There may be an impending crisis in American healthcare you may not have heard much about because it doesn’t involve cost or insurance. Experts predict that in the next few years, there simply won’t be enough doctors to treat us all- especially in rural areas and small towns. Joce Sterman reports part of the problem is a 20-year old law.
400 miles from Detroit, it’s a long trip over the Mackinac Bridge, into the picturesque, but isolated, Upper Peninsula - and Gwinn, Michigan.
Dr. Jesse Heard: Out buying groceries, there’s always ‘Hey Doc!’
At the rural Upper Great Lakes family health center, Dr. Jesse Heard sees as many as 22 patients each day - some traveling as far as 100 miles to see him.
Dr. Jesse Heard: I have gone from psychiatry to stitching up a 32-centimeter laceration from a band saw.
In Michigan, 1.7 million people lack access to primary care services. And in the Upper Peninsula, a health department survey shows there’s one psychiatrist for every 39,000 residents. With few specialists nearby, and practices few and far between, Dr. Heard is forced to tackle every medical challenge he learned in training.
Dr. Jesse Heard: A lot of people think, you're just a quiet country doctor. You don't really do very much.. is very much the opposite.
Challenges like this are reflected all over the country...and it’s about to get worse. The Association of American Medical Colleges - AAMC - is forecasting a major doctor shortage by 2030 - with rural communities hardest hit.
Dr. Atul Grover: We’ve been trying to educate on this issue for more than a decade.
Dr. Atul Grover is the Executive Vice President of AAMC.
Dr. Atul Grover: Our best estimates are that we're going to be short somewhere up to about 130,000 doctors across the nation of all types.
Joce: That seems like a huge amount.
Dr. Grover: It is a huge amount. This is a problem that's getting worse by the day.
The big reasons - Dr. Grover says - are population growth and aging. Thanks to advances in modern medicine, people with chronic diseases are living longer and needing care later in life. Also, a factor - one-third of all currently active doctors will be over 65 in the next decade, so there’s a wave of retirements just ahead...adding to the shortage. But you might be surprised to hear Dr. Grover say the solution isn’t getting more people into medical school. it’s ensuring training spots when they graduate.
Dr. Atul Grover: On the supply side our real bottleneck is the number of residency training spots. Remember after somebody goes to medical school after they've gone to college, they get an MD, they still need to train for another three to eight years in a particular specialty.
=Congress put a cap on medicare, federal tax money used to fund that training as part of the 1997 Balanced Budget Act.
Dr. Atul Grover: We put that cap on in the 90s and in fact, even our own association, every expert at the time said it’s probably okay to pause and not train any more physicians for a number of years so that we can see what’s going on.
But after more than 20 years, that cap remains, and Dr. Grover says it’s time to reconsider and reopen funding to get more doctors trained.
Joce: If we could lift this cap, would that be the solution?
Dr. Atul Grover: We would have a solution to what's stopping us from training more doctors. We've done as much as we can in terms of training more physicians without any help from the federal government. Congress typically looks at these things and says, oh I have 5 or 10 years to handle this. But again, you can’t just pull physicians off the shelf. They need to be trained. It takes 10 years.
Teaching hospitals incur $18.5 billion in direct training costs each year. Right now Medicare supports less than $4 billion of that total. Some hospitals have stepped up to fill the residency gap on their own, but that’s concentrated training spots in wealthier, more populated areas. It’s yet another factor that complicates the shrinking number of physicians.
Joce: Tell me about the human cost of a doctor shortage. Who pays the price when this happens eventually?
Dr. Atul Grover: Unfortunately, we all need physicians at some point. People who are underserved are really gonna suffer the most. But that’s going to be your neighbors, your family members.
Places like Gwinn, Michigan where Doctor Jesse Heard is the lifeline to a community. His county -- one of the hundreds of places nationwide -- already labeled by the Health Resources and Services Administration as a Health Professional Shortage Area.
Joce: What do you say to physicians who say, listen, I'm not really interested in underserved areas?
Doctor Heard: It's really nice to hear ‘thank you.’ I stop at the gas station. Hey Doctor Heard, thanks for helping my mom. You know, nothing, nothing feels better than that.