The Democratic presidential candidates have pushed sweeping plans for expanding health care coverage. And President Trump promises “truly great HealthCare” after this next election.
But no one has asked the thorny, urgent question about who will provide all this care.
The U.S. faces a yawning doctor gap, and it’s only getting wider. In 2018, the Association of American Medical Colleges published a report predicting a shortfall of up to 121,300 physicians in the U.S. by 2030, including both primary care doctors and specialists.
This shortage carries two ominous implications for American health care: soaring appointment wait times and heightened stress for physicians. Both effects would be deadly. In a study on 2001 data from 89 different Veterans Affairs health centers, researchers found that patients who waited 31+ days for an appointment died more frequently than their peers.
Physicians, too, could face greater mortality. An analysis of physician suicide from 1960 to 2004 found that male physicians committed suicide 1.41 times as frequently as U.S. men while female physicians did so 2.27 times as frequently as U.S. women. Research suggests that occupational burnout contributes to this elevated risk.
If the next president hopes to fulfill their promise to expand health care access, they’ll need to rapidly revive the ranks of health care providers across the country.
One way to do so involves foreign-trained physicians, who critically supplement the limited number of American ones. Today, they make up one fourth of the general U.S. physician workforce, and between 2000 and 2013, made up more than 33 percent of doctors entering the field of family medicine, where shortages are especially acute.
Unfortunately, many foreign-trained physicians decide not to practice in the U.S. because of the decade’s worth of regulatory hoop-jumping required of them. Before practicing in America, they must navigate an obstacle course of tests, applications, volunteering, and what are often second residencies—even when they hail from countries with advanced health care systems like the U.K. and Japan.
In many cases, these steps only duplicate their extensive training. The Educational Commission for Foreign Medical Graduates, which controls this process, could nix the glaring inefficiency by eliminating or reducing hurdles for graduates from top-tier foreign medical programs.
Licensed physicians work in complex ecosystems of residents, nurses, and other health care professionals, and in addition to pumping more doctors into the mix, the U.S. could elevate those who work around them: non-physicians, who are often professionally hobbled by archaic red tape.
These professionals are nurse practitioners, physician assistants, and certified midwives.
For nurse practitioners and certified midwives, rules vary by state on whether they can practice independently. The rules remain despite a robust consensus of research showing that independent nurse practitioners provide primary care that is equal to—and sometimes better than—that of primary care physicians. A growing body of research suggests that increased integration of certified midwives into our health care system improves the birth outcomes of American mothers. And when state law grants physician assistants more prescriptive power, the cost of care drops.
Some states do better than others with allowing these professionals more independence, and the federal government could prod all of them along by offering a small increase in federally matched Medicaid funds to states who have yet to update their rules.
Even with more providers, Washington will still need to do more to improve their distribution. In 2014, a fifth of Americans lived in rural areas but barely a tenth of physicians worked there. The National Rural Health Association estimates that there are almost nine times more specialists in urban areas than rural ones.
Telemedicine, which allows providers to consult with patients remotely via phone or webcast, could uniquely address this access disparity if it weren’t shackled by regulatory stoplights. In 2014, only 19 states had passed legislation to guarantee telemedicine reimbursement from third-party payers. Problems like this have stunted its growth, which will hinge on whether lawmakers work together to develop the political, financial, and medical infrastructure to support it.
In order to scale telehealth nationwide, the next president and Congress could direct the Department of Health and Human Services to work with key stakeholders to standardize industry rules.
For years, researchers have churned out dire warnings about the deepening doctor shortage. With today’s aging population and the Democratic contenders’ plans to massively expand health care access, action is no longer optional.
It is time for both and the 2020 Democratic president-hopefuls to provide a plan that equips all Americans with the health care professionals they need and deserve.
Laurin Schwab is a policy analyst for The New Center, which aims to establish the intellectual basis for a viable political center in today’s America, and just released a paper entitled “Closing the Doctor Gap,” which can be downloaded at www.newcenter.org.