Over the past several months, ThinkProgress, the New York Times, and several other outlets have reported about a potential future doctor shortage that could threaten Americans’ access to care. By 2020, the shortfall between the supply of physicians of all specialties and the demand for them is anticipated to top 91,000. By 2025, that number increases to over 130,000.
This problem existed long before the passage of Obamacare — the United States’ ratio of general practitioners to population has underperformed that of other developed countries for decades. But the Democrats’ signature health reform law does threaten to exacerbate the problem by bringing previously uninsured individuals into the nation’s health care system.
However, that’s assuming the threat of a doctor shortage actually exists. And according to a new paper in Health Affairs, flagged on Tuesday by The Washington Post’s Sarah Kliff, the extent of the problem may actually be vastly overstated. Researcher Linda Green points out that America’s health care market is capable of responding and adapting to pressures in unanticipated ways, and those adaptations could largely prevent the shortage:
Most forecasts of doctor shortages assume that a primary care physician can handle a set amount of patients in a practice, usually about 2,500. And if that remains the case, Green agrees there would indeed be too few doctors to meet the nation’s medical needs.
However, Green doesn’t think the status quo is here to stay: She argues that the health care system is rapidly changing. First, doctors are increasingly joining up into big practices. They’re able to share support staff and office space, which can make it easier to take on a bigger patient population. She refers to this as “physician pooling.”
Second, the health care workforce is changing, as physician assistants and nurse practitioners take on larger roles. Having non-physicians take care of routine care, things like strep throats and ear infections, can again increase the size of a doctor’s patient population.
In some ways, the country is already doing better than previosuly anticipated: Studies from back in 2002 pegged the doctor shortfall at 200,000 doctors, well above the current 91,000 prediction. And despite concerns about the programs that offer low reimbursement rates for doctors, recipients of Medicaid report a level of satisfaction with their access to care that’s virtually identical to those on private insurance.
On the other hand, Green’s anticipated innovations are much more likely to be taken advantage of by general practitioners than by specialists. That won’t address the fact that the latter group makes up half the incoming shortfall. But all of Green’s research goes to show that predicting the doctor shortfall isn’t an exact science, or an inevitable reality.