Doctor shortage
Encyclopedia
Physician supply refers to the number of trained physician
s working in a health care system
or active in the labour market. The supply depends primarily on the number of graduates of medical school
s in a country or jurisdiction, but also on the number who continue to practice medicine
as a career
path and who remain in their country of origin. The number of physicians needed in a given context depends on several different factors, including the demographics
and epidemiology
of the local population, the numbers and types of other health care practitioners working in the system, as well as the policies and goals in place of the health care system. If more physicians are trained than needed, then supply exceeds demand; if too few physicians are trained and retained, then some people may have difficulty accessing health care
services. A physician shortage is a situation in which there are not enough physicians to treat all patient
s in need of medical care. This can be observed at the level of a given health care facility
, a province/state, a country, or worldwide.
Globally, the World Health Organization
(WHO) estimates a shortage of 4.3 million physicians, nurses and other health workers
worldwide, especially in many developing countries. Developing nations often have physician shortages due to limited numbers and capacity of medical schools and because of international migration: physicians can usually earn much more money and enjoy better working conditions in other countries. Many developed countries also report doctor shortages, especially in rural and other underserved areas. For example, shortages are being discussed in the U.S., Canada, the U.K., Australia, New Zealand, and Germany.
balance. If the number of physicians is decreased, or the demand for their services increases, then an under-supply or shortage can result. If the number of physicians increases, or demand for their services decreases, then an over-supply can result.
s is one way to address physician shortage, or increasing the number of schools, but other factors may also play a role.
Becoming a physician requires several years of training beyond undergraduate education
. Consequently, physician supply is affected by the number of students eligible for medical training. Students that do not finish earlier levels of education, including high school dropouts and those that leave university without an undergraduate degree
or associates degree, do not qualify for entrance to medical school
. The more people that fail to complete the prerequisites, the fewer people that are eligible for training as physicians.
In most countries, the number of placements for students in medical schools and clinical internships is limited, typically according to the number of teachers and other resources, including the amount of funding provided by governments. In many countries that do not charge tuition payments to prospective physicians, public funding is the only significant limitation on the number of physicians trained. In the United States, the American Medical Association
says that federal funding is the most important limitation in the supply of physicians. The high cost of tuition combined with the cost of supporting oneself during medical school discourages some people from enrolling to become a physician. Limited scholarship
s and financial aid to medical students may exacerbate this problem, while low expected pay for practicing physicians in some countries may convince some that the cost is not appropriate.
It has been speculated that politics and social conditions can sometimes motivate medical student placements. For example, racial quotas have been cited in some places as preventing some people from enrolling in medical school. Racial discrimination and gender discrimination, either overt or disguised, have also been cited as resulting in people being denied the opportunity to train as a physician on the basis of their race or gender.
in local health care facilities), the demographics and epidemiology of the population being served, the nature of the health policies in place for health care delivery and financing in a jurisdiction, and also the international job market (e.g. increasing demand in other countries puts pressure on local competition).
For example, population ageing
has been attributed with increased demand for physician services in many countries, as more previously young and healthy people become older with increased likelihood of a variety of chronic medical conditions associated with ageing, such as type 2 diabetes mellitus, hypertension
, osteoporosis
, and some types of cancer
s and neurodegenerative diseases.
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s working in a health care system
Health care system
A health care system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations....
or active in the labour market. The supply depends primarily on the number of graduates of medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
s in a country or jurisdiction, but also on the number who continue to practice medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
as a career
Career
Career is defined by the Oxford English Dictionary as a person's "course or progress through life ". It is usually considered to pertain to remunerative work ....
path and who remain in their country of origin. The number of physicians needed in a given context depends on several different factors, including the demographics
Demographics
Demographics are the most recent statistical characteristics of a population. These types of data are used widely in sociology , public policy, and marketing. Commonly examined demographics include gender, race, age, disabilities, mobility, home ownership, employment status, and even location...
and epidemiology
Epidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
of the local population, the numbers and types of other health care practitioners working in the system, as well as the policies and goals in place of the health care system. If more physicians are trained than needed, then supply exceeds demand; if too few physicians are trained and retained, then some people may have difficulty accessing health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
services. A physician shortage is a situation in which there are not enough physicians to treat all patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
s in need of medical care. This can be observed at the level of a given health care facility
Health care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
, a province/state, a country, or worldwide.
Globally, the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO) estimates a shortage of 4.3 million physicians, nurses and other health workers
Health Human Resources
Health human resources — also known as “human resources for health” or “health workforce” — is defined as “all people engaged in actions whose primary intent is to enhance health”, according to the World Health Organization's World Health Report 2006. Human resources for health are identified as...
worldwide, especially in many developing countries. Developing nations often have physician shortages due to limited numbers and capacity of medical schools and because of international migration: physicians can usually earn much more money and enjoy better working conditions in other countries. Many developed countries also report doctor shortages, especially in rural and other underserved areas. For example, shortages are being discussed in the U.S., Canada, the U.K., Australia, New Zealand, and Germany.
Determinants
Anything that changes the number of available physicians or the demand for their services affects the supply and demandSupply and demand
Supply and demand is an economic model of price determination in a market. It concludes that in a competitive market, the unit price for a particular good will vary until it settles at a point where the quantity demanded by consumers will equal the quantity supplied by producers , resulting in an...
balance. If the number of physicians is decreased, or the demand for their services increases, then an under-supply or shortage can result. If the number of physicians increases, or demand for their services decreases, then an over-supply can result.
Number of physicians trained
Increasing the number of students enrolled in existing medical schoolMedical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
s is one way to address physician shortage, or increasing the number of schools, but other factors may also play a role.
Becoming a physician requires several years of training beyond undergraduate education
Undergraduate education
Undergraduate education is an education level taken prior to gaining a first degree . Hence, in many subjects in many educational systems, undergraduate education is post-secondary education up to the level of a bachelor's degree, such as in the United States, where a university entry level is...
. Consequently, physician supply is affected by the number of students eligible for medical training. Students that do not finish earlier levels of education, including high school dropouts and those that leave university without an undergraduate degree
Undergraduate degree
An undergraduate degree is a colloquial term for an academic degree taken by a person who has completed undergraduate courses. It is usually offered at an institution of higher education, such as a university...
or associates degree, do not qualify for entrance to medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
. The more people that fail to complete the prerequisites, the fewer people that are eligible for training as physicians.
In most countries, the number of placements for students in medical schools and clinical internships is limited, typically according to the number of teachers and other resources, including the amount of funding provided by governments. In many countries that do not charge tuition payments to prospective physicians, public funding is the only significant limitation on the number of physicians trained. In the United States, the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
says that federal funding is the most important limitation in the supply of physicians. The high cost of tuition combined with the cost of supporting oneself during medical school discourages some people from enrolling to become a physician. Limited scholarship
Scholarship
A scholarship is an award of financial aid for a student to further education. Scholarships are awarded on various criteria usually reflecting the values and purposes of the donor or founder of the award.-Types:...
s and financial aid to medical students may exacerbate this problem, while low expected pay for practicing physicians in some countries may convince some that the cost is not appropriate.
It has been speculated that politics and social conditions can sometimes motivate medical student placements. For example, racial quotas have been cited in some places as preventing some people from enrolling in medical school. Racial discrimination and gender discrimination, either overt or disguised, have also been cited as resulting in people being denied the opportunity to train as a physician on the basis of their race or gender.
Number of physicians working
Once trained, the current supply of physicians can be affected by the number of those who continue to practice this profession. The number of working physicians can be affected by:- The number of medical school graduates who choose to practice as a physician for their careerCareerCareer is defined by the Oxford English Dictionary as a person's "course or progress through life ". It is usually considered to pertain to remunerative work ....
- for example, some might choose instead to work in medical research, public policyPublic policyPublic policy as government action is generally the principled guide to action taken by the administrative or executive branches of the state with regard to a class of issues in a manner consistent with law and institutional customs. In general, the foundation is the pertinent national and...
or other areas where medical expertise is required; or they may choose a job where no medical knowledge is required. - The number of medical school graduates who fail to obtain (or fail to re-qualify for) their license or other professional requirementsHealthcare provider requisitesHealthcare provider requisites refer to the regulations used by countries to control the quality of individual healthcare workers practicing in their jurisdictions and to control the size of the health labour market...
for legal practice. - The number of medical school graduates who are unable to find work of their choice - for example, studies in Mexico have found high levels of unemployment among trained physicians in urban areas, even while large rural populations remain medically underserved.
- The number of physicians who emigrate abroad for better economic and social conditions, also referred to as "Brain drainBrain drainHuman capital flight, more commonly referred to as "brain drain", is the large-scale emigration of a large group of individuals with technical skills or knowledge. The reasons usually include two aspects which respectively come from countries and individuals...
". - Changes in the specialty balance - for example, in many countries, the balance is shifting away from medical students becoming general practitioners (GP) because of more attractive pay for medical specialists, leading to shortages of physicians for primary carePrimary carePrimary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
. - Changes in the practice environment - for example, changing legal conditions have been cited in the US, Canada and elsewhere as inciting physician attrition, notably the adoption of laws that require doctors to refer for certain procedures (such as abortion or sex change) with which the doctors disagreed on moral or religious grounds.
- The number of physicians who retire.
- The number of physicians who work part-time - in particular, while the number working only part-time does not affect the overall number of physicians, it does affect the supply of physician services (e.g. in terms of full-time equivalentFull-time equivalentFull-time equivalent , is a unit to measure employed persons or students in a way that makes them comparable although they may work or study a different number of hours per week. FTE is often used to measure a worker's involvement in a project, or to track cost reductions in an organization...
s). Many physicians may retain their professional license while working part time or after retiring; consequently, the reported number of active physicians is probably overstated in many jurisdictions.
