Gold Rush in the Medical Field: Why Do American Doctors Earn So Much?

The American healthcare system is indeed facing a shortage of medical doctors, with one major contributing factor being the mismanagement of the country's training system. However, for the doctors themselves, it's a golden age as the scarcity has resulted in higher salaries and increased wealth with each passing day.

The looming shortage of up to 124,000 doctors in America within the next decade presents a perplexing paradox. On the surface, it seems counterintuitive, especially when considering the lavish compensation that physicians receive, with an average salary of $350,000 as reported by recent available evidence. Furthermore, the overwhelming demand to enter the medical profession is evident through the staggering numbers of aspiring medical students taking the medical-college admission test, with over 85,000 individuals sitting for the exam annually. However, despite the high salaries and a substantial pool of potential candidates, the persistent shortage of doctors raises important questions about the dynamics of the healthcare system and medical education.

 Table 1: Doctor-Patient Ratio in the Developed Countries

Country	Doctors Per 1,000 People
Austria	5.5
Germany	4.6
Italy	4.3
France	3.3
Britain	3.2
Canada	2.9
United States	2.8
Japan	2.7
Mexico	2.5
Spain	4.4

Source: Culled from The Economist (2023)

The ominous specter of a doctor shortage has already descended upon a substantial portion of the American population, leaving many without adequate access to essential healthcare services. Presently, over 100 million people find themselves residing in areas characterized by a glaring absence of primary-care physicians, a crisis particularly pronounced in rural regions where healthcare resources are scarce. The situation becomes even more dire when considering mental health services, with an alarming statistic revealing that approximately half of all Americans live in regions grappling with a severe shortage of mental-health professionals. This glaring inadequacy in healthcare access not only hampers individuals' well-being but also exacerbates disparities in healthcare outcomes, disproportionately affecting underserved communities. Remarkably, despite the United States' exorbitant healthcare expenditures, the nation lags behind most other affluent countries in terms of physician-to-population ratios, with less than three physicians for every 1,000 people, raising profound questions about the efficiency and equity of the American healthcare system.

Several factors have been identified as the usual culprits contributing to the escalating doctor shortage crisis. One prominent factor is the demographic shift induced by the aging baby-boomer generation, which has ushered in a surge in demand for medical care precisely as many seasoned doctors approach retirement. According to projections by the Association of American Medical Colleges (AAMC), more than two out of every five practicing physicians will reach the age of 65 or older within the next decade, thereby amplifying the vacuum created by departing healthcare professionals. The COVID-19 pandemic has only served to exacerbate this problem, with a mounting body of evidence underscoring that healthcare workers are resigning from their positions at a rate 30% higher than the pre-pandemic era, which is nearly double the attrition rate observed across all industries today. This trend has sapped the morale of healthcare professionals, with many, like Jesse Ehrenfeld, a physician and president of the American Medical Association, expressing reluctance to encourage their own offspring to embark on careers in healthcare due to dwindling job satisfaction and a pervasive sense of burnout. The erosion of joy and fulfillment within the medical profession represents a poignant reminder of the pressing need for comprehensive reforms to not only address the shortage but also rejuvenate the spirit of healthcare provision in the United States.

 Table 2: USA Medical School Admissions (1980-2022)

Year	Number of Applications	Number of Acceptances
1980	35,090	18,082
1985	30,000	18,973
1990	32,000	18,000
1995	48,596	19,080
2000	36,706	19,470
2005	38,001	19,200
2010	46,811	20,050
2015	53,723	23,797
2022	55,443	24,005
Total	376,370	180,657

Source: Culled from OECD; Association of American Medical Colleges Data

MD Comedy

The doctor shortage can also be attributed to several additional factors, with the complex pipeline into the medical profession playing a significant role, in which the American Medical Association has played a part in its formation. In contrast to many prosperous countries where doctors typically undergo approximately six years of education and training, the path to becoming a doctor in the United States is a significantly longer and more demanding journey. Consequently, this extended and challenging process often causes numerous aspiring physicians to abandon their pursuit of a medical career along the way.

The path begins with four years of undergraduate education at a university, followed by another four years in medical school. After completing this extensive education, American doctors must embark on a residency program that can last anywhere from three to seven years, with the possibility of additional specialist training. All told, it takes a whopping 10 to 15 years from the time one enters university to finally become a doctor in America.

Adding to the daunting nature of this journey is the high cost associated with medical training. The substantial financial burden, coupled with the extended duration, discourages many potential doctors from pursuing their dreams. However, the challenges don't end there. The number of available positions within the medical profession has been artificially limited. In 1980, the Department of Health and Human Services issued a report warning of a projected surplus of 70,000 physicians in most specialties by 1990. To address this perceived surplus, the report recommended reducing the number of students entering medical school and proposed restrictions on foreign medical-school graduates entering the country. Despite the actual shortage of doctors, foreign-trained physicians are often required to undergo exams and complete residencies in most states, regardless of their years of experience.

