Better distribution by geography and specialty could solve physician shortage


It’s getting more difficult to find physicians in some specialties, but the available evidence suggests the doctor shortage may be more a function of efficiency than of numbers.

Because they deal with cancer treatment, oncologists tend to establish especially strong bonds with their patients. Oncologists specializing in specific cancers can be difficult or impossible to find in some parts of the country, according to a recent New York Times article, and given current industry trends, the problem is likely to get worse before it gets better.

A 2014 analysis from the Journal of Oncology Practice warns that the demand for oncologists will likely outstrip supply over the near term. That means oncologists will have to increase their productivity to prevent patient care from deteriorating.

Some states have had to scramble to counter an ongoing shortage of physicians, but Aaron E. Carroll, M.D., professor of pediatrics and associate dean at Indiana University School of Medicine, writes that the problem may not be quite as cut and dried as it seems. It may be that we turn to physicians to do work that lies within the scope and expertise of nurse practitioners, physician assistants and other “midlevel practitioners.”

If that’s the case, Carroll suggests, the solution to the problem doesn’t involve training and recruiting higher raw numbers of physicians so much as distributing physicians more efficiently throughout the system. Rural areas expend more resources to combat unequal geographic distribution, and Carroll notes a similar issue with regard to specialization.

The prescribed fixes require reconfiguring incentives to get more physicians into primary care and underserved specialties, making greater use of midlevel practitioners where possible and encouraging more equitable geographic distribution of doctors. That’s a tall order, according to Carroll, who believes they “all would most likely require governments to act.” Regardless of approach, he writes, some action needs to be taken to improve access to care.