sown confusion for physicians and patients and opened deep political rifts between neighboring states.”
Moreover, 83 million people in the United States live in areas without sufficient access to a primary care physician. “The average young doctor now leaves medical school more than $250,000 in debt. That huge debt load has implications for our health system, often forcing aspiring physicians to bypass primary care in less populated rural areas in favor of more lucrative specialties in or near large cities,” Ehrenfeld continued, reeling off a series of disturbing facts, including:
- Pregnant women in large parts of Idaho and Mississippi cannot find OB/GYNs.
- More than one-third of Black Americans live in “cardiology deserts.”
- Ninety percent of counties lack a pediatric ophthalmologist.
- Eighty percent of counties lack an infectious disease specialist.
“Why is this happening? Ask physicians and they’ll tell you,” Ehrenfeld said. “An increasingly impersonal, bureaucratic healthcare system places enormous administrative hassles and burdens right in our lap each day and leaves us feeling powerless to make meaningful change. Physicians today on average spend two hours on paperwork for every one hour we spend with patients.”
The increasing consolidation of hospitals and other healthcare facilities is stripping away autonomy for both patients and physicians.
“[The result] is widening health disparities for historically marginalized communities by race and gender, between wealthy and low-income people living in urban and rural settings,” Ehrenfeld said. “For the last 20 years, a shrinking Medicare reimbursement rate for physicians has pushed many small independent practices to the brink of financial collapse, jeopardizing care for millions of America’s seniors.”
This latter point requires “immediate attention from Congress,” as the Medicare system has become unsustainable, with reimbursement rates dropping 26% since 2001, Ehrenfeld explained. As providers cut costs, defer updating equipment, or reduce their hours, the toll is exacted on patients in terms of safety and access.
“Our nation’s physician shortage is complex,” Ehrenfeld said. “It doesn’t really lend itself to easy solutions, but it’s not hopeless. [There are] solutions with bipartisan bills pending in Congress right now that would make a huge difference in our ability to hold onto physicians we have and strengthen our physician workforce.”
Ehrenfeld specifically cited the urgency of passing the Strengthening Medicare for Patients and Providers Act. If it becomes law, the Medicare economic index would be adjusted to include physician payments that reflect the cost of inflation.3
Also bipartisan, the Improving Seniors’ Timely Access to Care Act would expand insurance prior authorization reforms and reduce the administrative burdens of the “overused, inefficient prior authorization process that insurers use to try to control costs,” Ehrenfeld said.
Congress also should expedite three bipartisan bills that seek to expand residency training options, provide greater student loan support, and create a smoother pathway for foreign-trained physicians who already comprise about one-fourth of the nation’s physician workforce, Ehrenfeld explained.
REFERENCES
- American Medical Association. AMA president sounds alarm on national physician shortage. Oct. 25, 2023.
- American Medical Association. Physician burnout rate spikes to new height. Sept. 15, 2022.
- 118th Congress. Strengthening Medicare for Patients and Providers Act. April 3, 2023.
- House.gov. House unanimously passes bill to improve care for 28M seniors, cut red tape. Sept. 14, 2022.
With high levels of physician burnout, demographic changes, and increasing demand for Medicare by an aging nation, the shortage of physicians may reach more than 100,000 in the next decade, the American Medical Association reported.
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