The ability of the United States healthcare system to meet the needs of Americans has been a major topic of public discourse over the last two decades. Much related legislation – such as the Affordable Care Act of 2010, modifications to the individual insurance mandate passed by Congress in 2017, and proposals discussed during the 2020 Democratic presidential primary such as “Medicare for All” – reflects Americans’ concerns about the affordability of care. Another crucial component of healthcare access is the availability of healthcare providers, as spikes of COVID-19 have demonstrated. To better understand the physician workforce, the Association of American Medical Colleges (AAMC) commissioned IHS Markit to forecast physician supply and demand over the 15-year horizon from 2019 (the latest available data for a reliable baseline) to 2034, and in June released a report forecasting that rapidly increasing demand for healthcare services will cause physician demand to exceed supply by 37,800 to 124,000 physicians by 2034.
We generated these projections using our proprietary Health Workforce Microsimulation Models, which have been employed by a variety of state and national government entities as well as professional associations and healthcare providers to better understand the future of the healthcare workforce. Using separate models for physician supply and demand, projections show that both will increase, but that physician demand will rise by about 17 percent over the projection period, while physician supply will rise by just 6 percent. This surge in demand for physicians is largely due to the growing number of older adults in the United States. Population projections driving the demand model suggest that the number of Americans age 75 and above will grow by over 70% from 2019 to 2034, which will cause a rapid increase in the prevalence of diseases and conditions that tend to affect older Americans. This in turn will sharply increase the demand for healthcare services and the physicians that treat these maladies.
Projecting workforce adequacy into the future requires making assumptions about conditions in the future. The large range of projected values for the physician shortage in 2034 (37,800 to 124,000 physicians) results from the variety of alternative assumptions made in both the workforce supply and demand models. In the supply model, these alternative scenarios modeled the workforce implications of changing the number of weekly hours worked for physicians, as well as the impact of proposed legislation that would increase the number of physicians being trained in the United States by 3,000 per year. Much of the funding for physician graduate medical education (GME) is allocated by Congress, meaning that the federal government has a large say in how many physicians the United States produces.
Alternative demand scenarios examined the effects of potential changes to the healthcare system, such as increased use of nurse practitioners and physician assistants, and increased use of managed care organizations. The hypothesized larger number of nurse practitioners and physician assistants perform more of the tasks currently completed by physicians, thus easing physician demand. However, other scenarios lead to higher projected physician demand. IHS Markit analysis of healthcare use data determined that patients enrolled in managed care organizations use more primary care services and fewer specialist services than patients not in managed care plans. Under this modeled scenario, the increase in demand for primary care physicians exceeds the decrease in demand for specialists resulting in a slight net increase in demand for physicians.
These and other scenarios not included in the chart above produce different projections of future physician shortage or surplus. The range of 37,800 to 124,000 additional physicians required in 2034 to meet demand represented the 25th and 75th percentile shortfall projections comparing each supply to each demand scenario.
Our Health Workforce Microsimulation Models produce projections for a wide variety of healthcare professions, not just physicians, and at geographic levels as small as individual counties. The study with AAMC also included supply and demand projections aggregated by primary care physicians and non-primary care physicians, projecting a shortage of between 17,800 and 48,000 primary care physicians and 21,000 to 77,100 non-primary care physicians in 2034. So, while primary care is often a focus of discussion regarding physician shortages, our models suggest a shortage of non-primary care physicians as well. In addition, we forecast large variability in projected adequacy by specific physician specialty not fully captured in the aggregated data. Furthermore, the ongoing COVID-19 pandemic could further negatively impact the projections. A discussion of the pandemic’s observed short-term impacts and expected long-term impacts on the demand and supply of physicians is included in the AAMC report.
In addition to affordability, many Americans’ healthcare access concerns stem from equity issues such as finding providers who accept public insurance, finding transportation to care that may be far away, or prohibitive costs of missed work to seek care. A special area of focus in the AAMC report is the number of additional physicians required to provide equity in healthcare use. This scenario estimates the level of physician demand required if healthcare services were to be accessed by all demographics at the rates observed for privately insured, non-Hispanic, White Americans living in suburban areas – the segment of the population with the highest rate of healthcare use, and hence likely having the fewest barriers to receiving care. This scenario results in an estimated gap of 180,400 physicians by 2034, meaning that many additional physicians would need to practice in the United States if barriers to care by race/ethnicity, geographic location, and insurance status were to be addressed. Of course, resolving these issues is a complicated task, so simply training 180,400 more physicians would not by itself ensure healthcare use equity. Nevertheless, efforts to increase healthcare use equity will also require additional physicians.
Without additional investment in the physician workforce, the combination of an aging population and measures to address inequities in healthcare will likely make finding a physician more difficult in the coming years.