Demand for physician services
The demand for physician services is influenced by the local job market (e.g. the number of job openingsJob (role)
A job is a regular activity performed in exchange for payment. A person usually begins a job by becoming an employee, volunteering, or starting a business. The duration of a job may range from an hour to a lifetime . If a person is trained for a certain type of job, they may have a profession...
in local health care facilities), the demographics and epidemiology of the population being served, the nature of the health policies in place for health care delivery and financing in a jurisdiction, and also the international job market (e.g. increasing demand in other countries puts pressure on local competition).
For example, population ageing
Population ageing
Population ageing or population aging occurs when the median age of a country or region rises. This happens because of rising life expectancy or declining birth rates. Excepting 18 countries termed 'demographic outliers' by the UN) this process is taking place in every country and region across...
has been attributed with increased demand for physician services in many countries, as more previously young and healthy people become older with increased likelihood of a variety of chronic medical conditions associated with ageing, such as type 2 diabetes mellitus, hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, osteoporosis
Osteoporosis
Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...
, and some types of cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
s and neurodegenerative diseases.
Effects of physician shortage
Physician shortages have been linked to a number of effects, including:- Lower quantity of medical care for patientPatientA patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
s, thereby limiting the ability of health systems to meet primary health carePrimary health carePrimary health care, often abbreviated as “PHC”, has been defined as "essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost...
goals, such as the Millennium Development GoalsMillennium Development GoalsThe Millennium Development Goals are eight international development goals that all 193 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015...
. - Lower quality of medical care for patients, due to shorter doctor visits.
- Increased workload and too many patients per doctor resulting in overworked and sleep-deprived doctors, thereby compromising patient safetyPatient safetyPatient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported...
. - Unnecessary patient deaths while waiting for health care.
- Higher prices for practicing physicians due to less competition, by the rules of supply and demandSupply and demandSupply and demand is an economic model of price determination in a market. It concludes that in a competitive market, the unit price for a particular good will vary until it settles at a point where the quantity demanded by consumers will equal the quantity supplied by producers , resulting in an...
in market-driven health care economiesHealth economicsHealth economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and health care...
.
Proposed solutions
A number of solutions, including short-term fixes and long-term solutions, have been proposed to address physician shortages. Some have been tested and applied in national health workforce policies and plans, while others remain subject to ongoing debate.- Increase the number of medical graduates through increased recruitment of minority students domestically, as well as intensified recruitment of foreign-trained graduates (also known as International Medical GraduatesInternational medical graduateAn International Medical Graduate or "IMGs", earlier known as a Foreign Medical Graduate or "FMGs", is a term used to describe a physician who has graduated from a medical school outside of the country in which he or she intends to practice...
or IMGs). - Increase the number of students eligible for medical school through lower high school and college dropout rates.
- Increase the number of medical schools.
- Bigger medical school classroom sizes.
- Higher medical school enrollment limits.
- Loosen the requirements for entry to medical school, such as eliminating the need for a pre-med bachelor degree as required in some juridisctions, thereby making the education path more attractive for potential students.
- Reduce the costs for students to attend medical school, such as through subsidies for (free or reduced) school tuition and more financial aid.
- Increase the number of placements in medical residency following medical school graduation.
- Improve the political, social and economic conditions in developing countries to prevent brain drain, including fewer wars and conflicts.
- Make better use of other categories of health care professionals, including more Osteopathic Physicians (DOs), nurse practitionerNurse practitionerA Nurse Practitioner is an Advanced practice registered nurse who has completed graduate-level education . Additional APRN roles include the Certified Registered Nurse Anesthetist s, CNMs, and CNSs...
s, physician assistantPhysician assistantA physician assistant/associate ' is a healthcare professional trained and licensed to practice medicine with limited supervision by a physician.-General description:...
s, clinical officerClinical officerClinical officers are health care providers who practice modern medicine. They practice independently but may be supervised by a physician in some settings....
s, community health workerCommunity health workerCommunity health workers are members of a community who are chosen by community members or organizations to provide basic health and medical care to their community...
s, and others. - Improve physician wages, such as through privatization of health care systems thereby enhancing market attractiveness for people to become doctors.
- Improve physicians' perspectives of their future career path, such as though reduced use of temporary employment contractEmployment contractA contract of employment is a category of contract used in labour law to attribute right and responsibilities between parties to a bargain.On the one end stands an "employee" who is "employed" by an "employer". It has arisen out of the old master-servant law, used before the 20th century...
s - Provide better incentives for physicians to practice in rural and medically underserved areas - for example, in the U.S., this could include expanding the National Health Service CorpsNational Health Service CorpsThe National Health Service Corps is part of the United States Department of Health and Human Services, division of Health Resources and Services Administration, Bureau of Clinician Recruitment and Service....
for rural areas. - Ensure better practice conditions for physicians - for example, medical liability reforms have been cited as an important factor in the U.S.