Dear Congress, Here’s How to Fix the Clinician Shortage
The US faces a predicted shortage of between 37,800 and 124,000 doctors over the next 10 years. While the shortage of physicians will affect almost all specialties, primary care, pediatrics and psychiatry will suffer the most. The shortage will make it even more difficult to serve a growing population, especially in underserved areas. Do not believe me? The nursing shortage in the country is just as great as the doctor deficit and patient safety is already endangered as a result.
Congress begins to pay attention. Senators Bernie Sanders (I-Vt.) and Bill Cassidy (R-La.) have solicited input on the root problems and solutions to the health care workforce shortage.
As an emergency doctor for almost 20 years, I have a few thoughts. Let’s tackle some of the causes first.
More than 62% of nurses and 42% of doctors consider themselves burned out. The suicide rate of these healthcare providers is twice the national average.
And yet, our system still makes it incredibly difficult for doctors to seek help. Doctors and nurses worry about the consequences of asking for help. One study found that 60% of surgeons who had thoughts of suicide were afraid to seek treatment because they feared it would affect their ability to keep their license.
Student debt also contributes to the country’s shortage of doctors.
Medical school enrollment has increased nearly 18% over the past 10 years. Obviously there are people who want to get into the medical field. But the average medical student graduates from medical school with about $250,000 in debt — a figure that’s seven times higher than the average for college grads, three times higher than for master’s degrees, and nearly double that for graduate students. Students from underrepresented communities have an even higher debt burden. Most residents do not earn enough to start paying off loans. The result is compound interest and increasing debt. Adding to these financial challenges is that the residency match system is broken. In 2022, around 2,200 students were unmatched. Black and brown students tend to be second to none, as are international medical students. A place of residence is mandatory for the practice of medicine. If these students cannot practice, they cannot pay off their debts.
If left unaddressed, these issues will have serious implications for nursing care in the United States
Well, here’s what Congress can do.
The country’s fee model not only increases costs for consumers, it also increases the commercialization of doctors. Doctors want to help and heal. Value-based care programs tie payments for care to the quality of care provided. These reforms reduce administrative burdens and allow providers to focus more on patients. An October 2020 Deloitte report concluded: “Values-based care is consistent with physicians’ intrinsic motivation to provide the best care to their patients as it leads to improvements in quality, outcomes and patient experience. Refocusing work from productivity to value can bring meaning to medical work and reduce burnout.”
Second, lawmakers must invest in clinicians while they invest in infrastructure. The current generation of students is aware of the impact rising student debt will have on their ability to buy a home — or even go on vacation — in adulthood. The American Academy of Family Physicians (AAFP) has asked Congress to expand funding for federal programs that offer credit forgiveness (like the National Health Service Corps program) and to pass the Resident Education Deferred Interest Act, which would allow physicians to do so , defer their student loans during the stay interest-free. The group also said interest on medical student loans should be deductible on federal tax returns. Finally, they asked Congress to strengthen the Teaching Health Center’s Graduate Medical Education program, which has trained more than 1,730 primary care physicians and attracts and retains physicians in rural and medically underserved communities. Our national healthcare spending and healthcare system would see a great return on these investments.
Finally, Congress must promote licensing reform. The majority of states require that healthcare professionals and institutions disclose any mental health treatment received, regardless of its magnitude or intensity. And a 2018 study showed that 32 admissions offices had questions about physicians’ mental health that could be ruled illegal under the Americans with Disabilities Act. As a result, many people have been reprimanded by regulatory agencies, lost their jobs, and faced other negative professional consequences. It’s time for Congress to step in.
These steps alone will not solve our clinical crisis, but they will help. The legislature has no time to waste.
N Adam Brown, MD, MBA, is a practicing emergency physician, founder of ABIG Health and professor of practice at the University of North Carolina’s Kenan-Flagler Business School.