Where have all the doctors gone? | members only

“How can I find a doctor who can help me?” As a physician, I get this question from friends and family all the time. And for most of my professional life, I was able to refer them to a

medical colleague; a simple phone call was all it took to get someone an appointment within a reasonable amount of time. But no longer. The average wait for new patients to see a physician

is 26 days, and that’s for mostly healthy people. In a medical emergency, the situation can become even more frightening: Twenty-two percent of acutely ill patients 65 or older who sought

medical attention had to wait six days or more for an appointment, according to a 2021 survey by the Commonwealth Fund. This is a crisis. And it’s a crisis that’s getting worse, rapidly.

“The backbone of our health care system, private practice, is on the brink of collapse,” warns Clarel Antoine, M.D., professor of obstetrics and gynecology at New York City’s NYU Grossman

School of Medicine. “As a result, the nearly 70 million Americans on Medicare, many with chronic conditions, can expect longer waiting times for medical care.” Due to an astonishing

combination of professional missteps, failed policies and an aging population, America is facing an unprecedented shortage of physicians — one that is putting each of us at increased risk.

Here’s what older Americans need to know about protecting themselves and their loved ones — and how you can ensure you get the care you need. A HEALTH CARE CRISIS Alli Phillips, 49, of

Denver, developed swollen joints in her hands in April 2023, but when she called her physician’s office, she was told the first available appointment wasn’t until June. When the appointment

finally came around, the doctor told Phillips that she suspected rheumatoid arthritis and referred her to a specialist. But the specialist had no appointments available until November. In

the meantime, Phillips’ knees began to swell, and she struggled to walk down steps and turn doorknobs. When her appointment finally came, her visit with the rheumatologist lasted only about

15 minutes. She left with a prescription for prednisone, which made only mild improvements to her symptoms. After two more 15-minute visits to the rheumatologist, Phillips finally hired a

concierge doctor for $3,500 per year — a fee not covered by insurance. The concierge doctor took time to discuss multiple treatment options and long-term care, and prescribed methotrexate, a

chemotherapy and immunosuppressant drug, to get her condition under control. Phillips was lucky, her new doctor told her: The delay in treatment could have caused further joint damage, and

she was fortunate to be able to afford the out-of-pocket expense. But, as Phillips says today, “How do people without resources to get around the system find the care they need?” Even being

an established, well-connected doctor doesn’t always help. One colleague of mine, working at a major medical center in the South, recently decided to move with his family to the Northeast.

But as the process was underway, his wife was diagnosed with cancer. Even though she’d already received a diagnosis, and even though they were using the same insurance company, the insurer

refused to cover her oncology treatment until she got a referral from a new primary care physician. Despite being a prominent doctor himself, my colleague could not find a single physician

willing to take his wife on as a new patient. The family was forced to go back to their previous state so his wife could receive care. Fortunately, she is doing well, but my colleague asks,

“How do people do this without the connections we have?” Too often, the answer is, they don’t. Although there were some 835,000 practicing doctors in America in 2023, according to the U.S.

Bureau of Labor Statistics, we are currently experiencing a shortage because demand exceeds supply. “My 82-year-old father almost died because it took us months to find him a doctor,” says

Michelle*, 54, of New York City. One night in August 2023, Michelle’s father, Marvin, a retired engineer, called her. He was slurring his speech and had developed a facial droop — both

classic signs of a stroke. She immediately sent him to a hospital. “The doctors told him that he needed an MRI, but there was one problem — his pacemaker needed to be switched to an MRI-safe

mode,” Michelle says. “I called every hospital and doctor I could — neurologists, cardiologists, even primary care doctors — but no one was available to get that done and the MRI

completed.” Over the next several months, Marvin experienced two more episodes. When he finally went back to the ER that November, he’d developed sepsis — from an infection in his heart —

and tests revealed he’d suffered two more strokes. “Finally, he had open-heart surgery,” Michelle says. “But it left us so angry and frustrated that he had to nearly die to get the care he

needed.” To understand why doctors are in such short supply, it helps to think of the medical field as a bathtub. To keep the tub full, the faucet needs to be adding water at least as fast

as the drain empties it. But that’s not what’s happening. The current shortage of physicians, combined with a number of other factors, has placed such an intense strain on doctors that many

in the medical field are choosing to switch professions or simply retire early. And despite efforts by the Association of American Medical Colleges (AAMC) to graduate more doctors, those

efforts to fill the tub simply can’t keep up with the drain. WHY DON’T WE HAVE ENOUGH DOCTORS? In 1980, a U.S. government report concluded that American teaching hospitals were graduating

too many medical students. It predicted a surplus of 70,000 physicians by 1990, an alarming statistic. In response, medical schools established what became a 25-year moratorium on increasing

class size, enforced by the AAMC and the American Medical Association (AMA). Yet there was a significant flaw to that initial report: It failed to account for the nation’s rising

population, which is now 110 million more than it was 45 years ago. By 2005, as the population grew and the potential for a severe physician shortage emerged, the AAMC and AMA reversed their

recommendation, and in the past 20 years, more and more young people have trained to be doctors. Yet despite the more than 97,900 students in medical school, 38,000 in osteopathic school,

and 162,000 doctors currently in residencies and fellowships, the AAMC predicts a shortage of up to 86,000 physicians by 2036. By then, it projects that the U.S. population will have risen

8.4 percent since 2021. The population of those over 65 will increase by 34 percent, while the number of people 75 and older will increase by 55 percent. “Medical education is a long

journey, and even though medical school enrollment has risen, we need more residency positions [where med school graduates get hands-on training], which requires increased government

support,” says David Skorton, M.D., president of the AAMC.