How best to respond to a predicted doctor shortage?

Another study predicting a future shortage of doctors in the U.S. is adding to the debate about the best way to respond.

While some argue that the answer lies primarily in training more doctors, others say there also needs to be an emphasis on giving other providers - such as nurse practitioners and physician assistants - the freedom to practice primary care on their own.

The Association of American Medical Colleges says the country faces a shortage of 46,000 to 90,000 doctors in the coming years.
 
"The doctor shortage is real, it's significant and it's particularly serious for the kind of medical care that our aging population is going to need," said Darrell Kirch, the Association's president.
 
Within the next ten years the U.S. will be down between 12,000 and 31,000 primary care physicians and about 28,000 to 63,000 specialty doctors, especially surgeons, the association predicts.

The study blames the oncoming shortage on a growing aging population, as well as expanded insurance coverage through the Affordable Care Act.
 
The association argues that the solution lies in a multi-pronged approach that could include different delivery and pay models but that mainly focuses on training more doctors, said Janis Orlowski, the organization's chief healthcare officer.
 
She said the association believes Congress should fund an increase to medical graduate education that would support an additional 3,000 residents annually, she said. Currently 27,000 to 29,000 physicians are being trained each year in the United States. It takes about $152,000 a year to train a physician; Congress pays for about $40,000 of it, according to Kirch.
 
"We feel strongly this is a public policy issue that puts the national health at risk; the onus is on Congress," Kirch said.
 
But that shouldn’t be the only strategy, say some health economists and other experts. They say the industry also needs to put more energy into giving nurse practitioners and physician assistants the autonomy to practice without a physician’s supervision.
 
This debate is playing out in Sacramento. In 2013, Gov. Jerry Brown signed a bill allowing pharmacists to expand patient care services as part of a team with doctors and other health care providers. The bill was authored by State Sen. Ed Hernandez (D-West Covina).
 
Last week Hernandez introduced a bill that would allow nurse practitioners to provide services independently from a doctor. Currently in California, they must work under a doctor’s supervision.
 
Hernandez, who is a physician, agrees that any doctor shortage needs to be addressed in a variety of ways.  
 
"Yes we should build more med schools, yes we need to make sure more individuals go into primary care, yes we should fund more primary care residencies, yes we need to make sure pharmacists can be part of the medical team, yes, nurse practitioners should have independent practices and be part of the team," Hernandez said.

Story updated on March 4, 2015 to reflect new figures provided by the Association of American Medical Colleges on the cost of training physicians.