The Future of America's Ailing Health Care System

We are all aware that Americans, on average, are getting older.  Older Americans result in one thing; a greater reliance on the health care system.  Unfortunately, the current health care system functions with family physicians (aka primary care physicians) acting as the gatekeepers.  While there is nothing inherently wrong with having a family doctor refer his or her patients through the health care maze, there is a looming problem with that model of care.  As background, in 2010, there were 208,807 practicing primary care physicians including 44,933 who are practicing in the more specific field of pediatrics and only 2,999 who practice in the field of geriatrics.

According to the Association of American Medical Colleges, this is the problem:

Between 2010 and 2015 (a year after the Affordable Care Act takes effect), the shortage of medical specialists in all fields will quadruple from 13,700 to 62,900 as a direct result of two key factors:

1.) the addition of 32 million Americans who are acquiring health care under the ACA.

2.) the addition of 36 million older Americans who are entering the Medicare phase of their lives.

By 2020, it is expected that there will be a shortage of more than 91,000 physicians; of these, 45,000 will be primary care physicians.  One of the biggest problems will be the synergistic effect of having one-third of all physicians reaching retirement age at the same time as the number of Americans who are older than 65 years of age increasing by 36 percent.

Here is a chart showing the shortfalls by year:

By 2025, the total shortfall in all specialties will hit 130,600 and there will be an additional shortage of 64,800 primary care physicians.

To show how critical the situation could become as more Americans are insured and as they get older, here are two graphs showing the number of annual office visits to primary care physicians by age for both insured and uninsured Americans:

Notice how the number of office visits to family doctors increases as one gets older and that the number of office visits is quite a bit higher for insured Americans?  Therein lies the problem.  According to the Annals of Family Medicine, with an average primary care physician seeing 2237 visits in an average year, the United States will need 260,687 practicing primary care physicians by 2025, an increase of just under 52,000 from the current level.  As shown on this graph, 33,000 of these will be needed due to population growth, 10,000 will be needed due to the aging population and 8,000 will be needed to meet the expansion of the insurance system:

One of the biggest problems facing the health care system has been the lack of growth in the funding of Medicare-supported physician training.  The level of funding has been frozen since 1997 (actually, the limits on the number of resident doctors that hospitals can count for Graduate Medical Education (GME) payments) and under sequestration, the across-the-board spending cuts triggered a 2 percent reduction in funding for the GME program.  These payments are made to hospitals to cover the added costs of training resident physicians, compensating hospitals for the salaries and fringe benefits of supervising faculty as well as stipends and fringe benefits for the residents themselves.

It would seem that the situation is rapidly becoming critical.  While the ACA may be allowing more Americans access to health care, the shortage of physicians, particularly primary care physicians, will have a strongly negative impact on medical services in America no matter what the President may want.