What’s Behind America’s Doctor Crisis?

 Physicians are retiring in greater numbers as burnout levels increase; at the same time Americans are placing higher demands on the health care system.

Securing an appointment to see a doctor in the United States is exacerbated by soaring health care demand and fewer doctors. Many specializations are increasingly affected by this trend, but primary care and emergency medicine are among the hardest hit.

The average wait time to see a doctor has increased since 2017 and continued to rise after the demand spike brought on by COVID-19.

A survey conducted by AMN Healthcare in 2022 of 15 large metro markets revealed the average time to see a physician was 26 days—an 8 percent increase from 2017 and a 24 percent spike since 2004.

Staff constraints are also felt in hospital emergency departments. Nearly 140 million Americans visited a hospital emergency department in 2021, based on data from the Centers for Disease Control and Prevention. Of those, about 13 percent resulted in hospital admission; while thousands waited hours to see a health care provider.

Consequently, many patients leave before being seen by a doctor.

One study analyzed more than 1,000 hospitals between 2017 and the end of 2021 and found those with the worst performance had 4.4 percent of emergency room patients leave before a medical evaluation was conducted. At the end of 2021, that number had risen to upwards of 10 percent.

Compounding the issue is that nearly half of the doctor population will reach retirement age within the next 10 years and career burnout is hitting the rest harder than ever, according to data from Association of American Medical Colleges.

Almost 50 percent of doctors report that they feel burned out, according to a 2024 Medscape report.

These are key factors driving America’s growing scarcity of doctors. Physician Thrive’s 2023 study noted that the United States may have a shortage of 124,000 doctors by 2034. Within that shortfall, up to 48,000 will likely be lost from primary care, while the industry is projected to lose another 58,000 specialists, surgeons, and nurse practitioners.

“This is definitely coming down the pipeline. It’s been coming for a long time, and we’re seeing this all across health care,” emergency physician Dr. Jared Ross told The Epoch Times.

Dr. Ross is also president of Missouri-based Emergency Medical Services, Education & Consulting. He’s watched America’s health care worker crisis unfold on the front lines and says the shortage of physicians is an old problem that’s reached a tipping point.

“We’ve talked about this for years. It’s nothing new. There’s been a number of attempted stop-gap measures that haven’t been all that successful,” he said.

Some of these provisional solutions include bringing in more practitioners from foreign countries, medical school loan forgiveness programs, expanding telehealth services, and increasing the number of resident physician training supported by Medicare.

Dr. Ross has seen doctor shortages impact emergency medicine but maintains primary care has “really struggled” to retain physicians.

This is critical for two reasons. One is because health care demands in the United States are rising. The average number of times Americans visit a doctor per year by age group is four times for adults, nine for infants, and twice for children between the ages of five and 15, according to Vanguard Medical Group.

The other reason is due to what Dr. Ross called the “corporatization of medicine.”

“The problem is we have an insurance system that is a massive bureaucracy,” he said.

During a recent conference with other medical leaders, Dr. Ross said it was discussed how America has “really pushed away from the model of traditional health care.”

There was a general consensus within the group that insurance companies have become too powerful in medicine.

“The administrative burden or hassle, as many doctors describe it, is very disheartening,” Dr. William Schaffner, infectious disease specialist at the Vanderbilt University Medical Center, told The Epoch Times.

Having worked in medicine for more than 40 years, Dr. Schaffner has witnessed it evolve into something “aggressively more complicated” as insurance companies expand power over doctors. He says this trend became more noticeable by the 1990s.

“Doctors didn’t go to medical school in anticipation of arguing with insurance companies. It’s depressing and discouraging,” Dr. Schaffner said.

In 2020, for the first time, fewer than 50 percent of U.S. physicians worked in private practice, according to the American Medical Association (AMA). Most have chosen to become employees of large medical groups, which has drastically changed the paradigm of health care.

“The shift away from independent practices is emblematic of the fiscal uncertainty and economic stress many physicians face due to statutory payment cuts in Medicare, rising practice costs, and intrusive administrative burdens,” AMA President Dr. Jesse M. Ehrenfeld said in a 2023 statement.

Battling With Insurance

The move from independent practice to medical group employee presents its own dilemma. Aside from increased patient loads, it has left doctors at the mercy of having to get prior approval from insurance companies to carry out a medical treatment or procedure.

This forces a quantity-over-quality approach to treatment, according to Dr. Ross.

Prior authorizations are “an absolute headache,” he said. Physicians are now stuck battling with a third party who creates “as many roadblocks as possible because they don’t want to pay out.”