In response to these constraints, medical colleges heeded the advice and effectively capped matriculation for 25 years, despite increasing applications and a growing population (see table 2). Not only that, in 1997, federal funding for medical residencies was capped, compelling hospitals to either limit their programs or assume a significant portion of the financial responsibility for training doctors. Although some spots have been reinstated, it remains insufficient to address the shortage, leading to many promising candidates being excluded from the medical profession.

In light of this artificially induced doctor shortage, a new type of medical degree gained popularity: doctors of osteopathic medicine (DOs). While in most countries, osteopaths are known for manipulating spines, American DOs are fully licensed physicians. They now constitute approximately 11% of the physician workforce and a quarter of medical school students. In essence, American DOs have adapted and integrated themselves into the healthcare system to meet the increasing demand for medical services.

In this evolving landscape of healthcare, nurse practitioners and physician assistants have taken on increasingly vital roles, extending their scope of practice to encompass responsibilities traditionally reserved for doctors, including the authority to prescribe medications. This expanded role has proven essential in bridging the healthcare gap and ensuring that patients receive timely care. While these professionals undoubtedly contribute significantly to healthcare delivery, their involvement has also raised debates about the boundaries of their practice, as some argue for more standardized regulations and oversight to ensure the quality and safety of care provided.

Another facet of addressing the doctor shortage involves the integration of foreign-trained doctors into the American healthcare system. These dedicated professionals, often hailing from diverse backgrounds and experiences, bring valuable expertise and skills to the field. However, they encounter hurdles such as the necessity to pass exams and complete residencies in most states, irrespective of their years of practice. While these measures aim to maintain the standards and quality of healthcare, they can inadvertently limit the ability of foreign-trained doctors to fully alleviate the shortage.

The persistent doctor shortage has continued, despite these adjustments; and it has ramifications that reach beyond the mere scarcity of medical professionals. As noted earlier, one striking consequence of this ongoing issue is the skyrocketing salaries that doctors command in the United States. With demand for healthcare services outpacing the available supply of physicians, the market forces of supply and demand have driven up compensation packages for doctors to astonishing levels. These mind-boggling salaries, while reflective of the value of their services, also contribute to the escalating cost of healthcare in the country. As a result, patients and healthcare systems alike face the dual challenge of securing adequate medical staff and managing the ever-increasing financial burden of healthcare provision.

The strain on the existing healthcare workforce is palpable, with doctors and healthcare providers often stretched to their limits in an attempt to meet the burgeoning demand. Patients across the nation may find themselves facing prolonged wait times for appointments and procedures, leading to delays in diagnosis and treatment. Furthermore, the quality of healthcare delivery may be compromised when healthcare professionals are overburdened, increasing the risk of medical errors and burnout among medical practitioners.

Addressing the doctor shortage necessitates a multifaceted approach that delves into its root causes, including the challenges of medical education and training, restrictions on foreign-trained doctors, and limitations on medical school matriculation. This approach should also aim to foster an inclusive and supportive environment for both newcomers and established practitioners, allowing them to contribute their skills and expertise to meet the growing demand for medical services in the United States. It is thus imperative that policymakers, healthcare institutions, and stakeholders collaborate to develop innovative solutions that not only attract and retain medical talent but also ensure equitable access to high-quality healthcare for all citizens.

 

 

Notes

 

Association of American Medical Colleges. (2021, June 11). AAMC Report Reinforces Mounting Physician Shortage. Retrieved from https://www.aamc.org/news/press-releases/aamc-report-reinforces-mounting-physician-shortage

Burke, M. C. (2005). The DOs: Osteopathic Medicine in America (review). Perspectives in Biology and Medicine, 48(4), 618-621. Retrieved 11 6, 2023, from https://muse.jhu.edu/article/188195/summary

Lowrey, A., & Pear, R. (n.d.). Doctor Shortage Likely to Worsen With Health Law. Retrieved 11 6, 2023, from https://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html

Rosenblatt, R. A., & Lg, H. (2000). Physicians and Rural America. Western Journal of Medicine, 173(5), 348-351. Retrieved 11 6, 2023, from https://ncbi.nlm.nih.gov/pmc/articles/pmc1071163

The Economist. (2023, October 31). Medicine’s Gilded Age: Why Doctors in America Earn So Much. Retrieved from https://www.economist.com/united-states/2023/10/31/why-doctors-in-america-earn-so-much