Healthcare News and Trends
Physician Shortages in Medical Specialties in 2021: An Inside Look
March 16, 2021
By Linda Beattie, contributor
Physician shortages have been affecting
America’s healthcare workforce for decades, contributing to a range of
problems, from limited patient access and poorer outcomes to physician burnout.
Despite ongoing efforts by many
healthcare leaders and academics to sound the alarm and find long-term solutions,
“there doesn’t seem to be a solution in sight,” said Andy Olson, divisional
vice president of recruiting for internal medicine subspecialties at Merritt Hawkins, the
nation’s leader in physician recruitment.
“The
physician shortage has always been part of the conversation, unfortunately,”
said Olson who has worked in physician search and recruitment at Merritt
Hawkins for more than 15 years. “We see the challenges every year, but sadly
nothing has changed. Multiple bills have been introduced, and Merritt Hawkins’
leaders have even testified before Congress.”
While
Congress recently voted to add graduate medical
education funding to last year’s COVID-19 relief
package and support 1,000 new residency slots, this increase will not come
close to bridging the gap between physician supply and demand.
The projected shortfalls in physician specialties
The most recent projections from the
American Association of Medical Colleges (AAMC) in June of 2020 show that the United States could see a shortage of between 54,100 and
139,000 physicians by 2033. This would include shortfalls in both primary and
specialty care.
The range of physician
shortages projected by 2033 include the following:
- Primary care -- between
21,400 and 55,200 physicians
- Nonprimary care specialties
– between 33,700 and 86,700 physicians
- Surgical
specialties – between 17,100 and 28,700 physicians
- Medical
specialties – between 9,300 and 17,800
- Other
specialties (i.e. pathology, radiology, psychiatry) – between 17,100 and 41,900
physicians
The annual AAMC study found that physician demand
will continue to grow faster than supply, largely driven by the aging
population and an expected 10.4 percent population growth between 2018 and
2033.
The population under age 18 is projected to
grow by only 3.9 percent, indicating low growth in demand for pediatric
specialties. Yet the 65 and older population is projected to grow by 45.1
percent, indicating high demand for physician specialties that predominantly
care for older Americans.
Additional findings showed that if
currently underserved populations are given equal access to healthcare during
this time period—which is a national goal—it could create even deeper
shortages, with demand rising by an additional 74,100 to 145,500 physicians.
Demographics
affecting shortages in medical specialties
“The
country’s demographics are definitely changing, and as we age as a nation, our
physician population is impacted greatly,” Olson said.
“We
have made great advances in how we care for our elderly population,” he
continued. “The average life span continues to increase, which is wonderful,
but the number of babies being born each year also continues to rise, or at
minimum remain steady. What that tells us is there are more patients to care
for now than ever before in our history.”
“Most
medical specialties also have roughly 50 percent or more of their physicians at
the age of 55 or older,” Olson noted. “We are on the verge of a perfect storm.”
He pointed
out that older patients have more chronic conditions and issues that affect
physician demand in a variety of specialties, including a greater number of
neurologic conditions, endocrinology issues, gastrointestinal issues and even
cancer diagnoses.
Physician
shortages
are also expected to get worse as physician supply will be negatively impacted by a
wave of retirements and older physicians who tend to cut back their hours.
”Without a plan to
increase supply, it will get worse before it gets better,” Olson said.
According
to the 2020 American Medical Association Physician
Specialty Report, (using data up through December 2019), 44.9 percent of all active physicians were
55 or older. The specialties with the largest number of physicians in the
near-retirement group included:
- Pulmonary
disease physicians – 90.1 percent are age 55+
- Preventive
medicine physicians – 69.6 percent are 55+
- Anatomic/clinical
pathologists – 67.7 percent are 55+
- Cardiologists
– 62.8 percent are 55+
- Psychiatrists
– 61.3 percent are 55+
- Thoracic
surgeons– 60.1 percent are 55+
- Orthopedic
surgeons – 57.7 percent are 55+
“Although
many of the physicians in these specialties extend their careers to help cover
the need, they reduce their total hours worked, and many hospitals have bylaws
that no longer require them to take call,” said Mike
Jowdry, vice president of recruiting for Merritt Hawkins, who has worked in
various divisions of the company for the last 20 years.
“We have yet to properly address
increasing our residency and fellowship programs to make up for the perfect
storm of physicians retiring or slowing down and the increase in overall demand
for their services,” Jowdry added.
