The United States could face a shortage of 24,000 doctors and nearly one million nurses by 2020 -- a double whammy “that may be more than the industry can bear,” according to a report scheduled for release today by a health-research group.
The shortages would come at a time when an aging population will need more care, concludes the report by PricewaterhouseCoopers’ Health Research Institute, a division of the international consulting and accounting firm.
The report, “What Works: Healing the Healthcare Staffing Shortage,” notes that baby boomers make up a big chunk of today’s physician and nursing work force, and that retirements are expected to thin the ranks significantly beginning in the next three to five years. Medical and nursing schools aren’t turning out enough new graduates to fill their shoes, but that’s not always for lack of interest.
Applications to nursing programs have been rising, in some cases dramatically, but the number of qualified students being turned away -- 41,000 in 2005 -- has grown sixfold since 2002, the report notes. It is based on more than 40 interviews with medical and nursing deans, and teaching-hospital and academic-association executives; a survey of 240 hospital executives; and an analysis of publicly available data.
“Applicants are coming in droves, but nursing schools don’t have the capacity to take them in, and they don’t have enough clinical-training spots,” said Janet Hinchcliff, a director in PricewaterhouseCoopers’ Health Advisory Practice.
One reason is that nursing schools cannot hire enough faculty members to expand their programs since nurses can earn much more money by practicing than teaching. At the same time, overburdened hospitals don’t want to spend the time or money providing on-the-job training, Ms. Hinchcliff said.
Universities also have fewer financial incentives to expand their nursing programs. While medical schools are heavily subsidized by the federal government, nursing schools usually are not. “Nursing-education programs often lose money for colleges, limiting colleges’ willingness to expand their programs and raise faculty salaries,” the report notes.
When nurses are in short supply, doctors report feeling overworked and frustrated, so recruitment and retention of both professions are intertwined, the health-care analysts who worked on the report said.
During his farewell speech in 2005, at the end of his term as president of the Association of American Medical Colleges, Jordan J. Cohen called on medical schools to increase their enrollments 30 percent by 2015 to avert a physician shortfall (The Chronicle, November 7, 2005).
Existing medical schools have begun doing that, and new schools are on the drawing boards across the country. After a 20-year drought in which no new medical schools were accredited in the United States, one was at Florida State University in 2002. Today, according to the report, there are at least 14 new allopathic medical campuses in some stage of development (The Chronicle, January 12, 2007).
The report cautions, however, that by the time those schools are finished, accredited, and starting to graduate new physicians, “it may be too little too late.”
While the nursing and physician professions face different challenges in meeting their staffing needs, the roles of practitioners in both areas “are starting to converge,” particularly those of primary-care doctors and advanced-practice nurses, the report states.
The report also raises concerns about the growing number of foreign medical students, many of whom will return to their home countries to practice. In 2005, about 26 percent of the new physicians entering residency training were graduates of international medical schools.
“To be an accredited medical school here in the U.S., there’s a pretty high bar,” says William M. Dracos, another health-care consultant at PricewaterhouseCoopers. “It’s variable across the world, so there’s a potential inconsistency in quality.”
When foreign medical students return to their home countries to practice, the United States loses doctors needed in this country, he says. But when they stay here, they may also be contributing to a brain drain from countries that desperately need medical attention.
Among the other topics the report examines are the high turnover and job dissatisfaction among new nurses, the maldistribution of physicians (Massachusetts has twice as many physicians per capita as Mississippi, for instance), and the continued slide in the number of physicians going into primary care. Over the past decade, the number of American medical graduates entering family medicine or general internal medicine has dropped by 50 percent.
Many medical graduates are turning to higher-paying specialties -- a trend that’s hardly surprising, given rising debt levels for new doctors. The average debt for 2006 medical graduates, including the amount they borrowed for undergraduate studies, has grown to $130,000.
Background articles from The Chronicle:
