Recently, U.S. surgeon general Vivek Murthy sounded the alarm on a growing crisis in the health-care industry: physician burnout and shortage. According to the Association of American Medical Colleges (AAMC), the U.S. is projected to face a shortage of between 37,800 and 124,000 physicians by 2034. Physician burnout is not a new phenomenon, but it has been exacerbated by the Covid pandemic. Dr. Murthy points out, “COVID-19 has been a uniquely traumatic experience for the health workforce and for their families, pushing them past their breaking point.” According to the Health and Human Services Press Office, even prior to Covid, physicians confronted myriad problems in the health-care system that contributed to significant rates of burnout. Covid simply compounded this crisis as doctors put their own lives on the line to save others.
Our nation’s doctors and health-care professionals are losing steam, and there simply aren’t enough of them. The AAMC’s 2021 updated report is projecting a shortage of primary-care physicians between 17,800 and 48,000 by 2034. The shortage of various non-primary-care specialists, the report predicts, will range from 3,800 to 35,600 by the same year. Americans are used to being able to see a doctor within a relatively short time; that may become a luxury of the past. Will America become like Canada, where the median wait time for a medically necessary procedure is approximately five months?
The shortage of physicians is largely caused by population growth and retirements. Population growth of those aged 65 and older is projected to increase 42.4 percent from 2019 to 2034. Americans in this age group tend to require specialty care, which they could be hard-pressed to find with fewer physicians available. Doctors will be aging as well. Within the next ten years, more than two in five current physicians will be 65 years old or older. The current average retirement age is 62, meaning many of these older physicians will soon stop working. The shortage is exacerbated by the fact that it takes between seven and 15 years to become a licensed physician. The number of American physicians being trained is not growing nearly as quickly as the number of those retiring or resigning. Between 2010 and 2020, the number of physicians increased by only 20 percent, from 850,085 to 1,018,776. Meanwhile, in the next decade, 20 percent of physicians will be over the age of 65, entering or nearing retirement.
Covid has had a jarring impact on doctors. Burnout is a common occurrence in the health-care industry and was a problem even before Covid: According to a 2019 report from the National Academy of Medicine, as much as 54 percent of U.S. doctors and nurses experience “substantial symptoms of burnout.” The report also found that 45 to 60 percent of medical students and residents suffered from burnout as well. Between January 2019 and October 2021, approximately 3,200 physicians in direct care exited the workforce. While that number is relatively small, given the impending physician shortage, it is not a good sign.
Physicians are burning out for a variety of reasons, including long hours, the burden of electronic medical record-keeping, and the strictures of prior authorization, which is a “cost-control process requiring health care providers to qualify for payment by obtaining approval from health insurers before performing a service.” A committee working under the purview of the National Academies of Sciences, Engineering, and Medicine revealed that some of the major reasons for clinician burnout were “excessive workload, unmanageable work schedules, and inadequate staffing,” as well as “administrative burden” and “time pressure and encroachment on personal time.” Burnout can lead to increased alcohol consumption, occupational injury, and even suicide. Every year, 300 to 400 physicians commit suicide. Another reason physicians are leaving may be tied to their loss of income during the pandemic. According to researchers at the AAMC, “the COVID-19 pandemic has been associated with loss of revenue, reduced work hours, and reduced earnings for physicians in the United States.”
Countering the shortage of physicians is the growth in number of advanced-practice registered nurses (APRNs) and physician assistants (PAs), who help considerably but are obviously not trained to do everything a doctor can do. Americans who are unable to get a doctor’s appointment may start seeking out alternatives such as One Medical, which provides 24/7 virtual primary care to members for an annual fee of $199. The company already works with 8,000 organizations nationwide.
Covid may have been the last straw for many physicians. In a field that can be very demanding physically, intellectually, and emotionally, and has the additional stress of vulnerability to litigation, many physicians have decided that the burden is just too great.