A doctor shortage threatens to set off healthcare crisis

LOS ANGELES -- A looming doctor shortage threatens to create a national healthcare crisis by further limiting access to physicians, jeopardizing quality, and accelerating cost increases.

Several states -- including California, Texas, and Florida -- are already coping with physician shortages. Patients are experiencing, or soon will face, shortages in at least a dozen physician specialties, including cardiology and radiology, and several pediatric and surgical subspecialties.

The shortages are putting pressure on medical schools to boost enrollment and on lawmakers to lift a cap on funding for physician training and to ease limits on immigration of foreign physicians, who already constitute 25 percent of the white-coated workforce.

But it might be too late to head off havoc for at least the next decade, analysts say, given the long lead time to train surgeons and other specialists.

``People are waiting weeks for appointments; emergency departments have lines out the door," said Phil Miller, a spokesman for Merritt, Hawkins & Associates , a national physician search company. ``Doctors are working longer hours than they want. They are having a hard time taking vacations, a hard time getting their patients into specialists."

The number of medical school graduates has remained virtually flat for one-quarter century, because the schools limited enrollment out of concern that the nation was producing too many doctors. But demand has exploded, driven by population gains, a healthy economy and a technology-driven boom in physicians' repertoire, from joint replacement to liposuction.

Over the next 15 years, aging baby boomers will push urologists, geriatricians, and other physicians into overdrive. Their cloudy eyes alone, one study found, could boost the demand for cataract surgery by 47 percent.

Yet, much of the nation's physician workforce also is graying and headed for the door. One-third of the nation's 750,000 active, post-residency physicians are older than 55 and likely to retire just as the boomer generation moves into its time of greatest medical need.

By 2020, physicians are expected to retire at a rate of 22,000 a year, up from 9,000 in 2000. That is only slightly less than the number of doctors who completed their training last year.

At the same time, younger male physicians and women -- who constitute half of all medical students -- are less inclined to work the slavish hours that long typified the profession. As a result, the next generation of physicians is expected to be 10 percent less productive, Edward Salsberg , director of the Association of American Medical Colleges Center for Workforce Studies , told a congressional committee in May.

Several other factors are contributing to the shortage. One is that health maintenance organizations have not produced the expected drop in physician demand, in part because of a patient backlash against inadequate choices and denial of care. New technology also has not reduced the need for physicians as much as expected.

Although some communities still have a glut of physicians, shortages have been reported in many places. One in five US residents lives in a rural or urban area that has so few physicians the federal government considers medically underserved.

The nation's physician workforce is approaching a tipping point, beyond which patients face dangerously long wait times and distances to see physicians. Or they get more care from nurses, physician assistants and other substitutes, whose ranks also are stretched thin. Or they go without.

Wait times for appointments are a sign of the emerging strain. The wait to see a dermatologist for a routine skin cancer examination in 15 big cities averaged 24 days, according to a 2004 survey by Merritt Hawkins.

For a routine gynecological checkup, women faced an average wait of 23 days, the survey showed. To see a cardiologist for a heart checkup, the wait was 19 days. And to have an orthopedic surgeon check out a knee injury, the average wait was 17 days.

Hospitals, practices, and academic medical centers in places not considered health care backwaters report more difficulty recruiting physicians -- primary care doctors and specialists alike. Recruiters charging as much as $30,000 per placement now count some of the nation's most prestigious medical centers as their clients.

With a greater premium on physicians, some experts fear an acceleration of a trend among some doctors to limit their practices to wealthy patients who can afford to pay cash. These so-called concierge practices further exacerbate the disparity in care between the rich and everyone else.

If nothing changes, officials say, the prognosis for the quality of healthcare is poor.

``People are going to really hurt," said Dr. Richard Cooper , a professor of medicine and economics at the University of Pennsylvania. ``Right now we have well-trained nurse practitioners to pick up a lot of the work, but when even they are overwhelmed, the whole thing really falls apart. We're at the cusp, and it's a little worrisome."