Three years later, I realized Meredith Grey could never exist in the real world. That’s because I had my first clinical rotation in a large public hospital in Mexico City.
In real life, doctors and other health professionals are often overworked and underpaid. They are expected to achieve the impossible every day and go through the most stringent bureaucracy to do it. You have to wonder, is it possible that fewer and fewer people are willing to go through all of this to achieve their dreams?
Throughout this article, I’ll try to shed light on the severity of physician shortages worldwide, give my opinion on the factors that have influenced this growing issue, and provide some suggestions on how to address them.
Is There a Shortage of Physicians?
The short answer is yes. A 2019 document released by the Association of American Medical Colleges revealed that they predicted a 38 – 125 thousand shortage of physicians by 2034 in the USA alone. Statista gives similar numbers for 2032 (46 – 122 thousand). These statements do not even consider that 83.7 million people in the USA live in designated primary-care health professional shortage areas, meaning that they live in places where there are even fewer doctors than average.
As staggering as these numbers are, the scenario only worsens when we consider developing countries. A 2022 Lancet study found that in order to meet the required target percentage of universal healthcare effective coverage worldwide for 2021, at least about 21 physicians per 10 thousand population would need to be active, along with 70.6 nurses and midwives. I’ll do the math for you before you reach for your smartphone; best case scenario, we needed at least 16 million doctors and 55 million nurses and midwives worldwide. We fell short by about 6.4 million doctors and 30.6 million nurses and midwives.
Recent Years Have Worsened Physician Shortages
You’ll notice that these numbers are pretty recent. That’s because the COVID-19 pandemic highlighted how disastrous the situation was, spawning a call to action by international sanitary commissions to provide a more exact physician shortage diagnosis. Talk to anyone involved in health care during these years. They will all have stories involving doctors working 72 hours straight, retired specialists taking crash courses on ventilatory management along with medical students, residents working while being knowingly infected, etc.
In case you were wondering, a recent Stanford study calculated that 622 additional doctors died during the COVID-19 pandemic in the US compared to non-pandemic years.
Why Are Doctors Leaving Their Profession?
This question has sparked debates among people much more intelligent and prepared than I am, and it still doesn’t have just one clear answer. However, I’ll do my best to present the most prevalent theories that have been given, combined with some of my own opinions on the subject:
#1 A population that is increasing in numbers and age
Our population size has been increasing steadily since the industrial revolution. This means that every year, the need for doctors increases substantially; however, governments are not entirely blind to this need. In 2021, the United States introduced the Resident Physician Shortage Reduction Act, which allowed up to 200 additional residency positions each year. This came after an already healthy increase of 19.8% in the number of physicians from 2010 to 2020. The US population grew from 308.7 million to 331.5 million people in that same period, and you need to consider that almost 250 thousand physicians are retired, semi-retired, or don’t actively participate in patient care.
Now let’s consider that the global median age has increased almost 10 years since the 70’s. Although this increase is at least partially due to advances in medicine, older patients lead to chronic diseases, chronic diseases lead to more expensive healthcare, and more expensive healthcare leads to a diminished capacity for additional physician recruitment.
#2 The culture of self-care has reached doctors
Let’s face it, we are growing increasingly conscious of how rewarding it is to work to live instead of living to work. Physicians are now choosing to work less and retire earlier, but before you decide to perform public executions at your nearest hospital, consider that doctors and nurses still have to work 24+ hour shifts regularly, and what we used to go through is plain nuts. The USA, as well as most developed countries, have created laws to restrain the amount of time physicians have to be in the hospital.
However, I can tell you from personal experience that there is still ongoing abuse towards all health professionals in developing countries. It’s extremely common to hear about physicians and nurses working 48 or 72-hour shifts, with little to no equipment, under constant bullying by senior personnel, and understaffing as a rule.
This is one of the most important reasons for the increasing shortage of physicians, in my opinion. You have to realize that studying medicine is already a significant challenge; people assume that their social lives will be significantly affected, they will work much harder than they would in regular jobs, start earning money at a late age, and study their whole lives.
But the fact that they have to be mentally and physically abused every day and live a constant disappointment on what they hoped hospital life would be is becoming increasingly apparent every day. People are starting to wonder if it’s worth it.
#3 Unwillingness to work in general practice and rural environments
This is another pressing issue. Doctors go through much effort to achieve their dreams, so obviously, they want what is best for their careers. Specialization and sub-specialization are always attractive options due to the financial and reputational benefits that come with it. Becoming a general practitioner is seen as less glamorous, almost as if they were settling into their careers instead of going the distance. This is seen much more dramatically in rural scenarios, where the promise of academic renown and enrichment is much less than in urban environments.
The problem is that having an imbalance in general practitioners and specialists is terrible either way you look at it; if you don’t have specialists, you can’t have access to advanced treatment for rare diseases; if you don’t have enough general practitioners, then the costs of healthcare skyrocket, people are forced to wait long hours to get care, and most importantly…there is something else that no one seems to consider: General practitioners are a lot better at providing primary and preventive care than specialists, they are more likely to remind patients about things like cancer screening and the dangers of smoking and drinking.
#4 Underpayment
Many will read this and immediately think, “Ooooh no, no, no, I know that doctors make a killing.” This is indeed a tricky subject; if you think about an interventional cardiologist living in Beverly Hills, you will probably believe that medicine is a very lucrative activity. Think about a resident in a developing country, though, working 80-90 hours in a public hospital and being paid meager wages.
For example, in Mexico, medical residents are paid an average of 684 dollars a month, less than 9 thousand dollars a year. The trend is similar in other developing countries; Colombian residents make 549 dollars a month, 19 thousand a year in Thailand, 32 thousand a year in India, and so on. Remember, being a medical resident is one of the most demanding professions in the world, and it requires a very high level of education.
How to Solve the Doctor Shortage
Empower and pay general practitioners in rural areas
Call me crazy, but if we are trying to convince people to go work in areas where they will have to sacrifice fame and recognition, we should at least offer to pay them accordingly. Salaries for these physicians should more closely resemble those of specialists, even more if they are willing to work in areas that have little to no other doctors. But not only this, we should also pursue governments to educate people on the importance of going to their primary care physicians before referring to specialists.
Embrace telehealth
The COVID-19 pandemic was one of the worst periods for healthcare in recent history. We did, however, find one hidden gem called teleconferences. More and more physicians are giving patients medical consults using digital means, and even though this is not ideal due to the obvious restraints in physical examinations, it does provide the opportunity to follow-up on studies and medication adjustments. Having the ability to see doctors face to face through a compute can help people living far away from hospitals to have access to healthcare without needing to travel long distances. This has the potential to expose patients to higher standards of healthcare and increase therapeutic adherence.
Protect physicians
Especially in developing countries. Although we have come a long way by passing laws that limit the maximum amount of hours that doctors can work, we need to go further. No one should have to work in a place that doesn’t have sufficient protective equipment or where they are constantly bullied by superiors. People need a very strong motivation to become doctors, so let’s do our best to not shatter their dreams the second they see the inside of a hospital; also, how about a living wage?
Encourage multidisciplinary cooperation between teams of health professionals
There is little doubt that hospitals and clinics everywhere are understaffed, so we need to put all hands on deck. Unfortunately, physicians have a long history of being condescending towards other health professionals.
Doctors can’t do all the work by themselves, if we empower nurses and technicians to have more responsibilities with patients, as well as better education and stronger positions in healthcare teams, we might have a shot at a better use of human resources.
