WASHINGTON – While a national nursing shortage has been well-documented, there’s also another looming health care crisis that’s less well known – the expected shortage of doctors in Minnesota and across most of the United States.
Dr. Randy Rice, a family medicine specialist in Moose Lake and the president of the Minnesota Medical Association (MMA), counts himself among the doctors who are considering an earlier retirement.
He said increasing red tape from health insurers, stress from the COVID-19 pandemic and the consolidations of medical practices have resulted in burnout and a loss of autonomy that is prompting doctors to leave their practices.
“It’s certainly a lot different now than it was when I started practice,” said Rice, 61.
The American Medical Association says the United States faces a projected shortage of between 37,800 and 124,000 physicians within 12 years. The impact of “medicine’s great resignation” will be felt soon, according to a study by the Mayo Clinic. It surveyed 20,000 respondents at 124 institutions across the country and found that one in five physicians plan to leave medicine altogether and one in three doctors plan to reduce their work hours.
“As a rural family physician, I have witnessed dimensions of burnout, including emotional exhaustion, depersonalization, and loss of personal accomplishment, up close – with my coworkers and in the mirror each morning,” Rice wrote in an opinion piece for the MMA newsletter.
He told MinnPost that many physicians have lost their drive to work long hours and make other sacrifices.
“A lot of them are feeling like they are punching the clock,” Rice said.
Even before the pandemic, health workers were experiencing high levels of burnout and Rice had begun to consider moving up his retirement date.
While many physicians who plan to leave their practice are older, many are far from retirement age, Rice said.
Minnesota is fortunate that it has more doctors per population than most other states. According to analysis of Bureau of Labor statistics and information from the Health Resources and Service Administration, Sterling Price of Value Penguin determined that Minnesota has more physicians per population than most other states. Only South Dakota and Massachusetts have more doctors per capita.
According to Sterling, Minnesota has nearly 34 physicians per 1,000 residents. But these doctors are heavily concentrated in certain towns, urban neighborhoods and suburban areas of the state. And the medical resignation will affect all of Minnesota as well as the rest of the nation.
“It will be harder for people to get appointments, harder for people to get the care they need and force people to drive longer to their appointments,” Rice said.
But Rice said doctor shortages will be felt most acutely in rural areas, like the one he serves in Moose Lake.
“One out of every three rural physicians report planning to leave their profession within the next five years,” said a recent report on health care workplace shortages by the Minnesota Department of Public Health.
Lower-income urban neighborhoods, which are already medically underserved, will also face shortages, Rice said.
The types of doctors who will be the most scarce will likely be primary physicians and those that treat mental illnesses.
Sterling predicted Minnesota will suffer a 34% shortage of primary care physicians. And the MDH report said the largest vacancies right now are in the areas of mental health and substance abuse care “where one in four jobs is currently vacant and open for hire.”
In fact, the Minnesota Department of Public Health said that already “providers are seeing workforce shortages across Minnesota.”
The MDH study cited several recommendations to stem the draining of health care professionals in the state, including implementation of a school loan forgiveness program for health care providers and pressing hospitals and other employers to make health care jobs “safe, flexible, well-paid and family friendly.”
Other solutions include establishing “rural clinical training tracks” to create a pipeline of primary care physicians and psychiatrists trained in greater Minnesota and new funding for mental health providers to pay for the supervised training they are required to complete before becoming licensed to practice.
Meanwhile, according to the American Association of Medical Colleges (AAMC), enrollment in the nation’s medical schools has crept up, but by just a few percentage points, over the past few years. The AAMC said graduate school enrollment stood at 95,475 for the 2021 -2022 school year.
In Minnesota graduate medical school enrollment was almost flat with a combined total of about 1,500 students at the University of Minnesota and the Mayo Clinic Alix School of Medicine in the past two school years.
I’ve never met a Dr who does their own billing and accounts receivable. To blame insurance paperwork isn’t really a valid argument. My Dr.s don’t even do most of their own script refills, referral letters and prior auth letters. Nurses draft them and Dr. just sign. If there are rural docs out there practicing as if it were 1822 instead of 2022, perhaps they do their own billing.
And with the college system focusing on equity and not individual achievement, I’m not sure if we’ll have enough people scoring high enough to get into med schools. Without lowering the standards of course.
And who is wondering why, with all the anti-medicine/science rhetoric going on? Take this shot and it will reduce the chance you will have to be put in intensive care, you don’t take the shot, because its political, and up in intensive care, of course its all the healthcare systems fault now. How does a rational doctor/nurse etc. have rational health oriented conversations with irrational, everything is political people? I’d leave as well before those folks drive you crazy!
With the inevitable turnover of the boomers (ages 58+) our economy is going to be further stressed if the older Gen X workers decide to leave professions early. There aren’t even enough 15-25 year olds to make up for the planned retirements. The number of students entering colleges is plummeting due to shrinking population and rising cost. Looking at the recent educational losses due to the pandemic (see the drops in proficiency in the latest Minnesota test results) this upcoming generation might also be less prepared for college than the last.
I know people like to say college isn’t the only path and there are alternatives but somebody has to go to college if we want to replace doctors, nurses, teachers, engineers, etc.
