NEJM article examines U.S. physician shortage

In this week's issue of the New England Journal of Medicine, national correspondent John Iglehart examines efforts by medical schools to enroll and train more physicians, as well as the lack of action by the federal government and private health insurance industry to address concerns about physician shortages in the U.S.

Iglehart writes that "one cannot dispute the new stirrings that suggest disequilibrium between the supply of physicians and the demand for their services." He adds, "Ironically, at a time when policymakers and private interests are once again seriously exploring ways to provide health insurance to many of the 47 million people who lack it, very few of the candidates vying for the presidency have raised the question of whether there will be an adequate number of doctors and nurses to treat patients, should they gain coverage."

"Given that Medicare beneficiaries and persons with private insurance are reported to have, in general, ready access to care," it is the uninsured "who have a difficult time finding a physician," as well as Medicaid beneficiaries and the 20% of U.S. residents who live in federally designated "medically underserved" areas, Iglehart writes, adding that physician recruitment and retention "presents a challenge for community health centers, the medical operations of the Departments of Defense and Veterans Affairs, community hospitals and even group medical practices."

He says that the last time the federal government "invested heavily in expanding the U.S. capacity to educate medical students, its policymakers moved cautiously before taking action," and there is "no expectation that Congress will wade into this complicated issue any more rapidly this time." The Association of American Medical Colleges has called on Congress to remove the cap on the number of Medicare-funded graduate medical education program positions.

Physician Richard Cooper recently wrote that if the cap had not been imposed and the number of slots had been allowed to grow without constraint, "the physician shortages that are developing today would not exist." Iglehart writes that removing the cap "has never been regarded as an easily achievable policy goal, but it became an even more difficult challenge when the [Bush] administration proposed in its 2009 budget to sharply reduce the overall growth of Medicare spending" (Iglehart, NEJM, 4/17).