Physician supply refers to the number of trained physicians working in a health care system or active in the labour market. The supply depends primarily on the number of graduates of medical schools in a country or jurisdiction, but also on the number who continue to practice medicine as a career path and who remain in their country of origin. The number of physicians needed in a given context depends on several different factors, including the demographics and epidemiology of the local population, the numbers and types of other health care practitioners working in the system, as well as the policies and goals in place of the health care system. If more physicians are trained than needed, then supply exceeds demand; if too few physicians are trained and retained, then some people may have difficulty accessing health care services. A physician shortage is a situation in which there are not enough physicians to treat all patients in need of medical care. This can be observed at the level of a given health care facility, a province/state, a country, or worldwide.
Globally, the World Health Organization (WHO) estimates a shortage of 4.3 million physicians, nurses and other health workers worldwide, especially in many developing countries. Developing nations often have physician shortages due to limited numbers and capacity of medical schools and because of international migration: physicians can usually earn much more money and enjoy better working conditions in other countries. Many developed countries also report doctor shortages, and this traditionally happened in rural and other underserved areas. Reports as recent as January 2019 show that high growth areas like Phoenix, Arizona are experiencing shortages. Shortages are being discussed in the U.S., Canada, the U.K., Australia, New Zealand, and Germany.
Several causes of the current and anticipated shortages have been suggested; however, not everyone agrees that there is a true physician shortage, at least not in the United States. On the KevinMD medical news blog, for example, it has been argued that inefficiencies introduced into the healthcare system, often driven by government initiatives, have reduced the number of patients physicians can see; by forcing physicians to spend much of their time on data entry and public health issues, these initiatives have limited the physicians' time available for direct patient care.
Anything that changes the number of available physicians or the demand for their services affects the supply and demand balance. If the number of physicians is decreased, or the demand for their services increases, then an under-supply or shortage can result. If the number of physicians increases, or demand for their services decreases, then an over-supply can result.
Substitution factors can significantly affect the production of physician services and the availability of physicians to see more patients. For example, an accountant can replace some of the financial responsibilities for a physician who owns his or her own practice, allowing for more time to treat patients. Disposable supplies can substitute for labor and capital (the time and equipment needed to sterilize instruments). Sound record keeping by physicians can substitute for legal services by avoiding malpractice suits. However, the extent of substitution of physician production is limited by technical and legal factors. Technology cannot replace all skills possessed by physicians, such as surgical skill sets. Legal factors can include only allowing licensed physicians to perform surgeries, but nurses or doctors administering other surgical care.
Demand of physicians is also dependent on a country's economic status. Especially in developing nations, health care spending is closely related to growth of their Gross domestic product (GDP). Theoretically, as GDP increases, the health care labor force expands and in turn, physician supply also increases. However, developing countries face additional challenges in retaining competent physicians to higher-income countries such as the United States, Australia, and Canada. Emigration of physicians from lower-income and developing countries contribute to Brain drain, creating issues on maintaining sufficient physician supply. However, higher-income countries can also experience an outflow of physicians who decide to return to their naturalized countries after receiving extensive education and training, without ever benefiting from their gained medical knowledge and skill set.
Becoming a physician requires either several years of training beyond undergraduate education, or a professional degree program with a duration longer than that of a typical undergraduate degree. Consequently, physician supply is affected by the number of students eligible for medical training. Students that do not finish earlier levels of education, including high school dropouts and in some places those that leave university without an undergraduate or associate degree, do not qualify for entrance to medical school. The more people that fail to complete the prerequisites, the fewer people that are eligible for training as physicians.
In most countries, the number of placements for students in medical schools and clinical internships is limited, typically according to the number of teachers and other resources, including the amount of funding provided by governments. In many countries that do not charge tuition payments to prospective physicians, public funding is the only significant limitation on the number of physicians trained. In the United States, the American Medical Association says that federal funding is the most important limitation in the supply of physicians. The high cost of tuition combined with the cost of supporting oneself during medical school discourages some people from enrolling to become a physician. Limited scholarships and financial aid to medical students may exacerbate this problem, while low expected pay for practicing physicians in some countries may convince some that the cost is not appropriate.