The top physician
specialties in “absolute demand”
A
June 2020 white
paper by Merritt Hawkins outlined a number of factors
that are affecting physician supply, demand and staffing during and post
COVID-19.
In
the months leading up to the pandemic, the following specialties were found to
be the top 10 in "absolute demand" – i.e., number of job openings vs.
number of physicians in a given specialty:
1.
Neurology
2.
Psychiatry
3.
Gastroenterology
4.
Hematology/Oncology
5.
Dermatology
6.
Urology
7.
Otolaryngology
8.
Geriatrics
9.
Rheumatology
10.
Family Medicine
While it’s hard for anyone to predict how
these specialties experiencing shortages may change in the new COVID
environment, the paper’s authors note several emerging trends, including an
increase in overall demand for physicians:
“Most of the factors driving physician supply
and demand, including an aging population, widespread chronic illness, and a
static supply of physicians, will
remain in place. It can be expected that general health, both physical and
mental, will be negatively affected by the pandemic, accelerating demand for
doctors. Added to these factors will be increased volatility in the physician
workforce, as doctors react to what for many has been an extremely challenging
time that has compromised their finances and their health.”
“The ‘new normal’ therefore is likely to
resemble the old normal in at least one regard -- shortages of both primary
care and specialist physicians will prevail,” they concluded.
How COVID
is affecting physician demand across specialties
“A
year ago, at least 50 percent of the physician recruitment business came to a
screeching halt, when hospitals and groups put a pause on nonessential services
and elective cases,” Olson said. “Specialties like orthopedic surgery, routine GI
routine screening and dermatology took a hit. But now it has started to pick
back up, especially as more services are now delivered via telemedicine,
including dermatology consults.”
Jowdry
expects that telemedicine will have an ongoing impact on the physician workforce.
“We
don’t see telehealth services going away,” he
said. “In fact, some candidates now are specifically looking for that, they
have narrowed their search parameters. While many physicians want to practice
in person, telemedicine will definitely be part of what candidates and clients
are looking for in the future.”
Olson
and Jowdry outlined several specialty trends during the pandemic:
- Pulmonary
and critical care have remained in-demand specialties, Olson noted, often with
ICUs being full to overflowing with COVID patients.
- Cardiology
has maintained consistent demand, and family practice has been flat, but Jowdry
expects the latter to start slowly increasing.
- After
the initial drop in demand, gastroenterology (GI) physician requests continue
to rise; “The need is still there, and has compounded itself in some cases.
Hospitals and practices are getting back on track,” said Jowdry.
- Dermatology
searches are also up again, as patients are now able to do some elective
procedures like laser treatments, and people desire to get back to normal life.
- Merritt
Hawkins has also seen more requests for geriatric medicine specialists lately, but
the supply isn’t expected to go up anytime soon. “As an industry we have to
consider physician compensation and reimbursement rates, and find a way to
incentivize entry into these fields,” said Olson.
- Orthopedic
and plastic surgeons saw a drop in demand when the pandemic hit, but urology
and ENT surgery didn’t really slow down, as the aging population tends to
always need these services.
- The
reduction in elective surgeries affected the demand for anesthesia providers,
but they are already seeing a rebound. “We’re seeing significant uptick in requests
for anesthesiologists and CRNAs over last two quarters,” said Jowdry.
- Other physician
specialties that have seen rising demand in recent months include psychiatry,
neurology and radiology, with more imaging and patient encounters being done via
telemedicine.
Pressing on toward future solutions
“What
to do about physician shortages is long-term
question; a lot of conversations still need to take place to overcome that
expected shortage of more than 130,000 physicians by 2033,” said Jowdry. “There
is a lot of work that needs to be done. Telehealth will certainly allow for
some physicians to have greater reach in their coverage, which will help, but
that’s just one piece of the puzzle.”
Moving forward, Merritt Hawkins will continue
to conduct industry research, lobby
government and work with our healthcare partners to address this ongoing
crisis.
Related:
Will There Be a Physician in the House? Physician Supply, Demand and
Staffing During and Post-COVID-19 – White paper
Merritt
Hawkins has the expertise to help
healthcare clients and physician candidates navigate uncertain times, and meet
their personal and professional goals.
Candidates: SEARCH ALL JOBS or CONNECT WITH A RECRUITER
Employers:DISCOVER OUR
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