Demand for physicians exceeds supply

Demand for physicians continues to grow faster than supply, leading to a projected shortfall of between 46,100 and 90,400 physicians by 2025, according to a report from the Association of American Medical Colleges.

It is true that growth in the supply of APRNs (e.g., clinical nurse specialists, certified registered nurse anesthetists, certified nurse-midwives, advanced nurse executives or nurse practitioners) and other health occupations may help to alleviate projected shortfalls to an extent. But even taking into consideration potential changes in staffing, the nation will likely face a growing shortage in many physician specialties, especially surgery-related specialties, according to AAMC. A multipronged strategy will be needed to help ensure that patients have access to high-quality care.

“The trends from these data are clear — the physician shortage will grow over the next 10 years under every likely scenario,” AAMC President and CEO Darrell G. Kirch, MD, was quoted as saying. “Because training a doctor takes between five and 10 years, we must act now, in 2015, if we are going to avoid serious physician shortages in 2025.

The most current report updates previous reports published by the AAMC Center for Workforce Studies in 2008 and 2010, and was intended to incorporate the latest modeling methods and available data on trends and factors affecting the physician workforce.

Total physician demand is projected to grow by 86,700 to 133,200 (11 percent to 17 percent), with population growth and aging accounting for 112,100 (14 percent) in growth. By comparison, physician supply will likely increase by 66,700 (9 percent) if labor force participation patterns remain unchanged, with a range of 33,700 to 94,600 (4 percent to 12 percent), reflecting uncertainty regarding future retirement and hours-worked patterns.

Projected shortfalls in primary care will range between 12,500 and 31,100 physicians by 2025, while demand for non-primary care physicians will exceed supply by 28,200 to 63,700 physicians.

Affordable Care Act

Expanded medical coverage achieved under the Affordable Care Act, once fully implemented, will likely increase demand by about 16,000 to 17,000 physicians (2 percent) over the increased demand resulting from changing demographics, according to the AAMC report. The Congressional Budget Office estimates that 26 million people who otherwise would be uninsured in the absence of ACA eventually will have medical insurance.

The anticipated increase is highest (in percentage terms) for surgical specialties (3.2 percent), followed by primary care (2 percent), medical specialties (1.7 percent), and “all other” specialties (1.5 percent). Within these broad categories there are differences in the impact of the Affordable Care Act for individual specialties.

Advanced practice clinicians
The lower ranges of the projected shortfalls reflect the rapid growth in the supply of advanced practice clinicians and the increased role these clinicians are playing in patient care delivery, reports AAMC. But even in these scenarios, physician shortages are projected to persist.

New payment methodologies — including bundled payments and risk-sharing arrangements — and innovations in technology suggest that the work of health professionals may be restructured in the coming years. Given the number of nurse practitioners, certified nurse midwives, and certified registered nurse anesthetists graduating each year, if labor force participation patterns remain unchanged, then the supply of advanced practice nurses (APRNs) will grow more rapidly than is needed to keep pace with growth in demand for services at current APRN staffing levels. These trends suggest that an additional 114,900 APRNs could be available to both expand the level of care currently provided to patients and help offset shortages of physicians.

Similarly, the supply of physician assistants (PAs) is projected to increase substantially between 2013 and 2025, though additional research is needed to quantify the expected impact, reports AAMC. While this rapid growth in supply of APRNs and PAs could help reduce the projected magnitude of the physician shortage, the extent to which some specialties (e.g., surgery specialties) can continue to absorb more APRNs and PAs given limited physician supply growth is unclear.

One bright spot
If there is a bright spot in these projections, it is that the projected shortfalls of physicians in 2025 are smaller than those cited in the earlier study. AAMC says this is due to new data and the dynamic nature of projected assumptions,

AAMC’s prediction that demand for physicians in 2025 will exceed supply by 46,100 to 90,400 compares with a 130,600 shortfall projected in the 2010 study. Current projections suggest primary care physician demand in 2025 will exceed supply by 12,500 to 31,100 physicians (the 2010 study projected a 65,800 shortfall, about half the overall shortage). The projected shortfall for non-primary care is 28,200 to 63,700 (vs. a projected shortfall of 64,800 in the 2010 study).

Factors explaining differences between the 2015 and 2010 projections include:

  • The U.S. Census Bureau revised downward its 2025 population projections by about 10.2 million people (from 357.5 million to 347.3 million). This downward revision equates to approximately 24,000 lower FTE demand for physicians.
  • The number of physicians completing their graduate medical education has risen from about 27,000 to about 29,000 annually.
  • The new projections more closely reflect implementation of the Affordable Care Act, growth in supply of advanced practice clinicians, and trends in use of healthcare services.
  • The 2010 study assumed that supply and demand were in equilibrium in 2008 for all specialties except primary care, whereas this update assumes supply and demand were in equilibrium in 2013 for all specialties except primary care and psychiatry. Hence, the new demand projections extrapolate a “2013” level of care delivery compared with the “2008” level of care delivery extrapolated by the earlier 2010 projections.

Journal of Healthcare Contracting readers can view the AAMC report, The Complexities of Physician Supply and Demand: Projections from 2013 to 2025, at

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