Where Have All the Doctors Gone?

They’re retired.

What caused the U.S. doctor shortage?

Obama-administration officials have reportedly become alarmed by doctor shortages, especially since millions of previously uninsured people would gain coverage—and therefore increase demand—if the president manages to pass national health care reform. To make up for the physician shortfall, which several studies suggest could reach 100,000 over the next 20 years, the Association of American Medical Colleges is recommending a 30 percent increase in med-school enrollment. Why don’t we have enough doctors?

Blame the baby boomers. Since 1965, the federal government has subsidized medical residencies through Medicare. To grow the population of doctors in the 1970s, Congress approved funds for additional places. The boomers who flooded into the profession back then, and who now represent one-third of the medical establishment, are starting to retire. That hasn’t stopped the ranks of doctors from growing, even on a per capita basis. But the rate of that growth is expected to shrink considerably over the next decade as the number of retirees increases.

At the same time, consumer demand for medical services is expected to increase. Again, blame the baby boomers: While the total population is expected to increase by 18 percent over the next 10 years, the population over the age of 65 will expand by 54 percent. Since older people require more health care, we’ll need more doctors to handle the same number of patients. According to some estimates, the demand for doctors will rise to between 1.09 million and 1.17 million by 2020—many tens of thousands more than we’ll actually have. *

There’s also a distribution problem. According to the Times, the ratio of primary-care doctors to population is higher in Massachusetts than in many other states, in part because more people have medical insurance there. In certain regions of the country where malpractice insurance is particularly costly, specialists in so-called high-malpractice fields are in short supply: In West Virginia, for example, it’s hard to find a neurosurgeon. And relatively few doctors want to work in rural areas, leading to dramatic, localized shortages of both primary care physicians and specialists.

Another strain on the doctor supply arises from changing expectations in the workplace. According to the Council on Graduate Medical Education, new physicians are working fewer hours than their predecessors, with a reduced patient load. They may also be devoting less time to patient care and more time to research.

Ironically, just a little more than a decade ago, there was a doctor surplus. In 1996, a committee of the Institute of Medicine warned that the United States had a surfeit of doctors caused by foreign-trained physicians coming here to work and recommended freezing med-school class sizes and limiting first-year residency positions. A year later, Slate ran an article on an alternative strategy for reducing the number of doctors approved by the federal Health Care Financing Administration. Under the Graduate Medical Education Demonstration Project, 41 teaching hospitals received $400 million in exchange for not training between 20 percent and 25 percent of the medical residents they would otherwise have trained over the next six years.

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Explainer thanks Jesse Pines of the University of Pennsylvania and Edward Salsberg of the Association of American Medical Colleges.

Correction, April 29, 2009: This piece originally stated that the demand for doctors in 2020 will be many tens of thousands less than we’ll have. The author meant “more.” (Return  to the correction sentence.)