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Conflicting JAMA reports highlight debate over reality of pending physician shortage

New report says patient-to-doctor ratio shows "healthy surplus" of docs; other report says aging population will exacerbate shortage.

Jeff Lagasse, Associate Editor

The American healthcare system is not facing a looming physician shortage, according to a new opinion piece published in the Journal of the American Medical Association. The assertion is in contrast to reports from the American College of Surgeons and Association of American Medical Colleges, the latter of which predicts a physician shortage of between 40,800 to 104,900 by 2030.

To make their case that no such shortage exists, the authors crunched the numbers. The United States currently has more than 900,000 active physicians, with a fairly even split between primary care physicians and specialists. Slightly more than 380,000 primary care physicians are full-time, including nearly 80,000 pediatricians.

According to recommendations from the Agency for Healthcare Quality and Research, the number of unique patients under the care of an individual physician -- the "panel size" -- should be between 1,500 and 2,000. The authors cite a recent Medical Group Management Association survey finding that the median panel size was 1,906, and the average was 2,184.

[Also: Low government reimbursement rates, crushing national debt fuels physician shortage in Puerto Rico]

The authors figure that if each of the 388,000 full-time primary care physicians cares for an average of 1,500 patients, they could care for about 583 million people. And there are only 240 million adults currently living in the United States.

With those numbers, the authors reason, only about 160,000 physicians would be needed to care for Americans, assuming a panel size of 1,500 patients each. With a 2,000 patient-panel, that number drops to 120,000 full-time physicians.

Using that math, the authors contend that there is, in fact, a healthy surplus of physicians in the United States, rather than a shortage.

[Also: Physician appointment wait times spike, highlight growing doctor shortage, survey finds]

A perceived physician shortage in certain pockets of the country, the authors said, can be attributed to maldistribution. Nearly a fifth of U.S. resident live in rural areas, yet less than a tenth of primary care physicians practice there. Rather than training more physicians, they say more of them should be incentivized to pursue underserved areas.

To further drive home their point, they highlighted the growing number of medical schools in the country: In the last 15 years, the number has grown from 125 to 145. Enrollment, meanwhile, has increased by 28 percent since 2002, and is expected to increase even further by next year.

[Also: Nearly half of nurses consider changing careers as nationwide shortage looms, RNnetwork study says]

Countering this viewpoint was a piece published in JAMA, on the same day, saying that a physician shortage will be exacerbated in the coming years by a growing, and aging, population. Current projections are that the U.S. population will grow 12 percent between 2015 and 2030, with the population of those aged 65 and older expected to grow by 55 percent. This, they say, will drive more demand for healthcare services.

The authors of the latter piece also point to data showing that nearly one-third of all active physicians will be aged 65 or older within the next 10 years, and many will retire, which will have a significant effect on physician supply.

Twitter: @JELagasse

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