Check out the session summary below.
hy the U.S. can’t produce the doctors it needs: Challenges in medical education
- Keren Landman, M.D., senior reporter covering health and science at Vox
- Robert Orr, social policy analyst at Niskanen Center. He works on social insurance policy issues, health care and labor market issues.
- Candice Chen, M.D., associate professor in the Department of Health Policy and Management at The George Washington University.
- Ramey Connelly, associate director of individual clinical training for Midwest Access Project (MAP), a Chicago-based group that links clinicians with sexual and reproductive health training
By Jon Harris
The United States does not have enough doctors — an ailment that won’t subside any time soon without major reforms and solutions, panelists said.
Vox Senior Reporter Keren Landman said the nation currently needs about 20,000 more doctors and, by 2034, the country is projected to be at least 38,000 physicians short.
The shortages are everywhere, Landman noted, but accelerating in rural areas. And a lack of physician diversity across the country often means Black and Hispanic patients are less likely to find racially concordant doctors than white consumers. This all creates the potential of worsening patient health outcomes, Landman said.
At least one reason behind the physician scarcity is the lengthy medical education pathway, since the United States is the only rich country — aside from Canada — that requires prospective doctors to earn a separate four-year bachelor’s degree prior to entering a four-year medical school, noted Robert Orr, a social policy analyst at the Niskanen Center in Washington D.C.
This longer pathway piles up student debt — average debt is $202,000 for a student after medical school — and postpones the start of careers.
There’s also an imbalance in how certain services are reimbursed, outdated policies that can incentivize doctors toward the higher-paying specialties and away from the in-need primary care space, said Candice Chen, M.D., M.P.H, associate professor in the Department of Health Policy and Management at The George Washington University.
Chen presented data that showed average physician compensation in plastic surgery, for instance, was $576,000 last year, compared with $255,000 for family medicine, $244,000 for pediatrics and $243,000 for public health and preventative medicine.
State abortion bans in the aftermath of last year’s Supreme Court decision to overturn Roe v. Wade create more barriers to training the country’s OB/GYNs. Further, it could cause some existing providers to leave the state they’re in due to the legal complexities, which means some communities could lose access to sexual and reproductive health services, said Ramey Connelly, associate director of individual clinical training for Midwest Access Project.
While major challenges remain, Connelly, Chen and Orr each left the audience with one recommended solution that could alleviate the physician supply pressures.
Connelly would like to see integrated abortion training included in medical residency programs to help expand the pool of providers.
Chen stressed the need to see payment models that incentivize services in underserved areas and in needed physician specialties.
And Orr pointed to Graduate Medical Education reform, specifically the need for flat reimbursements for each medical resident. The current funding model, which often favors teaching hospitals in the Northeast, has created geographic misallocation of training and physicians, making the scarcity of doctors even worse in some U.S. regions.
Jon Harris is the health care reporter at The Buffalo News in Buffalo, N.Y.