Doctor Shortage

On August 5, 2009, in Acceleration

The same need to factor in accelerating change in a broader context applies to discussion of the alleged impending doctor shortage. It is claimed that the US faces a doctor shortage of 200,000 in the year 2020, of whom apparently only 4,080 will be cancer doctors.
The general physician shortage already has resulted in a rapid increase in the number of nurse practitioners, who could also be trained to take over some aspects of cancer care, a member of the American Society for Clinical Oncology said.
However, nurse practitioners may be less able to ameliorate the decline in general surgery, one of the few fields where the absolute number of surgeons is actually shrinking.

We can also expect patients themselves to ameliorate the doctor shortage. Indeed, “Helping people to do more for their own health care may be the only thing that saves health care reform,” wrote Don Kemper recently on the Health Care Blog. Giving people, and incentivizing them to use, efficient and effective tools for self-care, disease self-management, and decision support will also help alleviate “the overtreatment and under-caring so prominent in today’s health care system,” Kemper continues.

As noted above, one medical tool increasingly available to the public is the genetic test. Emily Singer reports in Technology Review that “paternalistic concerns” about people’s ability to understand the results of these “somewhat subtle” tests have been “subdued” by two recent studies suggesting that most patients cope easily with negative genetic information (that tells them, for example, that they are susceptible to Alzheimer’s later in life).

Perhaps the most obvious way to deal with the doctor shortage is to increase enrolment at medical schools, and that is indeed happening, according to a conference report published last October by the Josiah Macy, Jr. Foundation. It reported that nine new allopathic medical schools are under development with at least five more in planning and all but 18 of the 126 existing schools are increasing class size, which will result in an additional 5000 physicians each year by 2020, not counting those coming from nine new osteopathic schools added since 2000 to the 19 already in existence, with more planned.

Unfortunately, if the 200,000-physician deficit is correct, that number is clearly a drop in the bucket; and more unfortunate still, the report added: “the enormous changes that have transformed medicine over the past century have outstripped the ability of the [extant model of medical education] to prepare future physicians adequately for the challenges and expectations of the new century.” Two paragraphs from the report resonate with arguments we have made repeatedly:

The overarching theme that coursed through the discussions was the urgent desire to bring medical education into better alignment with societal needs and expectations. Hence, much of the discussion focused on contemporary realities that are not yet adequately reflected in the preparation of future physicians. Notable examples include the accelerating pace of scientific discovery; the determined calls for more public accountability; the unsustainable rise in healthcare costs; the well-documented shortfalls in healthcare quality; the unconscionable racial and ethnic disparities in health and healthcare; and the inexorable increase in the burden of chronic illness and disability.

Among the tasks identified for medical schools were the following: (a) re-define the science that is the foundation of medicine; (b) underscore the importance of problem solving and self-directed learning in an era of exploding knowledge; (c) ensure that students experience continuity of care for individual patients, especially those with chronic illnesses; (d) provide students with opportunities to learn the principles of quality improvement and patient safety; (e) place less emphasis on hospital venues and more on community settings as “classrooms” for educating future physicians; (f) prepare students to work effectively as members of interprofessional teams; (g) broaden the understanding of public health and non-biologic determinants of illness; (h) foster long-term relationships between students and faculty; and (i) develop the teaching and mentoring skills of faculty.

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