Tuesday, September 27, 2011

Will The Physician Shortage Resolve Itself?

Much has been made about a possible physician shortage in the coming decade. Pundits point to the aging population and the large number of baby boomers reaching their golden years with its increased need for medical care. At the same time the large number of baby boom doctors themselves are set to retire. Then there is the fact that there is a very limited number of medical schools and residency programs to train new doctors. Add it all up and who can refute the prediction that the U.S. will face a dire need for more physicians in the near future.

However, statements about the future are rarely accurate. One of the most infamous predictions about the number of doctors needed was in the 1990's. At the time, many were predicting that there was going to be far too many anesthesiologists in this country. Because of these apocalyptic predictions, the number of medical students who chose to enter an anesthesiology residency in 1996 dropped to 325. The percentage of residency positions that were filled fell to only 34.3%. If you could fog a mirror, you could have gotten a residency spot into one of the most lucrative medical fields around. By comparison, in 2011, there were 841 anesthesiology residency positions available for the match. A full 820 of those were filled for a match rate of 97.5%. Today, anesthesiology is one of the toughest residencies to enter. How times, and predictions, change.

Now, we are bombarded by a bunch of Chicken Littles about the severe shortage of doctors in the near future and how it will limit access to health care. As I see it, there are several factors working to alleviate this deficiency. First of all, like the general population, doctors are expected to live longer. Their numbers of productive working years are likely to stretch far beyond what previous generations of doctors were able accomplish. So this bulge of baby boom doctors are likely to work well into their 60's, 70's, maybe even their 80's.

Second, they may need to work longer. Doctors have suffered catastrophic financial losses during the Great Recession. Many physicians have retirement accounts that have been devastated by the stock market. Reimbursements from payers have steadily shrunk, making it difficult to work your way out of these losses. Hoping to live off the interest of your savings is nearly impossible when the Federal Reserve is trying its hardest to keep interest rates nearly zero. So doctors may have no recourse but to keep working, just like everybody else who had hoped to retire soon.

Finally, the Great Recession has had a tremendous affect on the home front. Their kids may be going on five, six, seven, or more years of college education to gain that extra edge when it comes time to finally look for a job. At the same time, colleges are increasing tuition at a double digit inflation rate because of state funding cutbacks. So college expenses are gobbling up a huge chunk of income that would have gone towards retirement. If their kids have already graduated, they may still move back home for lack of a job, or a decent pay. With the kids back home, it is impossible to sell the house to downsize, like a normal retired couple would do. Unfortunately because of the housing market crash, it probably would have been difficult to sell the house at a decent price to move to Florida anyway.

As you can see, there are several major forces working against doctors leaving their jobs. In fact, nobody has retired from our group in over five years. And believe me, many of them should be in a retirement community playing golf at the country club by now. But financially, they can't do it. So now we have all these guys who are not leaving, preventing the younger anesthesia graduates from gaining a foothold in the field. Unless there is a sudden renaissance in the economy, we may have too many doctors trying to chase too few open jobs, just like the current fallout from the explosion in nursing school graduates. Then doctors will be facing a dearth of job prospects like everybody else.

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