The availability of adequate doctors has for long been a contentious discussion in the United States. The Association of American Medical Colleges (2019) predicted that the United States would experience a shortage of up to 120,000 physicians by 2030. In the discussion in the Wall Street Journal, Bob Watcher points out that is a doctor deficiency both geographically and by specialty. Doctors prefer to work in urban setups compared to rural settings due to the availability of amenities ( Stephan & Debertin, 2016) , which has led to a shortage of doctors in rural areas. The demand for specialists of lifestyle-related diseases and old age conditions is also higher than the supply. A sedentary lifestyle has also necessitated the need for more nutrition experts. Pulmonology, neurology, orthopedics, and ophthalmology specialist shortage is the most felt (Osbom et al., 2016).
However, despite the prospected shortage, the number of physicians has remained relatively constant. The relatively constant figures could be linked to a lack of incentives for students wishing to study medicine. Some doctors are still paying their student’s loans, which it takes close to a quarter of their annual earnings. As an incentive, graduates could be promised a waiver on student loans debts. The US government has also not addressed the issue of overworked doctors, which is a common cause of burnout. Doctors have long days at work and can be called back to work at any time in case of an emergency, yet the extra hours are not compensated for. For this reason, the number of assistants has to be increased as a way of reducing the doctor’s workload. Physicians being overworked discourages some students from venturing into the career. Instead of creating incentives and motivation for increased matriculation in medical schools, the current system is discouraging prospective students and future doctors.
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The government has insisted on all students paying their loans. The trump administration has proposed cancellation of the plan to waver student debts every twenty years (Friedman, 2019). The government would encourage more students to study medicine by promising a waiver for doctors. However, the Department of Health revised the wages for doctors. According to Career Explorers (2017), specialists such as Orthopedists, plastic surgeons, and otolaryngologists receive the highest compensation ( $329,000 annually) , while public health and preventive medicine experts who are general practitioners earn a lower income ( $223,000 annually ). This is a step towards increasing the number of doctors in the US.
Retaining employees requires that they remain motivated in the workplace. These factors also increase the desire of external parties to work for the hospital. The doctor’s daily work should be something they look forward to. Therefore, as much as doctors have intrinsic motivation due to the desire to save more lives, the employer must provide extrinsic motivation. Doctors who work in remote setups experience more challenges compared to those in urban settings. Thus, those in rural areas should receive a hardship allowance. All doctors must also be assigned fixed schedules for their work. Doctors should not be overworked, and extra working hours must be compensated for. Recognition of achievements also motivates employees to work harder. Introducing awards such as pediatrician of the year, ophthalmologists of the year, etc. would motivate specialists to give the best service.
Physician-hospital alignment and integration have created a personal relationship between doctors and hospitals. The hospital shares a greater risk with the doctor than before the practice was introduced ( Trybou, Gemmel, and Annemans, 2015) . Physician-hospital alignment has contributed to better healthcare by ensuring practitioners have enough time with their patients. However, it has also resulted in a geographical shortage of doctors since they are “tied” to particular locations. International medical programs have also affected the availability of practitioners in the US. The programs equip international students with skills that they practice in US hospitals before returning to their country. The program thus offers a momentary relieve to work pressure for doctors, which makes them available at that time. However, when mentees return to their home countries, the shortage re-occurs. The program does not offer scholarships, so there is no retention of beneficiaries to work as US doctors.
Figure 1: Shortage of doctors in the US. (The Association of American Medical Colleges copyright 2019)
The shortage of doctors is more evident in rural areas, as practitioners prefer to work in urban settings. The demand for doctor skills is higher than supply, which has left physicians strained. The fact that they also prefer to work in urban settings also means physician in rural areas have to work for long hours, and ever be ready for an emergency. According to The Association of American Medical Colleges, t he shortage increases by 20% every five years and is projected to increase from 13% in 2010 to 110% in 2025.
Reducing the wage gap between primary caregivers and specialists also needs to be looked into as one of the solutions to increase the number of primary caregivers. The number of hours should be equivalent to their pay. Doctors also need more physician assistants. Nurses and midwives, for instance, are competent to perform some of the roles that doctors perform. This will give them more time to focus on activities that are only limited to physicians without them experiencing burnouts.
Dr. Harlan Krumholz, a cardiologist, and professor of medicine at Yale University School of Medicine points out that the primary solution to the doctor’s shortage is relieving doctors of the duties that can be handled by other personnel. Dr. Krumholz argues that the shrinking doctor-patient time and increased burnout among doctors is as a result of overburdening them with roles that can be handled by other healthcare professionals. Dr. Krumholz’s argument is true, given the widely perceived idea that it is the doctors who primarily run healthcare facilities. While doctors have adequate knowledge in diagnosing and determining the needs of the patients, they are overworked by being assigned administrative roles. However, most policies stipulate that the head of certain functions in primary care facilities have to be medical doctors. Other healthcare professionals, such as laboratory personnel may also be competent in performing these administrative duties. A background in medical studies enhanced with managerial skills is sufficient in institutional administration. This training will ensure doctors will be relieved of some duties entrusted upon them, creating more time to care delivery to patients.
References
Antonelli A. (2019). Does America have a physician shortage—or are our doctors 'just bad at managing time’? Retrieved from https://www.advisory.com/daily-briefing/2019/05/14/physician-shortage
Career Explorers. (2017). Retrieved on 30 th June 2019 from https://www.careerexplorer.com/careers/doctor/salary/
Osborn, R., Squires, D., Doty, M. M., Sarnak, D. O., & Schneider, E. C. (2016). In a new survey of eleven countries, US adults still struggle with access to and affordability of health care. Health Affairs , 35 (12), 2327-2336.
The Association of American Medical Colleges. (2019). A specialist gap: the predicted shortage of doctors in the United States.
Trybou, J., Gemmel, P., & Annemans, L. (2015). The ties that bind: an integrative framework of physician-hospital alignment. BMC health services research , 11 (1), 36.
Wiens, C. (2013). The Experts: What Should Be Done to Fix the Predicted U.S. Doctor Shortage? Wall Street Journal. Retrieved on 30 th June 2019 from https://www.wsj.com/articles/SB10001424127887323393804578555741780608174
Zack, F. (2019) Trump Proposes To End Student Loan Forgiveness Program. Retrieved on 30 th June 2019 from https://www.forbes.com/sites/zackfriedman/2019/03/12/trump-proposes-to-end-student-loan-forgiveness-program/#69fe0706415e
