Increasing and aging population puts strain on supply.

As the population of the United States increases and ages, the country faces a physician shortage that will affect adults’ primary care, says a study published in Health Affairs.

Family physicians and general internists will see their workloads increase by 29 percent between 2005 and 2025, and pediatricians and family physicians who care for children will see their workload increase by 13 percent. For the care of children, the physician supply should be adequate, but the study predicts a shortfall of 35,000-44,000 adult-care physicians.

The population of the United States will increase 18 percent between 2005 and 2025, to 349 million, and the population above age 65 will increase 73 percent.

Generalist physicians -- physicians in family medicine, general internal medicine and general pediatrics -- provide 52 percent of all ambulatory care visits, much inpatient care, 80 percent of patient visits for hypertension, and 69 percent of visits for both chronic obstructive pulmonary disease and diabetes, the study says.       

The supply of physicians must increase to meet the higher demand for healthcare, but the number of generalist residency graduates has declined each year since 1998, and the supply of generalist physicians will increase by only 13 percent by 2025, the study says.

The number of physicians who care for adults will increase by only 7 percent. Because those physicians will have to handle a 29 percent increase in their workload, the study predicts that the shortage of adult-care generalists in 2025 will be 20-27 percent and that at least 2,800 additional residency graduates will be needed to eliminate the shortfall. Although generalist physicians are the foundation for U.S. healthcare, they are the only major specialties that show a decade of declining numbers of graduates, the study says.

The study examined several proposals to reduce the shortfall of physicians but found them all inadequate:

            • Increased physician efficiency. Efficiency can be achieved by shortening patient visits and decreasing the number of return visits, but this will frustrate patients and limit physicians’ treatment options.

            • Higher medical-school enrollment. This option will fail to correct the physician shortfall because too few students will become generalists.

            • Greater use of nurse practitioners and physician assistants. Many NPs and PAs work in emergency departments, hospital clinics, intensive care units, and inpatient services, not in office-based practice. “Limited numbers of NPs and PAs, lucrative alternative practice opportunities, and uncertain numbers of future graduates will likely limit their availability in primary care,” the study says.

            • Increased primary care by specialists. This option will fail because specialists lack the time to provide primary care, they also face increasing demand, and they do not view primary care as their responsibility.

Why are fewer graduates opting to become generalist physicians? The study cites lower pay for generalists than for specialists, an education system that promotes specialization, and huge education debts.