The vicious circle of doctor shortages and burnout

Anecdotes about long wait times and the extremely difficult process of making an appointment with a doctor — if you can find one available — have become a normal part of health care for many Americans in the United States. Figures from the Health Resources and Services Administration suggest that the U.S. already has a shortage of medical staff, while an Association of American Medical Colleges report says the deficit will worsen — with a projected shortfall of as many as 124,000 doctors by 2034, including junior Deficits in health care and specialist care.
Now, experts say physician burnout and stress — already well-known health care problems — have been exacerbated by the COVID-19 pandemic, adding another layer to the doctor shortage woes.

Dr. Jack Resneck Jr., president of the American Medical Association, told Yahoo News that there’s an intense relationship between the two — burnout fuels bottlenecks, and bottlenecks fuel burnout.

“Because people burn out, many may consider working less, which will certainly exacerbate the labor shortage. When fewer doctors end up working and seeing patients becomes more difficult, those who are still working will face challenges in caring for all the patients. A heavier clinical burden, which makes them more exhausted,” Resneck said. “So if we don’t take steps upfront to address the burnt-out driver problem and make sure we have enough new doctors on the front end as well, then you really can get into an unfortunate vicious cycle.”
In the U.S., more than two-fifths of practicing physicians will be 65 or older within the next decade, so many may retire as a result

But for some, stress and burnout may also play a unique role in these decisions. A survey published last year on pandemic-related stress and work intentions found that about 1 in 3 physicians plan to reduce work hours, and 1 in 5 physicians intend to leave their practice altogether.

A recent survey by the Commonwealth Fund, which looked at the effects of the pandemic on primary care physicians in 10 high-income countries, found that half of younger physicians in the U.S. (which the survey defines as physicians under 55 years old) said they are “definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion.” Meanwhile, nearly half of older physicians (those over 55 years old) in the U.S. and in most other countries in the survey said they intend to stop seeing patients within the next three years — “meaning that the majority of primary care physicians in many high-income countries may soon be younger professionals grappling with burnout and stress,” the report said.

“Younger physicians are at an earlier stage of their careers; they’re working longer hours; they may have more responsibilities outside of their work, including raising young families,” Munira Gunja, a senior researcher with the Commonwealth Fund and one of the authors of the survey, told Yahoo News. “We found that most of the younger primary care physicians are female, and we know that females have been disproportionately affected by the pandemic in terms of stress and burnout, whether it’s in or outside of the workplace.”

While burnout takes a toll on the physicians themselves, it can affect their patients as well. In the Commonwealth Fund survey, primary care physicians who said they experienced stress, emotional distress or burnout were more likely to report that the quality of care they provided had worsened “somewhat” or “a lot” compared to before the COVID-19 pandemic.

What’s causing a shortage of physicians?
Michael Dill, the Association of American Medical Colleges director of workforce studies, told Yahoo News that he believes a growing physician shortage is contributing to more burnout, but burnout doesn’t appear to be deterring more people from joining the profession.

“The number of applicants to medical schools is not going down, so it doesn’t seem like there’s any sort of feedback that’s driving people to say, ‘Oh, maybe that’s not what I want to do,’” Dill said. “Clearly there’s still a calling to become a physician, and that’s not going down despite the levels of burnout — which is good, since we need to train more.”

The problem, Dill said, is supply and demand; the baby-boomer generation is aging and the population is growing, but the influx of new physicians, while steady, isn’t increasing at the rate it needs to.

A major obstacle to training more physicians that Dill and Resneck both point to is a 1997 cap on the number of Medicare-funded residency programs in the U.S., which has created a bottleneck of qualified medical students with not enough training positions. The shortage of residency spots has been decried by many in the medical community for years; when Yahoo News reported on this in 2020, 40,084 applicants submitted program choices (or ranking lists) via the National Resident Matching Program for 37,256 residency positions, leaving many graduates unmatched to a program. Without a residency, medical school graduates cannot go on to become a physician.

“We haven’t expanded our training capacity to produce the number of physicians we need to meet the demands of an aging, growing population — and that at a time when not only is the population aging, but the physician workforce itself is aging,” Dill said.

Some have argued that the U.S. doesn’t have a physician shortage — it has a distribution problem, with not enough physicians choosing to work in primary care, not enough physicians working in rural or impoverished areas, and too much of doctors’ time being spent on administrative tasks instead of seeing patients. Difficulty in accessing doctors, some say, is creating the perception of a physician shortage.

Resneck and Dill said it’s true that the U.S. needs more primary care physicians. It’s not uncommon for medical students to come out of school with over $200,000 in debt, so many gravitate toward specialities that are more lucrative, leaving gaps in crucial primary care fields.

But Resneck also said that there are holes in other specialities, too, and that geographically there are no areas that have been spared from shortages.

“I’m not really seeing any specialties where we have too many doctors, so I don’t think the distribution thing is really an issue anymore,” Resneck said.


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