Radical change needed to address physician shortage

Reducing barriers to medical education a top priority

THE UNITED STATES is facing a severe shortage of physicians in the coming years – a crisis that could push our already fractured health care system beyond the brink. A comprehensive report by the Association of American Medical Colleges concluded that by the year 2034, our nation will be short more than 120,000 physicians. 

Given these projections, there is a clear and present need to do whatever is necessary to address not only the dearth of physicians we face in the next decade, but also the lack of diversity within our physician workforce. We are well past urgent in our timeline to do so.  

I confront this crisis every day as the president of the Massachusetts Medical Society and as a primary care physician. Obstacles to timely access to care threaten poorer outcomes for all patients, especially for those who have been historically marginalized and discriminated against by our nation’s health care system.  

My colleagues and I at the Medical Society believe we must act as quickly as possible to implement some changes to help course correct and prevent this public health crisis from becoming even more dangerous: 

Reduce barriers to medical education. The pathway to medical school poses numerous barriers to entry to the physician workforce, not the least of which is the cost. The average cost to attend four years of medical school in the United States is nearly $220,000; leaving the average medical school student with more than $200,000 in debt. For many, these costs are prohibitive.

Working to make medical school more affordable and accessible both expands the candidate pool and allows for those who complete medical school to do so with less debt, alleviating the struggle to meet repayment obligations while navigating residency and practice challenges. The Medical Society is working to foster relationships with students of all ages, especially those from historically marginalized communities, who are interested in pursuing careers as physicians to help them navigate the process of medical education.  

Invest in primary care. In Massachusetts, baseline spending on primary care in 2019 accounted for less than 8 percent of total medical spending for commercial insurance. The percentage is lower among MassHealth patients and those enrolled in Medicare Advantage. State-specific data around racial and ethnic disparities in access to and utilization of primary care providers are especially troubling.  In 2021, only 64 percent of Hispanic residents reported that they had a preventive care visit in the last year, versus 81 percent of White residents.

Data show that patients having a regular and trusted relationship with a provider decreases the usage of and strain on hospitals and emergency departments. We must invest in a better-funded system of primary care that delivers equitable access to all, incentivizing comprehensive practice transformation and allocating resources in an intentionally antiracist and just fashion, accounting for the severity of illness and social determinants of the population. Many countries assume the full cost of medical school and then require several years after training of work in underserved areas. A similar shift in the US would encourage more graduates to pursue primary care as there would be little debt incurred. 

Continue to combat burnout and its underlying causes. Burnout is irrefutably causing physicians to leave medicine. A survey conducted recently by the Medical Society revealed that one in four physicians in our state plan to leave medicine within the next two years. By treating the causes and the symptoms of burnout, the health care community can stave off the huge wave of physicians opting to substantially reduce their workload, retire, or leave clinical practice.

A main driver of burnout is excessive administrative burden, which prioritizes paperwork over patients. Administrative burdens such as prior authorization can be streamlined and automated so that it becomes useful to the provider and the patient to improve care and decrease cost. Providing greater work-life balance and offering improved flexibility of schedule for those who deliver care is also critical to addressing burnout. 

Expand the use of technology. Like many of my colleagues, the restrictions resulting from the COVID-19 pandemic forced me to immerse myself in telehealth at an expedited pace, but the results for my patients, especially those with chronic illnesses, have been overwhelmingly positive and have allowed me to be more efficient in my patient encounters. We must continue to build upon existing policies to ensure equitable access to care via telehealth, as well as enshrine parity of reimbursement so that all patients may continue to access care delivered via this game-changing modality. Universal internet access will be a key factor in eliminating disparities. 

Meet the Author

Barbara Spivak

President, Massachusetts Medical Society
Examine and adjust payment models. From 2001 to 2023, Medicare physician payment has decreased by 26 percent relative to inflation. The Medical Society and the American Medical Association (AMA) strongly support H.R.2474 – Strengthening Medicare for Patients and Providers Act, a legislative fix that will help to bring stability and a path for sustainability to physician practices. The federal proposal amends the flawed payment structure so that the volume of patients one sees does not outweigh the amount of time spent with and quality of care provided to patients. This change will allow physicians and their teams to focus on the needs of the patient and reconnect physicians with their personal “why?” and rediscover the joy in medicine.  

The Medical Society holds sacred its organizational belief that health care is a basic human right. With an invigorated, diverse, and resilient community of physicians and health care teams as the bedrock of a strong health care system, we can meet this public health challenge and improve outcomes and quality of life for all patients in Massachusetts.  

 Barbara Spivak is the president of the Massachusetts Medical Society.