The pending shortage of physicians projected has been preached about for so long it seems as though the healthcare thought leaders and policy watchers must be wearing sandwich signs direct from their ivory podia as they make their pronouncements. This is not to deny that the country is in the midst of a looming physician shortage —  something that is not to be helped by the rapid graying of America.^[1] The most convenient answers have centered around the simple increases in medical school class size and increasing the range of residency opportunities. Ambitious as these solutions seem, the problem of physician depletion and workforce shrinkage is much too complex to simply ascribe repletion as a mechanism for change.

Even if Medicare funding for available residency slots is taken into consideration, this solution is a non-starter, especially in the age of health reform — where the availability funds is at a premium and hierarchical determinations for those funds will continue to be hammered out as part of a possible bill reconciliation (as proposed by Howard Dean). Nothing is certain at this point. Perhaps the way to approach this crisis is looking from within. Instead of increasing med school class rolls and residency slots, it’s time to consider what medical educators and academic centers can do with what they already have — their greatest resources are innovation. Addressing the utilization and awareness of entities that may be helped by reform (public healthcare delivery improvements, a surge in the numbers of mid-level providers and ancillary medical providers) gives medical educators the tools they need to expose recent graduates (residents) and potential grads (med students) the exposure and hands on education needed to meet the challenges of a potentially strained physician workforce, at least in the near term.

Working from within as a mechanism for meeting the physician shortage head on builds awareness and partnerships (and hopefully greater efficiency) among providers in delivering healthcare — as politicians continue to consider how best to spend the money to make reform happen. Of course, the wildcard in any discussion of physician shortage continues to be the supply of primary care providers. This is probably the only area in medicine in which repletion should be the main goal. | LINK [PDF]

1. The U.S. Census Bureau reports that the world’s 65-and-older population is projected to triple by midcentury, from 516 million in 2009 to 1.53 billion in 2050. [↩]

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