1. A Doctor Shortage? Let’s Take a Closer Look
Aaron E. Carroll
NY Times
November

2. Wait too long?
Many people have to wait too long to see a doctor. And it could get worse. If, as many people believe, we have a shortage of doctors in the United States, then it follows that we can fix this only by training and hiring more physicians.
The main argument for a physician shortage is that we aren’t adding enough new doctors to keep up with changing demographics. The Association of American Medical Colleges has projected that by there will be a shortfall of between 46,100 and 90,400 doctors. In primary care, it projects a shortfall of between 12,500 and 31,100 doctors.

3. Compared to other countries
The United States had 2.56 doctors per 1,000 people, which is more than Canada (2.46), Poland (2.24), South Korea and Mexico (both 2.17). But we were way behind countries like Austria (4.99), Norway (4.31), Sweden (4.12), Germany and Switzerland (both 4.04).
Based on these metrics, it would seem that we need more physicians. It would also seem that we’re not training them. When it comes to medical graduates, the United States ranks 30th of 35 countries.

4. Wrong way?
There is strong evidence that we are thinking about this the wrong way. In 2014, the Institute of Medicine released a thorough analysis on graduate medical education that argued there was no doctor shortage, and that we didn’t really need to invest more in new physicians.
The system isn’t undermanned, it said: It’s inefficient. We rely too heavily on physicians and not enough on mid-level practitioners, like physician assistants and nurse practitioners, especially because evidence supports they are just as effective in primary care settings. We don’t account for advances in technology, like telehealth and new drugs and devices that lessen the burden on physician visits to maintain health.

5. Distribution
We also fail to recognize that what we really have is a distribution problem. Parts of this country have lots of doctors, perhaps too many. These are mostly in cities, especially in cities where it seems desirable to live.
The problem is made worse by the ways we reimburse for care. Medicare, for instance, pays more to doctors who live in places that are more expensive. The argument for this is that the cost of living is higher, so reimbursements must be, too.
But that also means that doctors can earn more in places where they already might want to live. A result is that many rural areas, and less popular cities, experience more of a doctor shortage than others.

6. Economics: Technology
MRP*, better technology
Compare a physician and a technician.
Technician
Wages, MRP
Physician
Wages, MRP
MRP LP LT
LT*