US faces chronic doctor shortage

One university is attempting a radical approach to healing the healthcare system.


    Jennifer Han is a smart, 24-year-old native of Los Angeles whose lifelong dream has always been to be a doctor. The daughter of immigrants from South Korea, she's a first-year medical student at the University of California at Riverside. Recently, she took time out from the stressful final-exam week to talk to us about her goals and what it takes to become a doctor in America in 2013.

    "Ultimately one of my major goals in going into medicine was to work with more under-served communities, hopefully with children and, of course, include their families in the health care system," she says.

    Han has a strong desire to give back, and to serve. But in the US system of for-profit health care, becoming a physician carries a heavy price tag. Medical school tuition is expensive and requires students such as Han to take out large loans which must be repaid following graduation. 

    "We are acquiring a lot of debt," Han admits. "It ranges from $40,000 to $50,000 per year over four years, so it can be $200,000 or more altogether."

    Riverside County and its surrounding area, where Han studies, is known in California as "The Inland Empire". It's an area of the state facing a severe shortage of doctors. "We have a desperate situation," says Dr Richard Olds, dean of the Riverside medical school.

    Dr Olds spent much of his career practicing tropical disease prevention and treatment in the Philippines, Egypt and Central America. He says the lack of access to medical care in those developing countries is mirrored by a shortage of medical professionals in the Inland Empire.

    "It's the fastest growing area in the state, and because 40 percent of the doctors in this area look like me - they are 55 years of age or older - we will have a 5,000 physician deficit in ten years, no matter what anyone does," he says.

    Healthcare on life-support

    The looming shortage is particularly severe for primary care doctors. These are family practitioners, internal medicine doctors, pediatricians and others. These physicians earn far less than elite specialists - plastic surgeons, cardiologists, oncologists,  or orthopedic surgeons, to name a few. Many doctors choose these relatively lucrative specialties partly in order to make a lot of money quickly and pay off those crushing medical school debts.

    Dr Olds warns: "We have a really critical problem in not enough primary care doctors."

    California is far from alone in grappling a looming doctor shortage. According to a new report by the American Association of Medical Colleges (AAMC), there could be a nationwide shortage of more than 90,000 doctors by the end of the decade.

    The shortage will worsen when President Barack Obama's Affordable Care act goes into effect next year, says the AAMC's chief public policy officer, Atul Grover.

    "You are going to be putting a few million - maybe up to 30 million people - into a system where they are going to want to have access to care - or perhaps in the past, they only sought out emergency care," he says.

    But the main cause of the shortage is that the country is simply getting older, and elderly people need more medical care than young people.

    "Over the course of the next 20 years, 10,000 Americans a day will turn 65," says Grover. "And they are the ones who use the majority of healthcare services."

    Triaging the system

    Recognising the problem, UC Riverside is trying a bold experiment, the only one of its kind in the nation. Certain students who choose primary care - and agree to practice in the local community for a period of time after they complete their internships - will get full scholarships.

    "We basically give them medical school for free," Dr Olds says. "At the end of the day, if they are a primary care doctor in inland southern California for five years, the deal's closed. They emerge debt free."

    He notes that graduates who change their minds and choose to practice elsewhere simply have to pay back their loans. "We basically reverse the financial incentives to try to get the result that our area of California, and society in general, needs."

    Han is one of the first students to participate in the programme. She says it is a good fit for her goals, and a great relief to her family. 

    "It definitely lifts a big weight off my shoulders, knowing that I won't have to pay back so many of my loans after I graduate," Han says. "And it gives me a better idea of what kind of doctor I want to be."

    For the next several decades, a shortage of physicians will almost certainly be a fact of life in the US. Patients will most likely have to rely on second-tier health care professionals, such as nurse-practitioners, to pick up some of the slack. And the country will need more original thinking and innovative programs such as UC Riverside's - as well as plenty of dedicated students, like Jennifer Han.

    Follow Rob Reynolds on Twitter: @RobReynoldsAJE



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