Que falta de médicos?

The conventional wisdom seems to be that we will be facing a doctor shortage due to the 10,000 boomers turning 65 each day, disparities in geographic distribution and inappropriate specialist/generalist ratios. Add that to the bottle neck in graduate medical education funding and the pundits would have you believe you’ll need to go the black market to find a doctor in the future.

A report from the Association of American Medical Colleges further underscores the projected physician shortage in the U.S. There could be anywhere from 54,000-139,000 fewer doctors in the U.S. by 2033, according to the report, which also predicts a primary care physician shortage of up to 55,200. Medical specialties, including surgical specialties, could also experience a deficit of more than 86,000 physicians in the next 13 years.

Technology, like Radiology 2.0 or Pathology 2.0, might , in fact, reduce the need for certain specialists or make the existing ones more efficient.

Researchers predict that the growing number of people across the world who will need chemotherapy will lead to a shortage of oncologists who can provide that treatment, according to a new study. There were an estimated 65,000 oncologists in 2018 needed to provide optimal care. That demand is expected to jump to 100,000 cancer doctors by 2040, the study found. The primary reason for the increase in anticipated cancer diagnoses is that people are living longer.

Some have cast doubts, though. Here’s why:

1. There has not been enough pain spread around to all the players to motivate change. The expectation is there will be in the near future.

2. Patients are becoming more and more accepting of physician substitutes , extenders and advanced practice professionals

3. The care delivery channels and business models are changing requiring fewer doctors or less skilled professionals to execute them

4. Necessity will drive innovation, particularly with population health management tools applied to the 20% of Medicare recipients who account for 80% of the costs.

5. A shift from a sick care system to a health care system might lessen demand

6. Rethinking end of life care would reduce the demand for services.

7. The shift from hospital based care to community and home based care will drive the need for non-physician substitutes.

8. One- on- one care is migrating to team based care.

9. Surrogates and families are being given the technology tools to support aging at home initiatives.

10. The realization that doing what we are doing now and paying what we are paying will bankrupt the country and severely compromise our global competitiveness.

11. DIY medicine will grow, but not without its perils

12. The entire sick care enterprise will downsize, a victim of its own weight and cost.

13. There is a maldistribution of specialists to generalists and geographical availability. Remote access, eConsults, medical travel, access to doctors out of country and telemedicine will reduce access for some who have the means to do it. Talent, technology, money and customers go where they are treated best, borders not withstanding.

The U.S. economy is out of recession, but its status could be described as “running on empty.” While the tech sector and professional services flourish and draw skilled workers from around the globe, crucial sectors like healthcare, housing and education are suffering. This drag on the economy mutes any kind of recovery underway, and puts tremendous strain on consumers, businesses and taxpayers. Improvements in sick care productivity could reduce the demand for more doctors.

In his book, Rise of Robots, author Martin Ford presents a gloomy scenario where machines no longer become tools for workers. They “engineer out the labor”. The same could hold true for medicine and the trends that are changing retail-online retailing (eCare), vending machines and kiosks (already in many doctor’s offices and hospital lobbies, and increased automation and robotics (say hi to your new nurse, HAL)- are already evident in medicine and threaten to eliminate many jobs thought previously safe.

Healthcare manpower prognostications, to paraphrase Yogi, are notoriously unreliable particularly when they involve predicting the future. When it comes to doctor supply, don’t go all in or necessarily believe everything you click.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@ArlenMD and Co-editor of Digital Health Entrepreneurship