Healthcare is a very important aspect for any nation, and often the health of the people is directly dependent on the number of physicians available. The number and the kind of physicians required depends on several factors of which many are unpredictable. The rapidly changing scenarios of the society in the twenty –first century and the duration of education required to become a physician really adds to the extent of the problem (Sheldon, George F. , 2004). There is an increasing necessity to increase the enrollments in the US medical schools because of several issues.
This has been a subject of debate in the US for many years. However, each of these issues needs to be looked into independently, so that we can really determine the extent of the problem and come up with an appropriate solution. Some people feel that there is excessive number of physicians in the US today, and the number of enrollments in the medical schools should immediately be cut down. However, many studies conducted by reliable organizations such as the Council on Graduate Medical Education (COGME) have said that there is going to be a serious shortage of physicians by the year 2020 (AAMC, 2005).
This study was conducted using comprehensive analysis and forecast of the population growth and any emerging problems in health. The COGME has roughly put the physician shortage at around 90,000 in 2020 (AAMC, 2005). Other groups have put this figure up to 50,000 in 2010, and 200,000 in 2020 (Sheldon, George F. , 2004). In several communities across the US at present a shortage of physicians already exits (Such as Utah, California, Georgia, etc) (AAMC, 2005). Even in certain specialties and super-specialties of medicine a deficiency is already apparent such as pediatric and adolescent psychiatry, cardiology and trauma-care physicians.
The issue of experiencing a physician shortage can be viewed from another angle. Let’s say there is going to be an excess of physicians tomorrow. In case of any medical crisis such as an epidemic, natural disaster, terrorist attack, war situation, etc, then the circumstances are going to be very disastrous. Studies have shown that by the year 2015, we could actually be feeling the effects of the shortage (AAMC, 2005). This may actually be the right time to start preparing to fill up this shortage. The population of US is not only increasing in size but is also living a longer life (Sheldon, George F.
, 2004). The life-expectancy of an individual in the US has increased from 45 (in 1900) to 78 (in 2000); the basic occupation has changed from farming to information technology (thus bringing about a drastic change in lifestyle) (Sheldon, George F. , 2004). In America, the total number of health workers is about 21740000, ensuring a density of 24. 8 per 1000 people (WHO, 2006). The number of the health service providers is 12460000, and which makes a total of 57% of the total healthcare workforce.
Meanwhile, the health management and support staff include 928000 workers, which make a total of 43% of the total workforce (WHO, 2006). People may be observing that several physicians in the US are unemployed or do not have many clients in their practices. However, this observation may be due to several other factors. Physicians tend to set up their practices in cities, leaving the people in rural areas unattended. They may want to set up their business in areas where the markets or business is more predictable. This decreases the chances of developing a healthy business.
Some physicians may also want to seek employment only in urban areas. Studies conducted by the WHO show that physicians may seek employment in cities in spite of rural areas critically short of them (WHO, 2006). This kind of a trend may also occur between nations (WHO, 2006). Many people may be leaving their native country and seek employment in a developed country, leaving a void, that may be difficult to fill up. They feel that with the development of information technology, there will be reduced unemployment amongst physicians as they will find it easier to get jobs.
The mal-distribution of physicians should not be considered as a surplus problem (AAMC, 2005). The US could face an even bigger crisis if a deficiency problem arises. Some people feel that with advances in medical care, there is actually no need of increasing the number of physicians. Several medical advancements such as vaccination, organ transplantation, efficient drugs, etc, have sorted out the previously unpredictable medical problems. Small pox was eradicated long before, and several other previously rampant diseases such as polio, cholera, plague, etc have been brought under control.
Before the World-war, duodenal ulcers and stomach cancer was very frequent (Sheldon, George F. , 2004). However, after the world war, the incidences of these disorders have been decreasing (Sheldon, George F. , 2004). However, we should not overlook the newer problems that are arising. Many new diseases are emerging. Diseases like HIV/AIDS and skin cancers, have reached pandemic proportions, and are really going out of control (WHO, 2005). Besides, people are undergoing a rapid change in their lifestyle (WHO, 2005).
