Med student question about doc shortage

[mh0311]

Hello Everyone,

M1 here and I was thinking about the physician shortage (should be studying for my cardiopulm exam). Maybe those of you more experienced can explain this to me, if I start practicing around lets say 2025-2027 when the physician shortage is supposedly going to really ramp up, won't hospitals and other health systems offer better salaries to to compete with each other to attract doctors? Is simple supply and demand the right way to think about this?

[Peds]

Nope. Depending on specialty salaries are going down.

[q-school]

supply and demand only loosely apply.

predictions are hard, especially about the future.

just do the best you can right now.  the parts you can control are your test scores.  there will always be a job for a physician.

they have been predicting physician shortages since at least the 80s that i can recall.

 

[MPMD]

there are shortages all over the place that positively impact salary, they are in places that aren't "desirable" to live.

Big coastal cities, Chicago, Denver etc are always going to be relatively tight markets.

But nothing going on w/ med school enrollment, residency spots etc is going to correct the geographic arbitrage you can exert if you're willing to live in small town or even a smaller city.

I have some friends who practice in "undesirable" locations and absolutely kill it.

[FIREshrink]

Supply and demand is part of it but only part of it. I think rather than pay docs more we will see an increase in licensing of AHPs. Net loss for health care, but not unreasonable if docs only want to work and live in major metro areas.

[AlexxT]

Impending doctor shortage since at least the 1970's, actually.   Oversupply in the big cities, desperate need in rural areas since the 70's as well.

Nothing has changed.

Every specialty is different.  Anesthesia was oversupplied at one point in the 90's, then suddenly there was a shortage.

Some specialties are stealth money printers.  Then they are not.

Ignore all of the above.  Get back to studying.

[VagabondMD]

It’s not like there is a giant, ever-expanding pot of money that “they” are trying to keep from you. Public interest in broadly paying for health care services is steadily declining.

The “doc shortage” is more theoretical than real, perhaps more a specialty/location distribution problem than a numbers problem. As discussed above, there are solutions to the problem (in the areas where it exists) that do not require paying docs more and may not require docs at all.

[Zaphod]

There will likely be a shortage in certain areas both geographic and specialty wise that is not what theyre predicting, and then there will probably be a massive oversupply elsewhere like today. We've conquered the main big drivers of health care need that used to drive mass use of facilities, which are mainly infectious in nature. Likely all of life will get safer on the whole and even accidents will decrease and there goes another huge driver. Cellphone use while driving is trying to give this another go, but will eventually revert back to trend.

You'll always have preventative I guess which unfortunately in the end is always up to the pt and hardest to address.

If I were to guess (because its fun), I would imagine some kind of a dichotomy of centralization/specialization and decentralization/general outside of that. Smaller hospitals with minimal inpt compared to today surrounding and feeding bigger ones.

Think of all the surgeries and issues that used to have people in the hospital for days and weeks that no longer are even 23hr obs situations. This trend will continue where it can, and inpt stays will decrease where outpt cant be done as safe.

More and more drugs/treatments will become over the counter, also eating into regular visits, etc...Then an impinging on space by NP/PAs, the not that obvious as docs hope for quality difference, too small for Joe/Jane American to care about given value proposition, and bam, you have an oversupply.

[mh0311]

Interesting, I asked this because I always get emails from the AAMC saying an aging population in combination with increased physician retirements and very small increases in residency spots will lead to this massive shortage but sounds like they're just trying to appeal to emotion to get more funding? And I had no idea they've been saying this since the before I was born, guess it is more of a maldistribution and can be offset in other ways like Zaphod mentioned.

[jz]

Two variables for physician reimbursement.  1) regional supply & demand for your specific skillset, and 2)  collections on your piecemeal work. 

The demand for your skills  will be downward if advanced practitioners can  replace you.

[ENT Doc]

Their modeling (full report and method available online for free) doesn't at all account for technology, nor does it fully account for the escalating enrollments in PA, NP, and DO programs. The former two affect productivity, something not accounted for either. I would agree with a dichotomy of care occurring before a doctor shortage, whereby people who are not of means or in more rural communities are seen by NPs, PAs, DOs, and FMGs, and less rural patients are more often seen by MDs and to a lesser extent the others.

[Zaphod]

ENT Doc wrote:

Their modeling (full report and method available online for free) doesn’t at all account for technology, nor does it fully account for the escalating enrollments in PA, NP, and DO programs. The former two affect productivity, something not accounted for either. I would agree with a dichotomy of care occurring before a doctor shortage, whereby people who are not of means or in more rural communities are seen by NPs, PAs, DOs, and FMGs, and less rural patients are more often seen by MDs and to a lesser extent the others.

Click to expand...

This is the whole problem with humanities never ending myopia. We almost always concern ourselves about the problems of tomorrow with the solutions/tools of today. We seem to forget some how, some way we innovate or work around those issues and they cease to exist at all sometimes.

One could look back historically at all the failed prognostications about something that was becoming or scheduled to be an issue that just never happened due to innovation/growth/etc...horse manure went away due to cars and food shortages and land scarcity due to increased yields.

As long as we dont kill our selves or run into some other fermi filter, we will eventually get there.