By Kevin M. Gibas
If you have tried to schedule a doctor’s appointment recently, you probably encountered the frustrating reality of increased wait times at many medical practices. Earlier this year, Merritt Hawkins, a research firm, conducted a survey of over 1,400 physician practices and looked at wait times in five specialties. Their findings showed what many Americans have experienced – wait times have increased. The average wait time for an initial doctor’s appointment is 24 days, an increase of 30 percent from 2014. But why?
One explanation is that the increasing wait times are a byproduct of the Affordable Care Act, which has dramatically expanded insurance coverage and therefore the number of people now utilizing the health care system.
A second explanation is that there simply aren’t enough doctors to handle the volume of patients that need to be seen. The Association of American Medical Colleges predicts a shortage of 62,000 to 95,000 physicians in the next decade. This same study showed that the principal factors contributing to this shortage include accelerated physician retirement rates, increased use of the health care system due to improved insurance coverage and the increasing needs of an aging population.
To meet the growing demand for physicians, more than 15 new U.S. medical schools opened between 2006 and 2016. Opening new medical schools has helped graduate more doctors – 2,800 more doctors graduated in 2016 than in 2006. However, to practice medicine independently, medical school graduates must complete residency training in a medical specialty. Unfortunately, the number of these available residency positions has not kept up with the increase in the number of medical school graduates. In 2016, there were over 4,700 more applicants than there were residency positions available.
The answer sounds simple – just increase the number of residency positions. Unfortunately, accomplishing this is easier said than done. Medicare funding covers most of the costs that hospitals devote to training residents, and any additional expenses fall on the hospital. It is often difficult for teaching hospitals to substantially increase the number of residents they employ without further funding. Increasing the number of residency spots was made more challenging under the Balanced Budget Act of 1997, which capped the number of residency positions the federal government would fund.
Although addressing the physician shortage may seem like a daunting task, there are steps we can take to address this. One proposed bill in Congress, the Training Tomorrow’s Doctors Today Act, would add 15,000 new residency positions over five years. Another, the Resident Physicians Shortage Reduction Act, addresses the shortage of primary care doctors.
Legislation like this is critical to addressing the physician shortage and ensuring that our health care system can meet the demands of an aging population.
Kevin M. Gibas, M.D., originally from Buffalo, is a resident in internal medicine at Harvard Medical School’s Beth Israel Deaconess Medical Center in Boston, Mass.