Doctor offers solution to potentially debilitating primary physician shortage in U.S.

WASHINGTON (TND) — Over the last 18 years, the wait time to see a doctor – the time it takes to schedule an appointment and end up sitting in their office – has increased by 24%. To put that in more concrete numbers, a survey from AMN Healthcare and Merritt Hawkins found that the average wait time in 2022 was 26 days.

Gloria Jones, a healthcare worker in Connecticut, told The National Desk she’s been waiting to see a doctor since October. “I had an appointment in October, [but] it needed to be rescheduled,” she explained. “And the practice that I was attending, I called them and wanted to reschedule it. And they said that I'd have to call back the end of January, because they had two providers who were full time that were out of practice,”

During that January call, the practice revealed it was not taking any appointments, so recommended another. A continuation of canceled appointments and lack of commitment to scheduling finally led to Jones finally scheduling that appointment – for a routine physical – this July.

However, her appointment is at a new office with a new doctor and a different locale than where she had been going for such regular care for the last two decades. “In July, I will meet a new primary care practitioner, in a different practice [and] in a different location. And, I did follow up with my primary practice – that I had been going to for 23 years – to see if anything changed. They said ‘no,’ they still have some doctors out and they can't schedule anyone.”

She feels perfectly healthy and is not inherently concerned about trying to find an appointment for herself over these last six months, but she is concerned that there are others who are not as willing or cannot wait like that. “I'm sure there are many people that wouldn't even bother and there would miss they would miss follow-up appointments that might be very important.

Part of the issue Jones and many other Americans face is that the U.S. has a shortage in primary care doctors, and, more specifically, a shortage of residency programs that are required for someone with a medical degree to acquire a license to practice medicine.

Justin Leventhal, a research associate for the Open Health Project at the Mercatus Center at George Mason University, notes that much of these shortages tie back to two federal institutions: the Centers for Medicare and Medicaid Services (CMS) and Congress (Robert Orr notes in an article for the Niskanen Center that the government has also potentially put caps on the number of medical school applicant spots and number of medical schools in the country).

CMS provides the bulk of funding for hospital residencies and that funding has been capped for the last 26 years at substantially low levels. The funding was first capped in 1997 at 1996 levels and was raised only once since: in the Omnibus spending bill of 2021 (which was passed in 2020).

The effects on the medical field by this funding cap was substantial: between 1987 and 1997 the number of residencies grew by 20.6% but between 1997 and 2007 the number of residency programs grew only 8%. The U.S. population grew by 10% during that same timeframe.

This growth in population without a corresponding growth in the doctors we train each year leads to higher salaries for doctors and higher costs for patients,” writes Leventhal. “More people are demanding the time of a similar number of doctors, driving up the price of doctor’s time.

The American Medical Associated found that, in 2021, roughly 7% of medical school graduates (those with a “doctor of medicine” degree) were in a state of professional limbo, unable to enter a residency program and develop the skills and proficiency needed for the full licensing.

“Many medical school graduates do not match with positions in accredited programs because the number of residency slots available has not increased at the same rate as the number of medical students,” says Dr. Jeffrey Singer.

Singer, a senior fellow at the Cato Institute, estimates that there could be a shortage of 40,000 to 48,000 primary care physicians in the U.S. by 2034 – and the Association of Medical Colleges puts that number around 14,900 to 35,600 by 2025.

He released a report Monday laying out a possible solution to this issue, allowing medical school graduates without a residency program to become assistant physicians (AP). Much like a residency program, the APs would work as apprentices to the licensed primary care providers they end up with.

And during the year, that they have to wait before they can apply for residency program again, at least they're serving society,” says Singer, “which they're trained to do, and otherwise letting their training go to waste.

He anticipates criticism from patients and others in the medical field who say that the APs would not have the sufficient training to properly treat and care for people. “Well,” he rebuts “they have actually more training than nurse practitioners do."

Singer further points out that the idea has historical precedent, since the residency program as we know only really emerged in the 1950s. So, for the first nearly-two centuries of American history, doctors learned as apprentices after graduating medical school.

Jones, who worked in the health care industry for over 45 years, supports Singer’s proposal for people like her who have endured and are enduring long wait times to see their primary doctors.

I would have no problem seeing someone in that situation at all,” she said. “I think they're more than capable to be able to help fill in, do some physicals, do some routine follow up visits. I think it would really add to the backlog of people being able to be seen in primary care.

Jones sees their youth as a possible benefit to, coming out of medical school with the latest developments in medical scientific knowledge and training, which could benefit patients in ways that older doctors who – while full of experience – may not be as up-to-date could not.

Singer says that at least seven states, including Arkansas, Arizona, Idaho, Kansas, Louisiana, Missouri and Utah have passed legislation allowing APs to work under licensed doctors and help provide primary care. Tennessee considered a similar piece of legislation this year. He also noted that Washington state recently passed a law that allows for doctors that have immigrated to the U.S. – and have been successfully practicing and licensed in other countries – to become assistant physicians.

The National Desk spoke with another doctor – wishing to remain anonymous – who expressed concerns that this type of program could allow too much leniency in the path to a professional medical license and extolled the continued values of residency training.