Books and Essays by Doctor Frank Boehm

(January 7, 2006)

      It is not a question often asked by the American media, yet it is an increasingly important one to address. Are there enough doctors in America to take care of us now and in the future?

      Currently there are approximately 800,000 actively practicing physicians in the United States, a number considered by many experts to be too few to adequately take care of the current population and especially in the very near future when we will have close to 80 million baby boomers (born between 1946 and 1964) reaching senior citizen status.

      The number of graduating medical students in this country has remained constant since the 1980s despite the fact that the US population has since grown by 50 million to its current 300 million. The Council on Graduate Medical Education has gone on record to recommend training 3,000 more doctors each year and the Council's Chairman, Carl Getto has stated, "Almost everyone agrees we need more physicians. The debate is over how many".

      For the past 25 years, the American Medical Association had claimed that we have too many doctors. and in 1994 stated that by 2000 there would be a surplus of 165,000 doctors in America. They were wrong and we are now suffering the results of their predictions.

      To their credit, the AMA has stepped back from its earlier position and now states that we will need more physicians in the future to take care of an ever increasing aging population. Even the Association of American Medical Colleges has dropped its prediction of a growing surplus of doctors and has stated, "It now appears that those predictions may be in error". The organization now recommends a 15% increase in the number of graduating medical students. It seems that we now all agree. We need more doctors.

      There are currently 126 medical schools in the country graduating approximately 17,000 students each year. Add to this group a large number of foreign medical students entering post graduate training and we wind up with about 25,000 new doctors entering the practice of medicine each year. The problem is that although today these new doctors equal the number of doctors retiring, within approximately 10 years the number of baby boomer doctors will begin retiring in larger numbers creating a significant shortage of needed physicians. Add to this the fact that doctors are working shorter hours than in the past, are reluctant to go into specialties in which malpractice is a concern, and reluctant to go to remote parts of America, and you can understand why so many experts are concerned that we are heading for a significant physician shortage in this country.

      To be fair, there are dissenting voices to the call for more doctors. Some experts believe it is foolish to think that more doctors will care for underserved populations or will go into needed specialties. Many experts also claim that physicians create their own demand and are concerned that more doctors will only drive up the cost of medical care by ordering more tests and performing more procedures without improving the health of America.

      Don Detmer, co-chairman of an Institute of Medicine committee, has claimed that, "If we produce an abundance of doctors, there's little incentive for the system to become more efficient". That opinion is countered by the argument that is also foolish to limit the number of physicians in this country as a means to control health care costs. Preventive health measures and illness is what drives health care costs today, not doctors.

      So what can be done to assure Americans that there will be an adequate number of doctors to care for us in the years ahead? To begin with, we can increase the number of students in existing medical schools all across America. We did that once before in the 1970s when, because of a perceived need for more doctors, each medical school class was doubled. My class at Vanderbilt in 1961 contained 52 students. Within 10 years it had grown to 104, a number that persist today. There are thousands of qualified premedical students turned away from medical schools each year. Most, if not all, of the medical schools could begin accepting more students without lowering standards of a first class education.

      In addition, we could also increase the number of medical schools. Florida State became the first new medical school in this country since 1982 and will graduate its second class this spring. Other schools in California, Arizona, Nevada and Florida are also interested in opening new schools. It is time we encouraged them to move ahead.

      These measures will require government help and will take time and money. However, it is critical that we act now. Too much is at stake to do otherwise.