Previously, the people in the US adopted a more rural lifestyle, which has been altered to a more urban one. Cities always pose significant health problems because people get exposed to several health risks such as overcrowding, poverty, poor sanitation, pollution, unhealthy lifestyles, eating unhealthy food, etc. People are getting densely populated in urban areas, and are also migrating from developing nations to the developed ones (WHO, 2005). All these problems could certainly increase the health problems and intensify the need to have more number of physicians in the future.
Another factor that needs to be considered is that physicians of the previous generations may not have much knowledge of newer diseases, as their training would be inclined at diagnosing and treating the older ones (Sheldon, George F. , 2004). Developed nations in the future could be facing several health problems including decreased fertility rates and having population with more number of senior citizens (WHO, 2006). This kind of a shift will increase the prevalence of chronic disorders (as these conditions are very frequent in the aged), thus increasing the demands for appropriate care (WHO, 2006).
Many planners feel that the concept of medical care would be changing in the future. Several healthcare packages such as Medicare, managed care and the NHS system of England have gained in popularity, and people would like to see such systems adapt to the changing needs of the population (Sheldon, George F. , 2004). Such healthcare programs would obviously require huge manpower inputs. In the mid-twentieth century, the healthcare industry in the US was put at around 12. 7 billion dollars (Sheldon, George F. , 2004).
Now it has reached about 4 trillion dollars (Sheldon, George F. , 2004). One of the most costly health industries in the world is the US health industry, and a shortage of physicians would really cripple its well-being. It was a common observation that people living in developed nations were not satisfied with the healthcare system prevailing in that country (Sheldon, George F. , 2004). This was because of several deficiencies such as scarcity of the logistics and unnecessary time delay in gaining access to the physicians or the specialists.
Besides, in the US, the dissatisfaction in patients was higher regarding costs and contact with the specialists (Sheldon, George F. , 2004). There has also been a shift in the expectations from the physicians. Previously the concept of general medical care from a single health organization (or physician) was expected. However, nowadays, specialization and super-specialization has become the keyword, and people are trying to visit specialist for each of their health problem (Sheldon, George F. , 2004).
Hence, there is a need not only to increase the number of specialists in each and every field, but to also increase the teaching staff in each of their fields, so that the healthcare workers can be trained efficiently. Some researchers feel that the sudden upsurge of managed care may decrease the need for physicians (Sheldon, George F. , 2004). Managed care is a cost-effective method of providing medical help, especially for elders who require comprehensive medical management. However, managed care may always not be successful. It mainly concentrates more on providing low-cost medical interventions.
It does not make use of advanced technology and this may not be acceptable. Another reason why there should be an increase in enrollments of the US medical schools is because there is a significant increase in the older population due to a general increase of the life-span. An increase in the number of physicians would mean more easily accessible services, and significant improvement in their health status. Besides, preventive strategies can be employed, and positive outcomes would result in further increase in their life-span and quality of life.
A point which should also be taken into consideration is that besides the general population, physicians are also becoming older. About a third of the number of physicians present in the US are above 50 years, and would be unable to practice in another ten years (AAMC, 2005). Hence, the shortage of physicians will be definitely felt by 2020. The newer generations may not like to work overtime to compensate for the sudden shortage of physicians (AAMC, 2005). Many physicians in the US are not honoring health insurance covers, because they feel that the excess patient situation may be a ground to earn more money.
Although it is legally wrong to dishonor an insurance cover, many hospitals are looking for loopholes in the present laws to make the patients pay for costly treatment procedures (Associated Press, 2006). The shortage of physicians can also be compensated by other means. These include increasing the number of medical schools, encouraging physicians to emigrate from other nations and promoting health tourism. Between the 1960’s and the 1980’s, about 40 new schools were being established in the US.
34 of them provided MD degrees, and about 2500 physicians were being produced in the year 1980 alone (Putnan, Constance E. , 2006). Today the US has more than 125 medical schools. In between the 1940’s and the 1960’s, the number of medical schools in the US had remained constant at 86 (Putnan, Constance E. , 2006). Between the 1920’s and the 1960’s, the number of schools in the US had more than doubled (Putnan, Constance E. , 2006). This occurred in spite of maintaining the physician-population ratio. Some of the schools were being replaced by others.
