Story at a glance
- The United States is currently in the midst of a healthcare worker shortage which experts project will only get worse.
- By the 2030s, the country could be faced with a shortage of nearly 200,000 nurses and 124,000 physicians.
- Experts say that an aging population, an aging healthcare workforce and workers leaving due to burnout are driving the shortage.
Jen Reinmuth-Birch decided to go to medical school two years ago, at age 50, in part because of the struggle her ailing parents faced getting care in a medically underserved part of Oregon.
Due to the lack of primary care doctors in their area, Reinmuth-Birch told The Hill her parents have struggled to get treatment for their multiple chronic illnesses. Her father has Parkinson’s disease, while her mother has rheumatoid arthritis and osteoporosis and suffers from chronic pain due to a spinal cord injury.
“Seeing what they have had to go through in order to access a specialist, which you can’t do unless you go through a primary provider … it’s been very tough,” she said.
The United States is experiencing a healthcare worker shortage — and it’s only expected to get worse over the next decade, meaning people like Reinmuth-Birch’s parents will more than likely continue to miss out on essential care.
As the aging population’s need for such care grows, retirement and burnout are both driving swaths of healthcare workers out of the field, fueling a crisis that shows no signs of stopping.
The healthcare worker shortage spans a range of jobs. The Bureau of Labor Statistics projects that the country will face a shortage of 195,400 nurses by the year 2031, and that the number of openings for home health aides and personal health aides will increase 37 percent by 2028.
But nowhere will the shortage be felt more than among physicians.
The country is expected to suffer a shortage of up to 124,000 physicians in the next 12 years, according to a 2019 report from the Association of American Medical Colleges.
Those numbers include a shortage of between 17,800 and 48,000 primary care physicians, a deficit that could have a significant impact on patients.
“When people don’t have access to routine primary care and preventative services, they live sicker and die younger,” said American Medical Association (AMA) President Jesse Ehrenfeld.
Ehrenfeld added that the primary care doctor shortage is hitting rural communities and communities of color especially hard.
“These are things that are only going to get worse as we put more pressure on the physician workforce,” he said.
An aging population and healthcare workforce
Why is the country suffering this shortage? One reason is that demand for physicians is growing faster than supply can handle.
In other words, the pool of people who need care is expanding more quickly than the ranks of doctors who can treat them.
This is mainly because the country has an aging population and an aging healthcare workforce, according to Ehrenfeld.
There are about 55.8 million people aged 65 and older in the United States, according to U.S. Census Bureau data, an age group at higher risk for a slew of health conditions.
Their numbers are growing and will continue to do so. In 2010, the Census Bureau found there were 40.3 million Americans 65 and older; by 2034, it predicts there will be 77 million.
The number of licensed physicians in the country is also rising — by almost 20 percent over the past decade, according to AMA data. But like the general population, that workforce is also getting older.
Currently, almost half of working physicians in the United States are 55 and older, according to the AMA. Thirty-five percent of the physician workforce will reach retirement age within the next five years.
Healthcare workers are burned out
Already, the growing shortage of doctors is creating a backlog of work for those who are practicing, according to Rush University System for Health CEO Omar Lateef.
And that backlog means that sick people are forced to wait longer to get medical help.
Lateef said that this consequence of the physician shortage can be seen in emergency rooms across the country.
“You see empty beds and people that are very busy but there are just not enough people to meet the demand of sick people that we have in this country today,” Lateef said. “And that did not happen overnight.”
The backlog of work is itself contributing to the shortage, as some healthcare workers are also choosing to leave the field due to burnout.
This was both highlighted and exacerbated in recent years by the COVID-19 pandemic.
One in five health care workers quit their job during the pandemic, according to a 2021 Morning Consult report.
A 2022 study found that nearly 63 percent of physicians experienced symptoms of burnout by the end of 2021, representing a 19 percent increase from 2017.
Another 2022 study determined that one out of five doctors said they were likely to leave their current practice within two years, citing burnout and workload as two major reasons.
Physicians are burning out in part because of their demanding workloads. A 2022 Medscape report found that while they experienced burnout for a variety of reasons, one of the top three was “too many hours at work.”
This was the case for Lisa, an emergency medicine physician currently working in Minnesota.
Lisa, who did not share her last name for fear of retribution, practiced in Tennessee for five years before moving to the Midwest mid-pandemic to be closer to family.
Her time in Tennessee was exhausting and almost pushed her out of the medical field, she said. The hospital where she worked was run by a corporate management group with a leanly staffed emergency room. And when ERs are “leanly” staffed, Lisa explained, that means non-stop work for the health care providers in them.
“It’s a grind. You are working really hard. You have tons of very sick patients. It’s cognitively very difficult work and you leave your shift completely spent,” she said.
Luckily, when Lisa moved to Minnesota, she landed in an emergency room that she said was more adequately staffed, or at least required less work from her.
“We actually have about the same amount of staffing, maybe a little bit less than we had in my old department, but we probably have less than half the patients in a day,” she said.
And that lessened workload has made a huge difference in the quality of care that Lisa has been able to give, she said.
“You have time to think about your patients, you have time to talk to them and explain what’s going on,” she said. “It’s better for the patients and it’s better for the physicians.”
Burnout stems from more than just staffing levels, however. The top reason for physician burnout is an increase in bureaucratic tasks like billing, approving health insurance coverage and overseeing medical personnel, according to the Medscape report.
On average, physicians are spending 15.5 hours a week on administrative tasks alone, with some specialists clocking almost 20 hours a week on paperwork and administrative chores, according to the 2023 Medcape Physician Compensation Report.
“The administrative toll in part [caused] by external regulations and the challenge of the electronic medical record [system] and the incredible demand of how billing works in healthcare takes up so much time,” said Lateef. “And it takes away a provider’s time to look their patient in the eye and provide care.”
What can be done to stem the crisis?
Ehrenfeld suggested several ways to mitigate the shortage, including passing legislation that would allow more doctors to train and practice and reducing medical school debt.
One possible solution, he said, is to boost the number of residents in hospitals.
Ehrenfeld noted that the Resident Physician Shortage Reduction Act of 2023 could help do this by lifting the cap on residency programs.
The bill, which was introduced by Reps. Terri Sewell (D-Ala.) and Brian Fitzpatrick (R-Pa.) earlier this year, would expand the number of Medicare-supported medical residency positions by 14,000 over seven years.
Another piece of legislation that could help stem the shortage is the Conrad State 30 and Physician Access Reauthorization Act, according to Ehrenfeld.
Under the bill, international doctors would be able to stay in the U.S. after their residency programs as long as they committed to practicing medicine in parts of the country with physician shortages.
Easing medical student debt could also potentially increase the amount of doctors willing to work in underserved areas, Ehrenfeld said.
“The typical medical school graduate has about $200,000 in medical school debt,” he said. “And that shortage contributes to shortages in rural and underserved areas because it drives physicians to seek higher paying jobs in cities.”
–Updated at 12:10 p.m.
Published on Sep 28,2023