AMA President Jesse M. Ehrenfeld, MD, MPH, addressed the National Press Club on October 25, 2023, discussing the pressing issue of the physician shortage in the U.S. He shed light on the impact of this crisis on doctors, patients, and the healthcare system, presenting a comprehensive five-step solution to tackle the problem.
Ehrenfeld began by emphasizing the under-addressed crisis of physician burnout, sharing personal anecdotes that illustrated the severity of the issue. He highlighted the tragic suicide of a friend and colleague, an ER physician, who struggled under the weight of the pandemic. Another example was a physician who left her position due to political pressures, reflecting a broader trend of doctors leaving communities due to legislative challenges.
The AMA President emphasized the current physician shortage, affecting over 83 million people in the U.S. who live in areas without sufficient access to primary care physicians. The shortage extends to specialized care, with examples such as the lack of OBGYNs in parts of Idaho and Mississippi. He stressed that the problem is already limiting access to care for millions and is poised to worsen.
Ehrenfeld provided alarming statistics regarding physician burnout during the pandemic, citing a survey indicating that two in three doctors experienced burnout, the highest level recorded by the AMA. He highlighted the intention of one in five physicians to leave medicine within the next two years, coupled with one in three planning to reduce their working hours. The demographic challenge was underscored, noting that nearly half of practicing physicians are over age 55, and it takes a decade or more to educate and train new physicians.
The AMA President outlined the reasons behind the physician shortage, as stated by physicians themselves. These include administrative burdens, attacks on science, government intrusion into healthcare decisions, healthcare consolidation, widening health disparities, and the challenges faced by foreign-trained physicians.
The financial aspect was a focal point, particularly the shrinking Medicare reimbursement rate for physicians. Adjusted for inflation, the payment rate has dropped by 26 percent since 2001, presenting a significant financial challenge for physicians. Ehrenfeld stressed the need for immediate attention from Congress to prevent further payment reductions.
The impact on patients was highlighted, with the closure of physician offices, reduction in hours, and limitations on new Medicare patients, all adversely affecting patient care. The consequences, especially for older adults, were emphasized, noting instances where patients had to wait longer for appointments or travel further for essential care due to physicians limiting their practices.
The AMA President presented a five-step solution to address the physician shortage:
- Financial Support:Advocated for the passage of the Strengthening Medicare for Patients and Providers Act, H.R. 2474, to provide physicians with annual payment updates to account for practice cost inflations.
- Reducing Administrative Burdens:Urged the adoption of the Improving Seniors’ Timely Access to Care Act to address the inefficient prior authorization process.
- Expanding Residency Training:Called for the passage of three bipartisan bills supporting residency training options, greater student loan support, and smoother pathways for foreign-trained physicians.
- Criminalizing Health Care:Opposed efforts to criminalize health care, citing the negative impact of recent decisions affecting abortion and gender-affirming care.
- Mental Health Support:Advocated for legislative fixes to address burnout, along with urging states and physician employers to audit licensing and credentialing applications to remove stigmatizing questions about mental health.
Ehrenfeld emphasized the urgency of these solutions, citing bipartisan support in Congress and growing momentum in states for additional safeguards. He stressed the need for immediate action, asserting that delaying action would only exacerbate the size of the public health crisis.
The AMA President called for leaders in Congress to step forward and address the urgent problem of the physician shortage, emphasizing that both major political parties have common ground on these issues. He reiterated that the public health crisis is growing daily, necessitating swift action to create a more resilient physician workforce and ensure that everyone in America has access to necessary healthcare.