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(3,000 to 1 if there are unusually high needs in the community). Unfortunately, Michigan has not escaped this trend. In fact, Michigan is experiencing a decline in the number of primary care physicians, with more shortages expected by 2030, particularly impacting residents in underserved areas.
More Contributors to the Pending Physician Shortage
The exorbitant cost of a medical school education is one of the largest barriers keeping more students from pursuing medicine. This has received more attention in recent media segments than many years before but unfortunately continues to remain a major deterrent to becoming a physician. The typical young doctor
in the U.S. leaves school with about $200,000 in medical stu- dent-loan debt, which also contributes to physician shortages in rural and underserved areas by driving these physicians to seek higher-paying positions in larger cities. There is an oversupply of physicians in the highly desirable locations and still not nearly enough in underserved areas.
As if that were not daunting enough, in July of this year, the Centers for Medicare and Medicaid (CMS) proposed a decrease to the Medicare Physician Fee Schedule conversion factor, which would lead to significant cuts to physician reimbursement starting in 2023. It is therefore no surprise that the physician community is not pleased with the 2023 Medicare Physician
Fee Schedule proposed rule, based on immediate reactions from physician advocacy groups. Many groups have suggested that
the proposed cuts to physician reimbursement threaten patient access to care. To that end, some patients have registered concern that it feels like their doctors have been placed on assembly line time clocks and can only spend an allotted amount of time with them. These kinds of reimbursement challenges not only affect physician’s numbers but there is an additional ripple effect on education, expertise, and health care value.
The COVID-19 pandemic, with all its variants, has put an even greater burden on this waning workforce --who are maximally stressed but despite-it-all continue to rally and show-up to fight against this national public health emergency.
Our physician workforce is aging! More than 2 of 5 currently active physicians will be 65 or older within the next decade, which will have a huge impact on the available supply of physicians to meet the nation’s medical needs and demands.
Further, if that’s not enough--- 40% of the country’s practicing physicians felt “burnt out” at least once a week even before the COVID-19 crisis began. The increasing concern for clinician burnout has been intensified by the pandemic—which could cause doctors and other health professionals to cut back their hours or even accelerate their plans for retirement.
The physician role may have blurred lines for the patient experience. It can be difficult for patients to figure out who is who during their hospital stays. We all wear white coats, many wear stethoscopes and have name badges with an alphabet soup of letters behind their names. From the patient perspective, is
it the Physician, Physician Assistant, Nurse Practitioner? Some patients are not always clear on who they are communicating with and may not distinguish among those they encounter.
Is Help on the Horizon?
The AMA supports current actions by Congress to expand federal support for graduate medical education through measures such as the Resident Physician Shortage Reduction Act (S. 834). This legislation, a version of which is also pending in the U.S. House, will add 2,000 more Medicare-supported medical residency positions each year for seven years at qualifying hospitals starting in 2023—with a particular emphasis on hospitals in rural areas and medically underserved communities. The actual bill was introduced to the Senate on 3/18/2021 and covers the following:
[This bill increases the number of residency positions eligible
for graduate medical education payments under Medicare for qualifying hospitals, including hospitals in rural areas and health professional shortage areas. Current law provides for an increase of up to 200 positions per fiscal year beginning in FY2023, with a total increase of 1,000 positions; each hospital may receive up to 25 additional positions. The bill provides for an additional increase
of 2,000 positions per fiscal year from FY2023 - FY2029; during this period, each hospital may receive up to 75 additional positions in total under the bill and current law. The bill also requires
the Government Accountability Office to report on strategies
to increase the diversity of the health professional workforce, including with respect to representation from rural, low-income, and minority communities].
In a recent article, Janis Orlowski, MD, Chief Health Care Officer, Association of American Medical Colleges (AAMC)
| Nephrologist, MedStar Health says “It’s Not just about tomorrow.” She states “We talk about a worsening physician shortage, but I want to make sure that people understand that there’s a physician shortage today. Dr Orlowski warned that according to data from the U.S. Health Resources and Services Administration (HRSA)— “there is a shortage right now.” HRSA data looks at and studies current shortages in primary care and psychiatry and finds significant shortages in both areas today. Dr. Orlowski added that a shortage of general surgeons
in rural communities is also a problem. She concludes, “It’s not enough to just think about tomorrow. We need to think about this as a present problem today!” •
References
1. https://www.aamc.org/news-insights/press-releases/aamc- report-reinforces-mounting-physician-shortage
2. https://mvic.sos.state.mi.us/PublicBallot/Index
3. https://www.kff.org/other/state-indicator/primary-care-health- professional-shortage-areas-hpsas/?currentTimeframe=0&so rtModel=%7B%22colId%22:%22Location%22,%22sort%22: %22asc%22%7D
4. https://www.nbcnews.com/business/business-news/doctor- out-why-physicians-are-leaving-their-practices-pursue- other-n900921
5. https://revcycleintelligence.com/news/providers-face-cuts-in- medicare-physician-fee-schedule-proposed-rule July 2022
Third Quarter 2022
Detroit Medical News 5