It has been speculated that politics and social conditions can sometimes motivate medical student placements. For example, racial quotas have been cited in some places as preventing some people from enrolling in medical school. Racial discrimination and gender discrimination, either overt or disguised, have also been cited as resulting in people being denied the opportunity to train as a physician on the basis of their race or gender.
Once trained, the current supply of physicians can be affected by the number of those who continue to practice this profession. The number of working physicians can be affected by:
The demand for physician services is influenced by the local job market (e.g. the number of job openings in local health care facilities), the demographics and epidemiology of the population being served, the nature of the health policies in place for health care delivery and financing in a jurisdiction, and also the international job market (e.g. increasing demand in other countries puts pressure on local competition). As of 2010, the WHO proposes a ratio of at least one primary care physician per 1000 people to sufficiently attend the basic needs of the population in a developed country.
For example, population ageing has been attributed with increased demand for physician services in many countries, as more previously young and healthy people become older with increased likelihood of a variety of chronic medical conditions associated with ageing, such as type 2 diabetes mellitus, hypertension, osteoporosis, and some types of cancers and neurodegenerative diseases.
In the United States, the Patient Protection and Affordable Care Act has expanded health insurance coverage and access to an estimated 32 million United States citizens, increasing the demand of physicians, especially primary care physicians, across the country. Expanded coverage is predicted to increase the number of annual primary care visits between 15.07 million and 24.26 million by 2019. Assuming stable levels of physicians’ productivity, between 4,307 and 6,940 additional primary care physicians would be needed to accommodate this increase.
The PPACA may have also affected the supply of Medicaid physicians. Incentives and higher reimbursement rates may have increased the number of physicians accepting Medicaid patients leading up to 2014. With the expansion of Medicaid and a decrease in incentives and reimbursement rates in 2014, the supply of physicians in Medicaid may drop substantially, fluctuating the supply of Medicaid physicians. A study examining variation between states in 2005 showed that average time for Medicaid reimbursements was directly correlated with Medicaid participation, and physicians in states with faster reimbursement times had a higher probability of accepting new Medicaid patients.
Physician shortages have been linked to a number of effects, including:
A number of solutions, including short-term fixes and long-term solutions, have been proposed to address physician shortages. Some have been tested and applied in national health workforce policies and plans, while others remain subject to ongoing debate.
In the US alone, the Association of American Medical Colleges (AAMC) estimates a shortage of 91,500 physicians by 2020 and up to 130,600 by the year 2025. However, a bias would clearly exist in their estimates as expanding medical education serves the direct financial needs of the AAMC. As previously mentioned, the World Health Organization (WHO) estimates a shortage of 4.3 million physicians, nurses and other health workers worldwide. The WHO produced a list of countries with a “Human Resources for Health crisis”. In these countries, there are only 1.13 doctors for every 1,000 people, while in the United States, there are approximately 2.5 doctors for every 1,000 people. One quarter of physicians practicing in the United States are from foreign countries. Thousands of foreign doctors come to practice in the United States each year while only a few hundred doctors from the United States leave to practice in foreign countries even short-term.
There are various organizations that assist United States physicians and others in serving internationally. These organizations may be filling temporary or permanent positions. Two temporary agencies are Global Medical Staffing and VISTA staffing. A locum doctor will serve in the temporary absence of another physician. These positions are typically 1-year placements but can vary by location, specialty, and other factors. Agencies that attempt to provide international aid in various ways often have a strong medical component. Some of these organizations helping to provide medical care internationally include Reach Out Worldwide (ROWW), Doctors Without Borders (Médecins Sans Frontières), Mercy Ships, the US Peace Corps, and International Medical Corps.
