In the past month, my immediate family has had three situations requiring urgent but not emergent medical care. In all three situations, the first-available appointment with a physician was weeks to months away during which time the medical problem could have changed from problematic to life-threatening.
Let me be transparent about my situation. I am a physician employed in one of the largest medical centers in the country. My family has private, high-quality insurance that is accepted by health care providers across the city. We are generally healthy people who have long-term relationships with our primary care physicians. By every definition floating around in the media or health services research, we are privileged.
And yet, despite every advantage, we still could not get timely medical care.
In the end, I used my position as a physician to make back office phone calls, pull relationship strings, and get sooner attention for two of us. Luckily – though that word seems inappropriate here given my specialty – my daughter has something I am medically qualified to follow for the next six weeks. We will, hopefully, be fine. But I had to work around the system. What if I hadn’t had that ability?
Timeliness is a pillar of health care quality. When timely medical care cannot be achieved, what could have been managed today with an exam, labs, and generic medication may require emergency room care, surgery, or hospitalization in the future. There is a whole body of literature establishing that timely care is better care. So why can’t we get it?
Because of provider shortage. The specific providers in my situation were hard-working, full-time physicians with no available appointments. There was simply no space in their schedules, or the schedules of their partners. Not in one clinic, but in three. This is a systemic problem.
Part of the problem is simple economics. The demand for medical services is increasing faster than the supply of physicians can keep up. In Houston, we have seen an unprecedented population growth of over 17 percent since 2000 through migration and longevity. If each one of those additional people attends a single well-person exam per year the medical system needs to absorb an additional 340,000 encounters.
Our successes in public health and medical technology, and subsequent improved life spans, generate need for medical care. For example, childhood cancer treatments have been extraordinarily successful at allowing children to survive their cancers. But many have life-long medical needs. If every survivor of childhood cancer had just one extra medical encounter each year, it would increase demand by almost 400,000 visits annually compared to 50 years ago. At the same time, the pandemic rise of preventable chronic illness such as diabetes, cardiovascular disease, and cancers strains medical services.
Though there are more patients, there are not more doctors. Medical training is expensive and lengthy. There are also limits to increasing the number of trainees due to teaching and educational constraints. But more troubling to me is that providers of all sorts are leaving practice. Some retire, as is expected. But more and more are leaving medicine because it is not the place they want to be anymore. Burnout is high. Depression is high. The system we have isn’t working for a precious resource: doctors.
The problem of physician shortages is real and pervasive. The Association of American Medical Colleges projects a shortage of 40,000 to over 100,000 doctors by 2030. This is not a problem limited to a single geographic location or social status. We can provide insurance to the entire country, but unless there are physicians to deliver or oversee care, people still won’t get what they need.
We need to address both sides of the problem. We should decrease demand through decreasing low-value, wasteful care so we can be most efficient with what provider time is available. We should improve health across our communities so preventable medical conditions do not strain our system. And, most immediately, let’s focus on the flaws in the system that drive physicians away.