In 2013, I wrote the following article suggesting that Congress needed to take action to prevent a 2025 shortage of physicians. The subsidy for residency programs needed to be increased. That would increase the number of doctors trained. However, with four years of medical school and four years of residency, it would take eight years for them to flow through the system.

“The law of supply and demand governs many things. One of those things is the number of physicians available to the population. There are many factors that are involved in trying to figure out how many physicians need to be trained.

Even if we have the right number of physicians nationally, that might not be what we need. There may be too many in one geographical area. There may not be enough in another. There may be enough physicians in an area but they may not be the right mix of specialties.

As we move forward over the next 10-15 years, there are a number of factors that will affect the number of physicians. Most of those suggest that there will not be enough physicians to meet the needs of patients.

As is often the case, there are a number of factors involved in this. One of those has to do with the way we practice medicine. When I was a pediatric resident in the 1970’s, the hours were long. There were many weeks that we spent 110 of the 168 hours of the week in the hospital. We had to cover the Emergency Room. We had to spend the night at the hospital. The expectation was that when we finished our residency, our practice would be similar. We would work in the office. We would cover the needs of the ER. We would take care of hospitalized patients at night.

Over the years, it became apparent that tired physicians were not the best decision-makers. Therefore, a number of changes occurred. Resident hours were shortened. ED physicians specialized in handling ER patients. Hospitalists began to take care of hospitalized patients. The result was a better lifestyle for the practicing physician. However, it meant that many physicians were now doing full-time things that other physicians used to do part-time. For example, about 10 percent of physicians practice as hospitalists. They do not work in an office. That 10 percent is available to treat patients only when they are hospitalized.

A second important factor is the Baby Boomer population. There will be many more patients. They will live longer. They will need medical care. The statistics suggest that this will double the number of patient visits for individuals over age 65. There will not be double the number of physicians treating that group of individuals.

A third factor is related to physician retirement. In the past, about half of physicians worked until they were 70 years of age. Now half of them retire by age 65. That results in less physicians available to see patients.

The Affordable Care Act is going to require more physicians to care for the individuals who will now have insurance. While many of those individuals without insurance are relatively healthy, that is not true for all of them. The estimate is that about 31,000 physicians will be needed to cover this group.

Another factor is related to practice ownership. In the past most physicians owned their own practices. The amount they made was dependent upon the number of patients they saw. More physicians are now working for hospitals. The result is that they receive a salary no matter how many patients they see. In the past physicians who owned their own practice saw more patients on the average than salaried physicians. This is liable to be true in the future.

Congress finally took action in 2021. That was years after I wrote the article above. The result is that the shortage has already hit and it will be at least 2033 before it is likely to improve significantly. So, the next time you have trouble making a doctor’s appointment, think of what might have been preventing it.