During the late 1950’s, there was an increasing need to have more physicians in the US, and hence necessity of having more schools developed (Putnan, Constance E. , 2006). Special concerns were being developed for the rural areas, in which the health problems were often thrown out of gear. In the 1970’s, studies demonstrated that the number of physicians were more than adequate (Putnan, Constance E. , 2006). In the year 1960, the number of students receiving their medical degree stood at about 8300, which was more than twice the figure of 1960 (Putnan, Constance E.
, 2006). Many undergraduate medical institutions in the US are searching for research priorities and better patient’s inflow. A lot of competition also exists between several such institutions. Hence, efforts are being enabled to make medical education more people friendly. Gorella, J. S. , a former dean of a Medical School in the US, feels that reforms in medical education should be based on solving problems that exist (Putnan, Constance E. , 2006). Looking at this trend, many people feel that it would be better to stop developing new medical schools.
However, several medical research organizations feel that it is very important to have new schools. They feel that areas of the country having a sudden growth of human activities, and which has not received any significant medical programs, should try developing new medical schools (AAMC, 2005). The state governments should realize the importance of setting up new schools in such areas, and may even have to take up the project by themselves (AAMC, 2005). Another alternative by which the shortage of physicians can be improved is by employing physicians from abroad.
Many people feel that such a measure may worsen the standards of medical care maintained in the country. However, if a few precautionary measures are being taken, such a problem could be minimized. Proper screening tests should be conducted to determine the proficiency of the physicians in their field. The US should also support human resource development programs in other countries (WHO, 2006). It should specifically encourage development and training of healthcare workers in the source countries. They could directly focus on expansion and increase in the number of human resources.
Nowadays, twining programs are becoming popular (WHO, 2006). In these programs, universities in the US could collaborate with institutions in other countries that have less knowledge of the medical field. This will create a healthy flow of medical professionals. Besides, better working conditions should be created for these healthcare workers (WHO, 2006). They should be treated like citizens. Nowadays emigrants are facing several problems in the US such as decreased payments, lower security, racial discrimination, isolation, unequal working conditions and decreased awareness of their rights (WHO, 2006).
Looking at the present state, a number of factors such as elderly population and their problems, emergence of new health issues, aging of the present physicians, rapid growth and development of the population, etc, there seem to be a rise in the utilization of the healthcare services (Sheldon, George F. , 2004). Present excess scenario of physicians may be due to an apparent mal-distribution problem. Several environmental changes, technological developments, lifestyle modifications, genetic changes, increased focus on specialization in the medical treatment, etc may further increase the utilization of the medical services (Sheldon, George F.
, 2004). It is important that development of such a shortage is identified early and is sorted out, well before hand, so that a medical crisis does not arise later. References: American Association of Medical Colleges. “Questions and Answers about AAMC’s New Physicians Workforce Position. ” AAMC. 2005. 7 Dec. 2006 http://www. aamc. org/members/orr/qaworkforce. pdf American Association of Medical Colleges. “Questions and Answers about AAMC’s New Physicians Workforce Position. ” AAMC. 2005. 7 Dec. 2006 http://www. aamc. org/workforce/workforceqa. pdf Putnan, Constance E.
“Reform and Innovation: A Repeating pattern During a Half Century of Medical Education in the USA. ” Medical Education 40 (2006): 227-234. Sheldon, George F. and Schroen, Anneke T. “Supply and demand—Surgical and health workforce. ” Surgical Clinics of North America 84. 6 (2004). The Associated Press. “Bias Alleged Against Hospital Over Civil Union Insurance Refusal. ” Human Rights Campaign (2006). http://www. hrc. org/Template. cfm? Section=Home&CONTENTID=30908&TEMPLATE=/ContentManagement/ContentDisplay. cfm World Health Organization. Working Together for Health: The World Health Report, 2006. Geneva: WHO Press, 2006.