Tuesday, May 13, 2014
Are Too Many Female Doctors Really Creating a Doctor Shortage?
Yes, on reading the header a certain amount of cognitive dissonance may be induced. It would appear instead that the more female physicians and medical students the better, and certainly the less the chance there will be a future doctor shortage. Already the signs are not propitious, and a shortage of primary care physicians seems almost inevitable which would be bad news for the quality of care provided under the Affordable Care Act.
According to a report released by the Association of American Medical Colleges' Center for Workplace Studies, estimates are that by 2020 the U.S. will experience a shortage of nearly 90.000 physicians and 130,000 by 2025. To a large degree this shortage will be caused by the millions of aging baby boomers who will require more medical care irrespective of how many times they go the gym or jog.
The less well known aspect is that the country isn't producing enough physicians to keep up with population growth. The U.S. population has increased more than 35 million since 2000, and the number of physicians ought to have increased by an additional 100,000 at least in that time, but it hasn't. Instead, the number of available residency slots to train new doctors has barely increased.
Another interesting aspect: While general enrollment rate at medical schools has remained steady, the number of female medical students has increased every year since 1969. In that year they accounted for just nine percent of all medical students, while in 2003 the number of females peaked at 49.6 percent. This went down slightly to 47 percent in 2012, while the percentage of women doctors in the workforce was 30 percent.
Now - what about the shortage aspect? This is mainly in the field of primary care and has been directly traced to female physicians and their tendencies. On the whole, women doctors have shorter careers, take more time off and work fewer hours than male doctors. No surprise either that the primary care field is most popular with women given residencies are shorter and there are more opportunities for time off and job sharing.
We both experienced this phenomenon when "Dr. Lisa" - one of our favorite primary care physicians - left the primary care center we favored, in 2006. In my last encounter with her, during a physical exam in 2006, she told me that she was leaving to take care of her child (she was 6 months pregnant at the time) and would not be returning to practice - opting to be a homemaker and mom. While I wished her the best, it basically meant that all those medical school hours invested in her - including her residency and training - were wasted. In hindsight, then, it would have been better to allocate her place to either a male, or older female at the cusp of child bearing or beyond.
Adding to this deficit, are the part time hours worked. According to 2010 group survey data from the American Medical Group Association, nearly 4 in 10 female doctors between the ages 35 and 44 work part time. In addition, these same females tend to work an average of 4.5 hours a day less than their male colleagues. It may not be totally fair, but this is a huge reason why the influx of women is blamed for an ongoing shortage of doctors.
This elicits the question of whether medical school admission should continue to be gender blind. What happens then, when these women leave the profession to become stay at home moms, or enter another work situation? Should we even be asking these questions? Aren't they incursions on the freedom of women to choose?
I don't believe so. If any kind of national health care system is to work and benefit the people enrolled, particularly under the Affordable Care Act (for which every person must purchase insurance) then we need to also ensure the doctors are there to expedite the services. This means, alas, that medical school admissions need to ensure the qualifying manpower (or woman power) is available. If this means a prospective female med student must sign a form constraining her to at least 20 years primary care service - contingent on her acceptance or admission -then so be it. The fact is that given the constraints and needs, medical school admissions can no longer be apportioned based on chance future whims or choices.
Of course, these same principles need to apply to any males who veer off the medical path as well, say to go into business or industry instead of remaining. There must be commitments made for both genders in terms of medical school acceptance. This is critical given current estimates are that for every doctor in his 60s that leaves, there will be need to be one and one half to two doctors to replace him.
Another step that could help alleviate the crunch is to make more medical school spaces available. This is where congress comes in. And it involves money because unlike other professions the medical field is heavily subsidized so, contingent on the money, there are only limited slots available to support any given year's applicants. In 1997, for example, congress imposed a cap on the number of subsidized residencies, the final hurdle to obtaining a medical license.
The effect? Disparity between the total pool of applicants and those who actually get subsidized slots. Last year, 34,000 potential physicians competed but only 29,000 slots were awarded. Assuming such a 5,000 deficit in support each year, and projecting linearly, this adds up to 30,000 denied spots by 2020. Or one third of the 90,000 physician shortfall anticipated.
Looking on this in hindsight, it seems it would have been wise to first have changed the cap before going full tilt on implementing Obamacare. I mean, you can't have decent health care without doctors and there are only so many hours in a day. Though bills have been introduced to increase the number of slots, they have generally been voted down because the costs have been considered prohibitive. If this is the case, it may mean medical care in this country is "prohibitive" for the majority of citizens, and we need to find out exactly why.
If other countries can attend to their people's medical needs, why can't we? Oh wait! Other nations don't consider themselves to be the "cops of the world" - responsible for supporting a mammoth military to put down conflicts and problems erupting anywhere on the planet. Maybe it's finally time for us to get our priorities straight: do we want an empire dedicated to endless security and military superiority, OR do we want to provide for the general welfare - as per the Preamble of the Constitution?