The Association of American Medical Colleges (AAMC is promoting a doomsday shortage where America is without 47-122,000 physicians, over a third of them being general practitioners, by 2032 and say it is due to the “graying” of America, both among providers and the public.

This is a market survey written for a trade group, it is designed to create a sense of urgency and get more money for their members, but the numbers are not wrong.(1)  While in the next dozen years there won't be a huge spike in kids, young people today are even abstaining from sex at record levels, there will be a surge in older people - we are living longer than ever, thanks to plenty of food, affordable energy, and better drugs - and many of those older people will be doctors who no longer practice. Up to 40 percent of current doctors will be over the age of 65.

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Who will fill the gap?

In a free market, supply will fill demand. Being a physician is a high paying job with a great deal of prestige. But, argues Citizens' Council for Health Freedom president Twila Brase, we no longer have a free market and points to a survey noting a majority of doctors say “barriers set by insurance plans have led to worsened conditions for patients in need of care.”

This is not really new. The government has long held a grip on health care. They are the biggest purchasers of drugs, they hold most of the money, since they control access for the poor and the elderly, and they draft the regulations that hospitals, doctors, and insurance companies must live under. It was always easy in the past to lay the blame for cost of treatment on greedy hospitals, greedy insurance companies, or greedy doctors, but those costs are nothing compared to premiums now. The offset, we are told, is that with more access to health care, societal costs in the future will go down.

Mortgaging the future or an ounce of prevention creating a pound of cure?

The problem with estimates is those checks can't be cashed. In corporate marketing if you create a plan and say project revenue will rise by X percent, you have an implied deliverable. You will lose your job if revenue goes down.(2)

And distrust of estimates is the issue doctors must face. The money new doctors will have to spend on medical school is real, it has to be paid right now, but the health care system itself is now unpredictable. It's increasingly difficult to just move somewhere and open a practice. Now that payment and care delivery models have become political footballs, the financial incentive for young people to go into medicine has declined.

Do we really want doctors who go into it for the money rather than as a public good? Of course we do, the same way the best young athletes in the US will go into baseball rather whatever other sports are in America. If we have brilliant potential surgeon M and the choice is to make a lot saving lives or a little studying fruit flies, let's not make saving lives onerous. If great people are deterred from medical careers, quality goes down. And if health care quality declines we are not saving money in the future. During the last few decades there has been an increase in osteopaths doing general practitioner work, and M.D.s have not minded because M.D.s go into specialties more. Many people can do routine check-ups.

But what about pediatricians? When government controls how much a pediatrician can charge for a visit using a Relative Value Unit (RVU), those doctors lose, because new parents with infants are going to ask a lot more questions and therefore demand a lot more time than an adult going for an annual physical. If there are fewer MDs in general practice, okay, but do parents want someone who didn't go to medical school advising them about their child? Will someone who wants to help kids go into pediatrics if their income is barely going to cover their medical school debt?

Yet that is the sentiment among physicians, even if they never make it into New York Times profiles where doctors glow about the future of nationalized health care. A few years ago, when double digit increases in annual premiums were still a new thing, over 60 percent of doctors surveyed were already advising that young people who wanted to go into medicine to help people should become nurse practitioners instead. It isn't that they felt like a medical degree was no longer valuable, it is that the regulatory future for doctors looked bleak. And it has gotten no better since.


(1) At least at the low end, analyses that provided an answer in the range of 300 percent make the whole methodology suspect but this is more of a marketing document than anything, so they want journalists to latch onto the cosmic number. 

(2) It happens. After General Mills rolled out a disastrous campaign claiming its Cheerios cereal is non-GMO (after their CEO argued earlier that they were safe), sales went down, and then Saatchi  &  Saatchi found themselves sharing the wealth with a whole bunch of new agencies when the GM centralized creative executive got whacked. Now they are dismantling the patriarchy using Reese's Puffs cereal. But it's funny. Using a voiceover from a guy who does monster truck arena ads in a spot about a teenage girl's prom dress is an extra layer of subversive. Or creepy. Your call.