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A Brewing Physician Shortage Has Been Eating Away at Medicine

Op-Med is a collection of original articles contributed by Doximity members.

Physician shortages are weighing down the health care industry. In a Doximity survey of 1,179 physicians conducted in March 2024, 88% report that their clinical practice has been directly impacted.

At least 30% of physicians describe the impact as "severe," 44% as "moderate," and 14% as "mild.” Only 12% say they are not directly impacted. For a large swath of the medical community, the overarching results come as no surprise.

“In constant dollars, physician pay is decreasing, while educational costs and student debt continue to rise, as does the population: Why should it be surprising that there is a shortage?” said Eric Romanucci, MD, assistant professor of surgery at the University of Arizona School of Medicine.

The effects of the shortage are extensive: Most physicians have experienced overwork or burnout (67%), diminished job satisfaction (60%), and deteriorating workplace culture (54%), according to the survey. And a substantial portion of physicians have faced unsustainable caseloads (41%), unsustainable work hours (39%), concerns over medical errors (39%), outbursts or threats from patients (37%), or anxiety or depression (27%).

As a result, 40% of physicians have already decreased the amount of time they spend in clinical practice, and half are considering leaving clinical work altogether. 

“One of the core issues is that we didn’t go into medicine to be tech geeks and data entry clerks; we went into it to do medicine,” Peter Papadakos, MD, professor in the department of anesthesiology and surgery at the University of Rochester Medical Center and professor of internal medicine at Mercer University School of Medicine, told Doximity. 

“But all too often, you’re sitting at a computer screen entering notes or waiting for the next text instead of going on rounds,” he said. “Older doctors like myself have seen this transition, which is why we’re retiring early.” 

Most physicians who responded to the survey believe that the shortage negatively impacts patients as well, leading to longer wait times (87%), diminished access to care (75%), worse health care disparities (75%), patient frustration or anger (74%), or delayed treatment (70%).

Furthermore, the vast majority of physicians (86%) are concerned that the U.S. health care system will not be able to care for an aging population.

Inadequate Support

The survey results are further supported by a separate Doximity poll of 2,980 physicians conducted in August-September 2023, in which 92% report having experienced clinical staff shortages. 

At least 82% of the poll respondents say that shortages have negatively impacted patient care, affecting as much as 96% of cardiology and emergency medicine practices to 61% of plastic surgery practices. 

One of the specialties strongly impacted by the shortage — based on the poll — is pediatrics, which only filled 91.8% of open positions in the 2024 Match, down from a steady 97%-98% since 2017.

“Children represent 100% of the future population,” Sandy Chung, MD, immediate past president of the American Academy of Pediatrics, told Doximity. “Sadly, there has been a decline in the number of physicians entering pediatrics … which has implications for the long-term health of society.” 

What’s more, the initial Doximity survey indicates that rural areas are especially impacted: 95% of physicians working in rural areas are affected by the shortage, compared with 88% in suburban areas and 87% in urban areas.

“We have gutted our rural health,” said Dr. Papadakos, who has written extensively on the topic. “Financial incentive in rural areas has gone down. The ability to recruit staff has gone down. If someone told me years ago that no one in Washington would care that hospitals are closing down, I wouldn't have believed it. Now it’s a weekly event.”

Amid their growing concern, nearly all physicians believe that institutional and governmental support has fallen short. Survey results show that only 3% of physicians feel that they are adequately supported by health care institutions and policymakers in addressing challenges spurred by the shortage. And 92% of physicians are concerned with their own health care institution’s ability to attract and retain physicians.

“I don’t see any major movements to try to take care of the physician shortage,” Dr. Papadakos said. “I do see a massive amount of bureaucracy. After a while, it gets kind of old.”

Addressing Shortages

Indeed, most measures have not effectively addressed physician shortages. The AAMC’s latest report predicts a shortage of up to 86,000 physicians by 2036.

Some research, however, including a study by associate professor of pediatrics at Eastern Virginia Medical School J. Bryan Carmody, MD, has suggested that the potential shortage of physicians might not necessarily entail a shortage of doctors overall. He noted instead that limitations with the GME process have created a frustrating bottleneck for doctors — preventing some who graduate from medical school from even entering residency and funneling many others toward select specialties and regions.

“I’ve grown increasingly skeptical that there is — or will be — a shortage in the absolute number of physicians,” Dr. Carmody said. “From my standpoint, most of the ‘physician shortage’ is distributional, and most of the problems that are cited as demonstrating evidence of a physician shortage won’t be fixed by simply increasing the number of doctors that are trained.”

Nonetheless, the physicians who responded to the survey cite a wide range of factors contributing to shortages, with the leading cause being administrative burden (70% of physicians).

For front-line physicians such as Dr. Papadakos, three of the most prevalent concerns are the growing demand of administrative tasks, increasing violence, and limited opportunities for remote work. 

“Twenty to 30 years ago, we had billers working at hospitals — and people would never think of verbally or physically abusing healers,” Dr. Papadakos said. “Now, physicians are doing our own billing and we’re getting yelled at by patients while they are texting. That’s a big breakdown.”

Accordingly, nearly three out of four physicians say that the most compelling ways to attract and retain physicians amid the shortage are by decreasing administrative burden (73%) and increasing compensation (74%).

In addition, physicians cited a wide range of system-level strategies that could help alleviate the shortage: medical education funding to train more physicians (58%), loan forgiveness programs to incentivize work in areas with the greatest shortage (54%), AI and technologies to streamline administrative tasks (44%), and eliminating noncompetes to allow side gigs (44%), among others.

Collectively, the survey results suggest the need for both individual benefits and system-level strategies that deal with the underlying causes of the shortage, rather than stopgap measures such as hiring temporary staff.

“We need both short-term mentoring and recruitment initiatives, as well as long-term changes in the medical infrastructure,” said Dr. Chung, who has advocated for sweeping changes to the current payment structure, especially in relatively low-paying specialties such as pediatrics.

“Payment transformation that supports pediatrics and pediatric subspecialities must occur to address the impending shortage,” she said. “All of society benefits when children and families are thriving and able to get their routine, preventive, and urgent health care needs addressed.” 

Dr. Papadakos agreed on the broader call for change: “The medical field needs to get its butt in gear. We need to open more medical schools, give appropriate salaries and more time off for decompressing, and lower the cost of education. I know people who are still paying off their medical school loans at 40 to 50 years old.”   

Several additional long-term initiatives that Dr. Papadakos said could help tackle the shortage include creating more government-funded programs for physicians who provide services to the general public and disadvantaged groups; bringing back medical and pharmaceutical manufacturing to the U.S. to help ensure that supplies essential to physicians’ work are available; and supporting the development of technology that helps physicians. 

“There are so many changes that have occurred in medicine that are beyond our control, many of them generational,” he said. “But there are some changes that are simplistic: Make it more about the work. Take away the shortages by giving us the tools to work with. And make it more lucrative for certain types of practice.”

Illustration by Jennifer Bogartz

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