There was a man with tongue of wood

We have seen that there is a physician shortage, but it is confined to primary care–the number of specialists relative to the population has expanded.

In addition, there is a geographical factor that is beyond the scope of this blog: are the physicians, primary care and others, distributed to provide coverage of those in need, or are they concentrated geographically so that they are adequate in numbers but inadequate in dispersion? Huang and Finegold believe 44 million Americans will be living in places where the demand for physicians exceeds supply by more than 5 percent, 7 million where the deficit will exceed 10 percent.

The American Association of Medical Colleges (AAMC) advocates lifting the cap on Medicare-financed medical residencies imposed by the Balanced Budget Act of 1997. Senator Charles Schumer (D-NY) has introduced the Resident Physician Shortage Act to increase the number of residencies by 15,000 over the next several years. He is particularly concerned about the absence of physicians in the more rural–and colder–upstate New York. His argument is that the shortage is driven by retirements. Aside: New York appears to have more medical schools (12) than any other state (7 next highest).

However, if the problem is really primary care, will simply increasing residencies address the problem? The following chart from the Washington Post is cause for optimism or pessimism, depending upon how you look at it. The number of residents choosing family practice residencies has declined precipitously since 1998, followed by an upturn, which may be brief or long-lived.

Consequently, the AAMC, as does Schumer, stresses that retirement will affect specialties as well as primary care.

The question of adequate numbers of medical residencies is actually a separate, though indirectly related, question than the adequacy of the physician supply. According to Peter Ubel, who supplies the following graph from Karen Sliff of the Washington Post. The source of the data is the AAMC, which is why it is so difficult to get at the truth of an issue in Washington: the providers of information have an interest in actions taken on that information.

So, let us grant that it is probably reasonable, although not necessarily essential, to increase the number of financed medical residencies; however, it is fair that those residents take responsibility for part of the cost to us of providing them, and that such obligation be forgiven if they are willing to serve rural populations for 5 years? My support for increasing residencies is conditional on them going where the need is, not where specialists find the big bucks.

Next time, we will finish this series by looking at other approaches of providing care to a growing population.