Katy comes from a family of physicians. Her uncle, father, and brother are all practicing physicians. Her grandfather was a physician before he passed. She wants to carry on the legacy, too, creating memorable relationships with patients and saving lives. When Katy begins to research the path to medical school, however, her motivation dwindles. Katy learns of the unprecedented U.S. physician shortage, which has continually increased post-pandemic. The path ahead seems uncertain, and that scares her. How can a student like Katy, so passionate about the field, continue her journey to medical school with several unknowns?
Phillip Wallace, senior physician recruiter for Baptist Health in Little Rock, recently spoke at the University of Arkansas for Medical Sciences (UAMS) match ceremony, a day of profound excitement for medical students like Katy. Yet, before the celebrations began, Phillip made it clear that while there has been some progress in closing this gap, there is still a long way to go.
We are in a hole that we cannot emerge from overnight.
Several sources use varying figures to measure the physician shortage. “Just a few weeks ago, according to the Association of American Medical Colleges (AAMC), that figure was between 37,800 and 124,000 physicians needed by 2034 to close the gap,” Phillip says. “Similar figures have been projected by the American Medical Association (AMA).”
These are usually the two most respected and accurate sources, with the AAMC releasing a report every two years. “However, just a few weeks ago, the AAMC released a new report that had the projected figure at up to 86,000 by 2036, a decrease from many previous years of the growing physician shortage projection,” Phillip says.
This caveat is based on the hypothetical success of increasing the supply of physicians. “Either way,” Phillip adds, “we are in a tremendous hole that we cannot emerge from overnight.”
What are the biggest needs in Arkansas?
Ask any hospital in the state, and you’ll probably get a different answer based on their current need. However, there are a few specialties that rise to the top across the board:
Obstetrics/Gynecology: “Arkansas has been labeled a maternity care desert,” Phillip says. “Nearly half of our 75 counties do not have a single obstetric provider, making it difficult for mothers and their babies to get the care they need.” Arkansas also has one of the highest maternal and infant mortality rates in the nation.
- Psychiatry: “We will not know the damage COVID has done to mental health for several years,” Phillip says. “But, we were already in great need of mental health services before the pandemic.”
Geriatrics: With the aging population expected to increase over 30% by 2036, geriatric care will also need a boost.
In Arkansas in particular, there is a great need for physicians willing to practice in rural areas of the state. Arkansas ranks 46th in number of physicians in patient care per 10,000 resident population, according to the Centers for Disease Control and Prevention’s (CDC) most recent 2019 report.
“It is difficult to get someone to practice here, especially in rural areas, unless we can do more to make this more attractive,” Phillip says.
What has caused the physician shortage?
According to the CDC, in 2019, there were 3.5 times as many physicians per 10,000 population in the District of Columbia compared with Idaho, the state with the lowest supply of physicians.
Image credits: CDC National Center for Health Statistics
Key factors that have led to some states having more than enough physicians and some having nowhere near the needed amount are population growth and aging. “Throw in a significant cap on Graduate Medical Education (GME) residency slots that have remained relatively unchanged since 1997, as well as a worldwide pandemic, and it makes for the perfect storm,” Phillip adds.
“The number of physicians has increased, but not at a rate that keeps up with population growth,” he says. “The aging population has more healthcare needs and a greater need for physicians. With the population aged 65 and older expected to grow by 34.1% and the size of the population 75 and older expected to increase by 54.7% by 2036, we must find a newer supply of physicians.”
The pandemic brought out the best and worst of medicine. But healthcare rose to the challenge, and we will be better prepared for the next crisis. “Unfortunately, the pandemic has led to tremendous burnout,” Phillip says. “Physicians and healthcare workers are fatigued.”
An AMA survey cited that as many as 40% of physicians polled between 2021 and 2022 were considering leaving their organizations within the next 2 years because of burnout. Some have retired early. Other data from the AAMC have shown that physicians are working fewer hours per week than they were 20 years ago, much of it due to the desire for a better work/life balance.
What is being done to address the shortage?
“Some private hospitals have tried to alleviate this shortage by getting into the GME business,” Phillip says. “However, this track alone would not meet the numbers needed. More realistic remedies would come from the Resident Physician Shortage Reduction Act of 2023, which would increase the number of Medicare-supported residency slots by 14,000 over 7 years.”
The AAMC has placed great value on this type of legislation to reduce the projected shortages in previous years. Failure to fund these additional programs would cause a larger shortage than projected.
“Medical schools have increased their enrollments by almost 40% since 2002, so they are doing their part,” Phillip adds. “But, these increases don’t truly address the need if a substantial amount of residency slots are not created.”
How do we recruit medical students despite this shortage?
While it is easy to see how Katy may have some uncertainty or fear about entering the medical profession, there is still plenty of room for optimism.
“Although we can’t predict how it will be delivered in the future, we are always going to have a need for healthcare,” Phillip says. “As the baby boomers (and I myself am one) continue to age and the population increases, so does the need for a number of physicians. There’s a lot of job security in that. Obviously, the attraction to earn a high income has also been, and continues to be, a great factor in recruiting.”
Some medical students do not match at in-state residency programs. Residency programs may play a role in the loss of support if they require students to move out of state to a different program away from family and loved ones. “This could also impact our state from a physician shortage standpoint,” Phillip explains.
“Of our graduates who match in other states, 57% of them will stay in that state upon graduation. It can be difficult to get them back here once they have trained elsewhere.”
Regardless of where a resident trains, however, Phillip is confident they’ll be able to make a difference in patients’ lives when they begin their practice.
Final Thoughts
“I am sure there are going to be some uncertainties in the medical field in general that might be of concern, but overall, the future is very bright for physicians,” Phillip says. “The shortage should give them relief in the form of job security!”
The impact of the pandemic has forced the medical community to address the changes that need to be made to avoid burnout. Further recognition of mental healthcare needs and relieving physicians of day-to-day business concerns to give them a better work-life balance are keys to retention.
“The AMA stated that practices and organizations should encourage teamwork to alleviate additional pressure on physicians and should focus on supporting physicians in their jobs. Let doctors be doctors,” Phillip explains. “I agree with that. Above all, I would tell up-and-coming med students like Katy to find a specialty she enjoys practicing every day if she can. Financial rewards alone will not make a happy career.”
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