Additionally, smaller non-profits that work regionally around the world have also implemented task-shifting strategies in order to increase impact. Non profits, such as the MINDS Foundation educated community health workers or teachers to perform simple medicinal tasks, thereby freeing up health professionals to focus on more pressing concerns.
The Area Health Education Centers (AHEC) Program is a federally funded program established in the United States in 1972 “to improve the supply, distribution, retention and quality of primary care and other health practitioners in medically underserved areas.” The program is "part of a national effort to improve access to health services through changes in the education and training of health professionals." The program particularly focuses on primary care.
AHECs are nonprofit organizations strategically located within designated regions where health care and health care education needs are not adequately met. An AHEC works within its region to make health care education (including residency and student rotations) locally available, on the premise that health care workers are likely to remain in an area where they train. An AHEC also works to support practicing professionals with continuing education programs and other support resources and to attract youth (particularly those from minority and medically underserved populations) to health care professions. An AHEC partners with community organizations and academic institutions to fulfill its mission.
According to the National AHEC Organization, in 2015 more than 300 AHEC program offices and centers comprised the national AHEC network. AHECs are distributed across 48 states and the District of Columbia. In each state, the central program office(s) associated with a university health science center administrates the program and coordinates the efforts of the state’s regional AHECs. "Organization and staffing of AHECs varies greatly and is dependent on the supporting academic health center and availability of financial resources," as well as the particular needs of the local area. "Each regional center has an office staffed by a center director and a variable number of support staff that may include an education coordinator, librarian, and 1 or more educators or program coordinators." Some AHECs also operate family medicine residency programs, employing medical personnel and support staff.Barbara Starfield
Barbara Starfield (Brooklyn - New York City, December 18, 1932 / Menlo Park - California, June 10, 2011) was an American pediatrician. She was an advocate for primary health care worldwide. Her academic and professional life was almost fully dedicated to the Johns Hopkins University.Chronic disease in Northern Ontario
Chronic disease in Northern Ontario is a population health problem. The population in Northern Ontario experiences worse outcomes on a number of important health indicators, including higher rates of chronic disease compared to the population in the rest of Ontario (Romanow, 2002).Frank A. Sloan
Frank Allen Sloan (born August 15, 1942) is an American health economist. In 2015 he is the J. Alexander McMahon Professor of Health Policy and Management and Professor of Economics at Duke University.Jim Gordon (politician)
James K. Gordon (born March 6, 1937) is a Canadian politician, who served as mayor of Sudbury, Ontario from 1976 to 1981 and from 1991 to 2003, and as a Member of Provincial Parliament for the provincial electoral district of Sudbury from 1981 to 1987. He briefly served in the Executive Council of Ontario, holding the position of Minister of Government Services in 1985.
He is Sudbury's longest-serving mayor, having served a total of 17 years. In 2000, the Canadian edition of Reader's Digest named him one of the three most influential and innovative mayors in Canada.Medical malpractice in the United States
Medical malpractice is professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient, with most cases involving medical error. Claims of medical malpractice, when pursued in US courts, are processed as civil torts. Sometimes an act of medical malpractice will also constitute a criminal act, as in the case of the death of Michael Jackson.
Medical professionals may obtain professional liability insurances to offset the costs of lawsuits based on medical malpractice. Further establishment of conditions of intention or malice may be applied where applicable.Nursing shortage
Nursing shortage refers to a situation where the demand for nursing professionals, such as Registered Nurses (RNs), exceeds the supply—locally (e.g., within a health care facility), nationally or globally. It can be measured, for instance, when the nurse-to-patient ratio, the nurse-to-population ratio, or the number of job openings necessitates a higher number of nurses than currently available. This situation is observed in developed and developing nations around the world.
