Shortage of Doctors!

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Posted by Is this true? from IP 71.249.13.194 on April 15, 2010 at 03:33:23:

I thought there were too many doctors in USA, IMG (pre
residency )included...

The new federal health-care law has raised the stakes
for hospitals and schools already scrambling to train
more doctors.

Experts warn there won't be enough doctors to treat the
millions of people newly insured under the law. At
current graduation and training rates, the nation could
face a shortage of as many as 150,000 doctors in the
next 15 years, according to the Association of American
Medical Colleges.

That shortfall is predicted despite a push by teaching
hospitals and medical schools to boost the number of
U.S. doctors, which now totals about 954,000.

The greatest demand will be for primary-care
physicians. These general practitioners, internists,
family physicians and pediatricians will have a larger
role under the new law, coordinating care for each
patient.

The U.S. has 352,908 primary-care doctors now, and the
college association estimates that 45,000 more will be
needed by 2020. But the number of medical-school
students entering family medicine fell more than a
quarter between 2002 and 2007.

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A shortage of primary-care and other physicians could
mean more-limited access to health care and longer wait
times for patients.

Proponents of the new health-care law say it does
attempt to address the physician shortage. The law
offers sweeteners to encourage more people to enter
medical professions, and a 10% Medicare pay boost for
primary-care doctors.

Meanwhile, a number of new medical schools have opened
around the country recently. As of last October, four
new medical schools enrolled a total of about 190
students, and 12 medical schools raised the enrollment
of first-year students by a total of 150 slots,
according to the AAMC. Some 18,000 students entered
U.S. medical schools in the fall of 2009, the AAMC
says.

But medical colleges and hospitals warn that these
efforts will hit a big bottleneck: There is a shortage
of medical resident positions. The residency is the
minimum three-year period when medical-school graduates
train in hospitals and clinics.

There are about 110,000 resident positions in the U.S.,
according to the AAMC. Teaching hospitals rely heavily
on Medicare funding to pay for these slots. In 1997,
Congress imposed a cap on funding for medical
residencies, which hospitals say has increasingly hurt
their ability to expand the number of positions.

Medicare pays $9.1 billion a year to teaching
hospitals, which goes toward resident salaries and
direct teaching costs, as well as the higher operating
costs associated with teaching hospitals, which tend to
see the sickest and most costly patients.

Doctors' groups and medical schools had hoped that the
new health-care law, passed in March, would increase
the number of funded residency slots, but such a
provision didn't make it into the final bill.

"It will probably take 10 years to even make a dent
into the number of doctors that we need out there,"
said Atul Grover, the AAMC's chief advocacy officer.

While doctors trained in other countries could
theoretically help the primary-care shortage, they hit
the same bottleneck with resident slots, because they
must still complete a U.S. residency in order to get a
license to practice medicine independently in the U.S.
In the 2010 class of residents, some 13% of slots are
filled by non-U.S. citizens who completed medical
school outside the U.S.

One provision in the law attempts to address
residencies. Since some residency slots go unfilled
each year, the law will pool the funding for unused
slots and redistribute it to other institutions, with
the majority of these slots going to primary-care or
general-surgery residencies. The slot redistribution,
in effect, will create additional residencies, because
previously unfilled positions will now be used,
according to the Centers for Medicare and Medicaid
Services.

From the Archive

Opinion: How to Fix the Doctor Shortage (01/04/10)
Health Blog: Would Adding Residency Slots Solve the
Primary-Care Shortage? (11/27/09)
Opinion: The Coming Shortage of Doctors (11/06/09)
Health Blog: Obama: 'Severe Shortage' of Primary Care
Doctors (08/11/09)
Some efforts by educators are focused on boosting the
number of primary-care doctors. The University of
Arkansas for Medical Sciences anticipates the state
will need 350 more primary-care doctors in the next
five years. So it raised its class size by 24 students
last year, beyond the 150 previous annual admissions.

In addition, the university opened a satellite medical
campus in Fayetteville to give six third-year students
additional clinical-training opportunities, said
Richard Wheeler, executive associate dean for academic
affairs. The school asks students to commit to entering
rural medicine, and the school has 73 people in the
program.

Journal CommunityDISCUSS
“As a specialist physician I will suggest that until
primary care physicians can earn 70-80% of what most
specialists make without killing themselves, there will
be no incentive for the best and the brightest to go
into primary care. ”
—Michael Brennan
"We've tried to make sure the attitude of students
going into primary care has changed," said Dr. Wheeler.
"To make sure primary care is a respected specialty to
go into."

Montefiore Medical Center, the university hospital for
Albert Einstein College of Medicine in New York, has
1,220 residency slots. Since the 1970s, Montefiore has
encouraged residents to work a few days a week in
community clinics in New York's Bronx borough, where
about 64 Montefiore residents a year care for pregnant
women, deliver children and provide vaccines. There has
been a slight increase in the number of residents who
ask to join the program, said Peter Selwyn, chairman of
Montefiore's department of family and social medicine.

One is Justin Sanders, a 2007 graduate of the
University of Vermont College of Medicine who is a
second-year resident at Montefiore. In recent weeks, he
has been caring for children he helped deliver.

He said more doctors are needed in his area, but
acknowledged that "primary-care residencies are not in
the sexier end.

A lot of these [specialty] fields are a lot sexier to
students with high debt burdens."

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