Understanding the Underlying Factors of America's Doctor Shortage

Increasing Wait Times and Staff Constraints

The struggle to secure a doctor's appointment in the United States is becoming increasingly challenging due to the rising demand for health care and a diminishing number of doctors. This trend is particularly affecting primary care and emergency medicine. Since 2017, the average wait time to see a doctor has been on the rise, with a significant spike following the onset of the COVID-19 pandemic. In 2022, a survey by AMN Healthcare revealed that the average wait time to see a physician in 15 large metro markets was 26 days, an 8% increase from 2017 and a 24% increase since 2004.

Emergency Room Challenges

Staff constraints are also impacting hospital emergency departments. In 2021, nearly 140 million Americans visited a hospital emergency department, according to data from the Centers for Disease Control and Prevention. Of these, about 13% resulted in hospital admission, while thousands had to wait for hours to see a health care provider. As a result, many patients left before being seen by a doctor. A study analyzing over 1,000 hospitals between 2017 and 2021 found that those with the worst performance had 4.4% of emergency room patients leave before a medical evaluation was conducted. By the end of 2021, this figure had risen to over 10%.

The Aging Doctor Population and Burnout

Adding to the crisis is the fact that nearly half of the doctor population is expected to retire within the next decade. Furthermore, career burnout is affecting the remaining doctors more than ever. According to a 2024 Medscape report, almost 50% of doctors reported feeling burned out. These factors are contributing to the growing scarcity of doctors in America. A 2023 study by Physician Thrive projected that the United States could face a shortage of 124,000 doctors by 2034. Of this number, up to 48,000 are expected to be from primary care, while the industry could lose another 58,000 specialists, surgeons, and nurse practitioners.

The Corporatization of Medicine

Another contributing factor to the doctor shortage is what has been termed the "corporatization of medicine." The health care demands in the United States are rising, with the average number of times Americans visit a doctor per year varying by age group. Adults average four visits, infants nine, and children between the ages of five and 15 average two visits, according to the Vanguard Medical Group. However, the insurance system has become a massive bureaucracy, creating an administrative burden that many doctors find disheartening.

Insurance Companies' Influence on Medicine

Doctors and medical leaders have expressed concern over the power insurance companies have over medicine. In 2020, for the first time, fewer than 50% of U.S. physicians worked in private practice, according to the American Medical Association (AMA). Most have opted to become employees of large medical groups, which has significantly changed the health care paradigm. This shift is indicative of the financial uncertainty and economic stress many physicians face due to statutory payment cuts in Medicare, rising practice costs, and intrusive administrative burdens.

The Battle with Insurance

The transition from independent practice to being an employee of a medical group presents its own set of challenges. In addition to increased patient loads, doctors now have to seek prior approval from insurance companies to carry out a medical treatment or procedure. This has led to a quantity-over-quality approach to treatment. Prior authorizations have become "an absolute headache," with physicians often having to battle with a third party that creates as many roadblocks as possible to avoid paying out.

Closing Thoughts

The doctor shortage in America is a complex issue with multiple contributing factors, from an aging doctor population and career burnout to the corporatization of medicine and the influence of insurance companies. As we consider these factors, it's clear that systemic changes are needed to ensure the availability and quality of health care in the United States. What are your thoughts on this issue? Share this article with your friends and let's continue the conversation. Don't forget to sign up for the Daily Briefing, which is delivered every day at 6pm.