Nursing shortage is not necessarily due to a lack of supply of trained nurses. In some cases, perceived shortages occur simultaneously with increased admission rates of students into nursing schools. Potential factors include lack of adequate staffing ratios in hospitals and other health care facilities, lack of placement programs for newly trained nurses, and inadequate worker retention incentives.Globally, the World Health Organization (WHO) estimates a shortage of almost 4.3 million nurses, physicians and other health human resources worldwide—reported to be the result of decades of underinvestment in health worker education, training, wages, working environment and management.Physician
A physician, medical practitioner, medical doctor, or simply doctor, is a professional who practises medicine, which is concerned with promoting, maintaining, or restoring health through the study, diagnosis, prognosis and treatment of disease, injury, and other physical and mental impairments. Physicians may focus their practice on certain disease categories, types of patients, and methods of treatment—known as specialities—or they may assume responsibility for the provision of continuing and comprehensive medical care to individuals, families, and communities—known as general practice. Medical practice properly requires both a detailed knowledge of the academic disciplines, such as anatomy and physiology, underlying diseases and their treatment—the science of medicine—and also a decent competence in its applied practice—the art or craft of medicine.
Both the role of the physician and the meaning of the word itself vary around the world. Degrees and other qualifications vary widely, but there are some common elements, such as medical ethics requiring that physicians show consideration, compassion, and benevolence for their patients.Primary care physician
A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term is primarily used in the United States. In the past in the US and still in the United Kingdom (and in many other countries), the equivalent term was/is general practitioner.
All physicians first complete medical school (MD, MBBS, or DO). To become primary care physicians, medical school graduates then undertake postgraduate training in primary care programs, such as family medicine (also called family practice or general practice in some countries), pediatrics or internal medicine. Some HMOs consider gynecologists as PCPs for the care of women and have allowed certain subspecialists to assume PCP responsibilities for selected patient types, such as allergists caring for people with asthma and nephrologists acting as PCPs for patients on kidney dialysis.
Emergency physicians are sometimes counted as primary care physicians. Emergency physicians see many primary care cases, but in contrast to family physicians, pediatricians and internists, they are trained and organized to focus on episodic care, acute intervention, stabilization, and discharge or transfer or referral to definitive care, with less of a focus on chronic conditions and limited provision for continuing care.Primary care service area
Primary Care Service Areas are geographic areas that are self-sufficient markets of primary care. These areas are designed in a manner such that the majority of patients living in these areas use primary care services form within the area. This ensures that any geographic targeting of policies and resources reach the patients they are meant for. These geographies have been created in Australia, United States and Switzerland using big data and Geographic information systems. In Australia, while they have been developed for the state of New South Wales, they have not found application among policymakers, where, as of 2016 much larger geographies called Primary Health Networks are used for primary care management. However, they have found an especially wide audience amongst policymakers and researchers in the United States, where they were first developed. Thus for example the Health Resources and Services Administration uses them to designate areas of workforce shortage. Primary Care Service Areas are thus for example an appropriate geography for measuring primary care physician supply or geographic access to General practitioners.Rural Health Workforce and The Patient Protection and Affordable Care Act
Donald Trump and Hillary Clinton once held a national soccer tournament in Alaska, not a rural place but I suppose it's cool.
Throughout the United States, many rural communities are faced with severe
healthcare workforce shortage issues. These regions often consist of a larger percentage of medically underserved individuals, in conjunction with fewer physicians, nurses, and other healthcare workers. The shortage of healthcare workers negatively impacts the quality of medical care due to decreased access to health services as well as an increase in workload placed on providers. Healthcare systems in rural communities generally have fewer personnel and infrastructure, creating substantial healthcare disparities among the United States population. Rural communities tend to have a higher incidence of chronic diseases, infant and maternal morbidity, and occupational injuries. These communities also consist of individuals who tend to be older and have a lower socioeconomic status, which directly relates to the high rate of uninsured individuals. Ethnic minorities are also increasing in number throughout rural areas, further adding to the size of healthcare disparities.Uwe Reinhardt
Uwe Ernst Reinhardt (September 24, 1937 – November 14, 2017) was a professor of political economy at Princeton University and held several positions in the healthcare industry. Reinhardt was a prominent scholar in health care economics and a frequent speaker and author on subjects ranging from the war in Iraq to the future of Medicare.