It is estimated that the United States currently has over 222,000 practicing active generalists that are either office or hospital based. This includes trained internists, family physicians, and pediatricians who provide primary care to the great majority of the U.S. population. Physicians in family medicine, general internal medicine, and general pediatrics are the foundation of U.S. health care, providing 52% of all ambulatory care visits, much of the inpatient care, 80% of visits for hypertension, 70% of visits for chronic obstructive pulmonary disease (COPD) and diabetes. Yet it is expected that there will be a significant shortage of primary care physicians over the next 20 years because the U.S. population is expected to increase by 18% between 2005 and 2025, and the population over age 65 (which utilizes the health care system twice as often as younger adults) will increase by 73%.
At the same time, the number of medical school graduates who plan to enter general internal medicine has decreased annually since its peak in 1998, by nearly 40% overall in 2009. Increasing numbers of graduates who are entering general internal medicine are choosing to practice Hospital Medicine exclusively. More women are entering medical school and the physician workforce (at a nearly 50% expected even representation by 2025), and women are more likely than their male counterparts to work in part-time positions. Finally, the number of hours working and patients seen by older physicians who are approaching retirement is unlikely to be matched by the newly graduated physicians that are their replacements.
Between the growth of the population over age 65 and the decrease in physicians practicing outpatient primary care, there is expected to be an outpatient physician shortage by 2025. An expected 30% increase in ambulatory care visits for adults will significantly increase the workload for those who primarily practice outpatient medicine. Deficits of 35,000 to 44,000 adult generalists are expected by 2025, threatening the foundation of primary care for adults. Geographic differences in physician supply indicate that shortages will be more acute in rural areas. These numbers do not take into account health care reform, with the provision of universal coverage. This will add an additional 31 million people into a system that is already challenged, with expected increases in wait time for visits and further increasing workload on primary care providers.
Compare this to the physician workforce in Great Britain and Canada. The United States spends the most per capita on health care in the world, accounting for 15% of gross domestic product (GDP), yet, according to the World Health Organization, it ranks 37th in the world in several leading health indicators. In comparison, Canada spends about half as much per capita, and health care spending accounts for 10% of the GDP. One of the differences quoted between the two systems is access to primary care providers who act as “gatekeepers” to specialty care, helping to keep costs down. The number of physicians entering ...