Dr. Schaffner said it took “numerous telephone conversations” with an insurance provider so a family member could get a necessary medical procedure done.

He said part of why it’s challenging is because there needs to be a level of trust on the insurance company’s end. “It’s not just a formal relationship that happens, but there also has to be a trust that develops with the benefits manager. It can take time,” Dr. Schaffner said.

An AMA survey of physicians showed that 88 percent felt the burden associated with prior authorization protocols was “high” or “extremely high,” and they spent an average of 14 hours per week doing only that.

Beyond fueling the upward trend of doctor burnout, there are also concerns about clinical outcomes for patients due to lengthy prior authorizations. Eighty-nine percent of doctors reported either a “somewhat” or “significant” negative impact on their patient outcomes.

Dr. Ross believes the overarching bureaucracy in medicine is a major component of physician burnout, but there’s also what he called the “documentation burden.”

Filling out electronic health records eats up hours of a physician’s day. Much of this record-keeping is devoted to billing, which is a source of frustration for many health care practitioners. One study noted primary care physicians spend a median 36.2 minutes per patient working with electronic health records.

It also significantly reduces the amount of time a doctor can spend treating or educating patients about their conditions.

Moreover, Dr. Ross says many doctors have no choice but to bring their work home with them at the end of the day. “They’re seeing patients during the day and writing notes after hours when they’re home with their families.”

“Medical records have given us a lot of wonderful things. The idea was it would make things faster, but it’s not. We used just to scribble some notes in a folder, but now we’re expected to write a whole diatribe. Information is being constantly added from government and insurance providers … electronic records have given us access to more information, but it’s also become overcomplicated and less efficient,” Dr. Ross said.

Dr. Schaffner concurs, saying insurance companies have created a “time sink” with the added documentation. Many doctors maintain that electronic health records are too focused on billing and not on the patient’s condition.

Consequently, the medical scribe industry has sprung up alongside the growing paperwork burden for doctors, but it’s an added expense for physicians already struggling with rising industry costs. A medical scribe will take the doctor’s recorded audio notes for a patient and transcribe them, saving time for the doctor.

“There are only 24 hours a day. You can either be on your computer documenting a patient, or you can be seeing the next patient,” Dr. Schaffner said.

One study by AMA linked medical scribes to a 27 percent lower physician burnout rate among primary care providers.

However, other data suggests that administrative help doesn’t have much of an overall impact due to the amount of time doctors spend proofreading.

Patient Care Impact

In 2023, nearly 30 percent of medical groups had at least one physician leave or retire early due to burnout, according to a survey by the Medical Group Management Association.

Six out of 10 doctors and residents say they’re feeling burned out, while seven out of 10 medical students say they’ve also hit that point, according to The Physicians Foundation’s 2023 survey.

Many health care professionals are sounding the alarm over the future of patient care. “We’re already seeing this. We have huge waits for primary care doctors. This is especially true in inner city and rural settings,” Dr. Ross said.

The National Association of Community Health Centers estimated that 100 million Americans lack reliable access to primary care, in its 2023 report.

Dr. Ross said, that means many simply head to urgent care or the emergency room.

“What we’re doing at the end of the day is asking non-medical people to make a decision on where to get care,” he said.

Due to rising levels of career burnout, Dr. Schaffner has observed that the younger generation of physicians is beginning to limit their working hours. He said new physicians are more keenly aware of “professional life balance” and are much less likely to be on call. “They want to do burnout prevention,” he said.

While this may keep more doctors from leaving their respective fields, it still poses a problem from a patient accessibility standpoint.

This is becoming an urgent issue in America’s aging and chronically sick population. Six in 10 adults in America have a chronic disease, according to the Centers for Disease Control and Prevention. Four in 10 have two or more.

At the same time, a little more than 17 percent of the population is over the age of 65, data from the Census Bureau indicate. That number is expected to surpass 20 percent by 2040.

The rules of corporate medicine aren’t making this problem any easier, says Dr. Ross. The “revenue value unit,” or RVU, is now the standard method of evaluating physician productivity.

“Physicians really feel like cogs in a wheel. They’re evaluated on their production. How much are they billing? How much [money] are they bringing in for their practice? Not so much the quality of care or patient satisfaction,” Dr. Ross said.

A 2023 satisfaction survey of overnight hospital patients revealed barely 36 percent of patients said they were able to speak with a doctor when needed—a 43 percent drop from the 2011 J.D. Power survey.

“It all comes back to what medicine has become,” Dr. Ross said.