In the last 5 years, 3 friends who were suburban and rural doctors joined the “great resignation” and found higher paying, lower stress and work hours jobs in the medical industry: pharma and medical devices. They are all well-under retirement age but they all suffered from long term Covid effects from contracting the virus in 2020 and between the attitudes of their clinic management and their patients’ disrespect they decided it was time to care for themselves and their families and stop worrying about people who, apparently, want to die. Like Dr. Sterling says, this is not a sudden change in who is going into medicine but one that was evolving until 2020 when evolution was accelerated. Rural clinics have closed, downsized, or become triage hubs all over the country and most of the reason for that is that rural people have gone from being suspicious of anyone with an education to being outright hostile. There are consequences for misbehavior and this one will take generations to fix, if that ever happens.
The neighborhood family clinic that I’ve been using for the past 40 years is now down to one doctor and two nurses from three doctors and 6 nurses a few years ago. The one remaining doctor only works Thursdays. The pandemic dramatically affected their revenue and I expect them to close within the next year or so.
Doctor shortages have been and issue for decades, that doesn’t mean this isn’t real but it’s not “new”, especially in rural areas.
In many ways the medical profession just isn’t as alluring as it used to be for a variety of reasons. Back in the early 90’s we had a Democrat in MN running against Arne Carlson (I can’t remember the guys name) who had some kind of State-wide public health care system in his platform. I remember the Docs I was working with at the time warning us all that this was going to socialize medicine and ruin our jobs. Some of us tried to explain to these docs (this was at a time when Group Health HMO’s were supposed to be the big solution) that the trajectory of the health care industry was turning docs into employees like everyone else. They’re status, influence, treatment decisions, AND pay were all on a downward trajectory while a growing legion of administrators were pushing them out of the way and capturing the revenue dollars. By the late 90’s the med schools my wife was looking at were actually warning new students that MD income’s were decreasing. Meanwhile there’s been a trend of replacing MD’s with less credentialed professionals like physician’s assistants and nurse practitioners because they’re cheaper. And medical practice itself has become an administrative nightmare that Obamacare (ACA) did nothing to relieve. Prescribing treatment that covered by insurance, and billable, and collecting all while prices are exploding is just too much.
Mr. Adam’s observation regarding residencies is also significant. Decades of closures, mergers, and buy-outs have severely impacted the number of hospitals and teaching hospitals, clinics, and practices that offer residencies. There used to be three times as many hospital in the Twin Cities… two thirds of them have closed. While the remaining hospitals are quite large, with a lot of beds, the staff/doc to patients rations have been decreasing steadily along with the closures. Doctors and nurses now have much larger patient loads, and any given hospital can only provide so many residencies.
“Back in the early 90’s we had a Democrat in MN running against Arne Carlson (I can’t remember the guys name) who had some kind of State-wide public health care system in his platform.”
Was that John Marty? I think his platform plank eventually became Minnesota Care.
The adoption of Minnesota Care was an interesting event. The medical community was adamantly opposed to it, and organized a day of lobbying against the bill. Unfortunately for their public image, the event was called the Mercedes Caravan, as the physicians made no effort to hide their economic status.
From what I’ve heard, the medical community has changed its position. Physician no favor single-payer or some form of government-sponsored coverage. They have come to see that their mission of protecting the public outweighs their mission of keeping their neighborhood Tiara dealer happy. We have come a long way from the days when my Mother explained to me why it was funny that the witch doctor on George of the Jungle was throwing darts at a target labeled “Medicare.”
“Meanwhile there’s been a trend of replacing MD’s with less credentialed professionals like physician’s assistants and nurse practitioners because they’re cheaper.”
Cheaper and less credentialed, but also very capable for handling the routine medical needs of most of us. Routine ailments and conditions don’t necessarily need a physician for diagnosis or treatment.
Yeah, for a bunch of highly educated people American docs have been embarrassingly slow to realize the need for MFA and get behind it. Now the docs, like a majority of their patients, are supporting it.
Exactly.
I think it’s important to note, when we talk about the stress our health care professionals have been enduring for the last two years, stress that has driven many out of the profession… those stresses have been exacerbated by pandemic/COVID denialism on a variety of fronts. Vaccine resistance kept hospitalizations higher than they should have been for over a year. The vaccine should have significantly decreased hospitalizations and intensive care, but resistance kept those levels high. Likewise other measures like crowd avoidance, masking, etc. would have lowered infection rates and illness, but significant resistance contributed to continual outbreaks and transmissions that landed in the laps of doctors and nurses. The pain and frustration of dealing with a pandemic that should have receded rather than regrouped into multiple new waves took a tremendous toll on our health care professionals and others trying to cope with the crises.
Doctors are no different than everybody else. When you have been in the same job for many years, eventually many people get bored or burn out and want to do something else. That’s not a problem. The root of the problem is that we don’t train enough doctors to replace the ones who are retiring. Getting into a medical school is incredibly difficult, given the limited number of slots. Significant numbers of aspiring doctors end up studying at schools in the Caribbean. Is that what we want?
The solution is easy, double the number of med school openings and residency programs. But of course, the biggest obstacle to that is the medical profession itself, who don’t really want a dramatic expansion of the number of doctors due the pressure this will put on reducing the professions’ wage levels.
MD salaries don’t reflect simple supply and demand relationships. The heath care economy is far too complex for that. Salaries have been dropping despite shortages, not increasing because of shortages. Cranking out more docs in and of itself wouldn’t lower salaries, so THATS not a legitimate dilemma. Cranking out more MDs doesn’t solve the problem because it’s the consolidation and subsequent closure of hospitals and clinics that’s limiting access to docs and residencies.
Too many medical practices have been swallowed up by large corporations. The suits in the boardroom care about the quantity of patients a doctor sees, not the quality of the care he/she provides.