Doctor shortage predicted

May 4 2011 - 10:48am

Images

K.U Med Center resident doctors Linh Nguyen, left, and Karim Masri, foreground, work with Dr. Susan Hull, April 27, 2011, in Wichita, Kansas. (Mike Hutmacher/Wichita Eagle/MCT)
K.U Medical School student Branden Comfort, right, consults with Dr. Donna Sweet's nurse practitioner Kathryn Thiessen, April 27, 2011, in Wichita, Kansas. (Mike Hutmacher/Wichita Eagle/MCT)
K.U Med Center resident doctors Linh Nguyen, left, and Karim Masri, foreground, work with Dr. Susan Hull, April 27, 2011, in Wichita, Kansas. (Mike Hutmacher/Wichita Eagle/MCT)
K.U Medical School student Branden Comfort, right, consults with Dr. Donna Sweet's nurse practitioner Kathryn Thiessen, April 27, 2011, in Wichita, Kansas. (Mike Hutmacher/Wichita Eagle/MCT)

Despite a surge in the expansion and building of new medical schools, two national reports say the country is heading for a physician shortage.

It's a shortage that, depending on which report one reads, could see the nation short 91,500 physicians by 2020. That estimate is from a June 2010 report from the Association of American Medical Colleges.

State and local officials don't doubt that there will be a greater demand for health care -- and physicians -- in the coming years.

After all, a greater proportion of the population is aging to the point at which it will need to access more health care more often. That aging population also will live longer because of advances in medicine, meaning not only will those people need more services, but they'll also need them for a longer period than past generations.

And officials think that as implementation of the federal health reform law continues, more people will have access to more health care services, and they will use them.

But experts differ on whether efforts to train more doctors will succeed in meeting the increased demand, at least in the short term.

H. David Wilson, dean of the University of Kansas School of Medicine-Wichita, is overseeing an expansion of the local campus to a four-year program.

Previously the school trained only third- and fourth-year medical students, with all students spending their first two years at the school's main campus in Kansas City.

In July, the Wichita campus will receive its first freshman class of medical school students. Wilson said he hopes that in a few years, its freshman class size will consistently be at 50 students.

Between the expansion of the Wichita campus and one in Salina, he said he thinks that will be enough to eventually meet increasing demand in Kansas.

He also thinks medical school projects in California, Florida, Michigan and other states will help to counter any long-term physician shortage nationally.

"There are probably six brand-new medical schools starting (in the country) and another half-dozen on the docket, if you will," Wilson said. "There's going to be a fair number of new doctors produced within a short amount of time."

But that "short amount of time" is not one, two or even five years.

Wilson and other health officials say that in the best scenario, it takes medical students seven years to get to the point where they are able to practice medicine: four years of medical school and a minimum of three years of residency.

And that seven-year span of training is mostly representative of primary care physicians, so-called family doctors. For medical students going into specialties such as surgery, cardiology or orthopedics, the training could take one, two or three more years.

The problem is, the issue isn't just about having enough physicians, but enough primary care physicians, officials said.

"I think it's clear that ... primary care is the real pressing need for the next five to 10 years," said Jon Rosell, executive director of the Medical Society of Sedgwick County, Kan.

Rosell said that's where he thinks the need will be greatest, especially with more people having access to the health care system because of the changes to federal law. Primary care physicians are one of the first stops in the system.

"The more physicians we can start preparing, the more incentives we can put in place to get them to spend their years in a primary care environment is going to be the real answer to the problem."

Wilson agrees, and said a big part of the problem is compensation.

"When you have sub-specialists making four times as much as generalists, obviously there is a certain amount of pressure ... for medical students to choose high-paying specialties," Wilson said. "When they graduate with a debt of $150,000, and they are looking at primary care and maybe making $150,000, it's difficult to pay off that debt.

"Part of that will have to be resolved by the reimbursement system."

Jerry Slaughter is concerned that predictions of a physician shortage could be worse than the figures in the two reports.

"On matters like this it's very difficult to make accurate predictions about needs, particularly in an environment where there's already a tremendous amount of change afoot," said Slaughter, executive director of the Kansas Medical Society.

Slaughter said he thinks that not only will changes in federal law increase the number of people accessing the health care system, it also could accelerate physician retirements.

That's because of all the changes the law brings about in terms of compliance with provider accountability measures, electronic medical records requirements and changes in reimbursement.

For physicians in solo or small practices, Slaughter said, "these demands on them are real, they are costly and they will have an effect on their future plans for practice."

Looking forward, he said it will be a "bumpy" few years.

But, Slaughter said, the "health care community is pretty adaptable."

And once a few years have passed, the health law is fully implemented, and more physicians are out of school and practicing, the business of health care will be clearer.

"Then things begin to level out, probably stabilize," he said.

(c) 2011, The Wichita Eagle (Wichita, Kan.).

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