AARP's Timely Message About the Doctor Shortage

In the AARP's current bulletin from Jan/Feb 2025, there is a timely story by Howard Zucker, M.D. about the difficulties of finding a doctor. The full article is "Where Have All The Doctors Gone?" [https://www.aarp.org/benefits-discounts/members-only-access/info-2025/where-are-all-the-doctors.html] A 20% summary of the article is shown below:

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Summary: Navigating the Doctor Shortage Crisis in the U.S.

The U.S. faces a severe and worsening physician shortage, leaving many patients struggling to access timely and adequate medical care. With wait times averaging 26 days for new patients and acute cases seeing delays of six days or more, the situation is dire, particularly for older Americans and those with chronic conditions. This crisis stems from a combination of failed policies, professional burnout, and systemic inefficiencies.

Origins of the Crisis

A significant turning point was a 1980 government report predicting a physician surplus, leading to a 25-year moratorium on increasing medical school class sizes. However, this failed to anticipate a growing and aging population. Although medical school enrollments have since increased, residency positions have not kept pace due to limited government funding. Consequently, the Association of American Medical Colleges (AAMC) projects a shortage of up to 86,000 physicians by 2036.

Compounding the issue is the financial burden of medical education. With an average debt of $235,000, many students are deterred from pursuing lower-paying primary care roles, opting instead for higher-paid specialties. Primary care physicians (PCPs), crucial for preventive care and referrals, are dwindling, leading to gaps in early detection and management of health issues.

The Impact of Burnout and Corporate Control

Physician burnout is widespread. Many doctors face unsustainable workloads, with corporate-owned practices and hospitals prioritizing profit over patient care. These organizations often limit patient visits to 15 minutes, undermining the doctor-patient relationship. Administrative burdens further exacerbate the problem, with doctors spending two hours on paperwork for every hour of patient care.

Burnout has led to early retirements, reduced work hours, and an exodus from clinical medicine. A 2023 Mayo Clinic study estimated these trends could reduce the physician workforce by over 20,000 doctors, equivalent to the annual graduating classes of U.S. medical schools. Alarmingly, physician suicide rates are double those of the general population.

The Shift to Concierge Medicine and Other Trends

To counteract these challenges, many doctors are turning to concierge medicine, where patients pay annual fees for personalized care and shorter wait times. However, these fees, often ranging from $2,000 to $10,000, are unaffordable for most Americans, further straining the system. Others are moving into hospitalist roles, focusing on inpatient care during set shifts. While this improves work-life balance for physicians, it leaves fewer doctors available for routine outpatient care.

Challenges for Older Americans

The physician shortage disproportionately impacts older adults, a demographic requiring more complex and frequent care. The U.S. has fewer than 7,000 geriatricians, with a projected shortfall of over 2,000 by 2037. Efforts to address this include expanding geriatrics training for PCPs and specialists and implementing age-friendly care models. However, progress is slow, leaving older patients at risk of delayed or inadequate treatment.

Policy Recommendations and Solutions

Experts advocate for a multipronged approach to address the crisis:

• Expand residency funding: Increase government support to create more training positions for medical graduates.

• Improve primary care incentives: Enhance compensation and reduce administrative burdens to attract more doctors to primary care.

• Develop age-friendly care systems: Train all Medicare-supported healthcare providers in geriatric care and promote seamless integration across care settings.

• Support physician well-being: Implement measures to reduce burnout, including mental health resources and reasonable workloads.

• Reform corporate practices: Address the profit-driven policies of corporate-owned healthcare entities to prioritize patient care.

The Path Forward

The U.S. healthcare system faces a critical juncture. Without systemic changes, the doctor shortage will continue to worsen, endangering patient outcomes, especially for vulnerable populations. Addressing the crisis requires coordinated efforts from policymakers, healthcare organizations, and educational institutions to rebuild a resilient and patient-centered system.

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All in all, Dr. Zucker wrote a thoughtful article which emphasizes how little control physicians have had for decades in managing our practices. My only addition to what has been written is that while some doctors are attempting to regain some control by pursuing a concierge path, other doctors are reasserting their role in healthcare by focusing directly on the doctor-patient relationship and opening, or joining, direct care practices such as Evexeya Health.

Drs. Mike and Susan have practiced long enough to understand the current system is broken and we are pursuing the direct care model to allow us to provide Prompt Tailored Care for each individual patient. With the Evexeya Health clinic, members will benefit from greatly improved access to their doctors in terms of longer appointments, more timely care, and improved after hours access directly with their doctor. Feel free to contact us for more information.