Doctors Vanish From View
Harried by the bureaucracy of medicine, physicians are pulling back from patient care
The doctor is out. While it's still very competitive to get into med school, some worry the best and the brightest may soon avoid the profession altogether. Med school applications are more than 10,000 below 1996's peak of 47,000. In a 2001 survey by the California Medical Association, two thirds of doctors were not advising their kids to enter the profession. "When I did my rotations, I had older physicians every other day telling me to get out now," says one recent med school graduate who subsequently dropped out of her residency program.
You may be thinking, "I don't like Monday mornings either, and I'm sure not getting paid as much as a doctor." Indeed, doctors still earn a very good living--an average of about $150,000 for family practitioners and two or more times that for lucrative specialties like cardiology. But doctors also spend many years in training earning little or nothing and face big bills from med school. In 2003, the median debt for graduates of public med schools was $100,000 and, for those graduating from private schools, a whopping $135,000, according to the Association of American Medical Colleges. (In 20 years, the median debt level has increased more than 4.5 times.) Meantime, malpractice insurance rates are still climbing. An obstetrician-gynecologist in Illinois could pay as much as $230,000 per year in Illinois or $90,000 in Los Angeles, according to Medical Liability Monitor.
All of this adds up to a growing concern that people may soon have trouble finding a doctor. Estimates of the shortfall vary. Miller is predicting a shortage of between 90,000 and 200,000 physicians by 2020. Richard Cooper, director of the Health Policy Institute at the Medical College of Wisconsin, has long predicted shortages and also says the gap could hit 200,000 by the same year. Both urge an increase in the number of doctors being trained, which has been stagnant for years. The Council on Graduate Medical Education, the American Medical Association, and the Association of American Medical Colleges, all of whom had projected surpluses in the past, have recently changed positions and acknowledged the problem.
Shortages will (and do) vary by geographical area, depending on reimbursement levels, malpractice insurance rates, and the cost of living. The problems are always grim in rural regions--the National Rural Health Association says that 25 percent of the population lives in rural areas, though only 10 percent of doctors practice there. Most experts say shortages of primary-care physicians will occur mainly in these parts of the country--primary care isn't appealing for its relentless office schedule and relatively low compensation. (Last year, the Task Force on Wisconsin's Future Physician Workforce said that the state is already short 506 primary-care physicians, with no relief in sight.) Already underserved inner-city areas may also be at particular risk. African-American doctors, who are far more likely to treat minorities in these urban areas, are no less bummed out than the rest of the profession; a survey of African-American doctors sponsored by the National Medical Association last year found that most were dissatisfied with practicing medicine.
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