How the U.S. physician workforce is changing-2020 and beyond

These future doctors are training under the most difficult and stressful medical conditions the world has experienced in several generations-a global pandemic of a contagious respiratory pathogen. As such, they will have a unique perspective as they begin and pursue careers as practicing physicians.

 

Your next doctor or one you will see in 10-20 years is likely in medical school or a residency program in a United States medical center right now. Within 1-10 years, they will join the ranks of practicing physicians, as those doctors transition to non-clinical jobs, retire, or die.

These future doctors are training under the most difficult and stressful medical conditions the world has experienced in several generations-a global pandemic of a contagious respiratory pathogen. As such, they will have a unique perspective as they begin and pursue careers as practicing physicians.

More women physicians are training to be doctors.

Medical school enrollment looks more like the general population now.

For 3 years in a row, the number of women entering medical school has steadily increased and exceeded the member of men, while the number of men has decreased.

First year students

  • Male students -10, 560
  • Female students-11, 612

Total students

  • Male students- 42, 735
  • Female students- 44, 579

statistics from the Liaison Committee on Medical Education (LCME)

image from the American Medical Association

Due to the lag time of the numbers catching up, slightly more men than women graduated in 2020.

  • Male graduates- 10,517
  • Female graduates-10, 324

Among the 140,000 resident physicians, 64,000 are women.

Large numbers of women medical graduates pursue training in these fields-

  • internal medicine
  • family medicine
  • obstetrics/gynecology
  • pediatrics
  • dermatology
  • geriatrics
  • neurology
  • ophthalmology
  • psychiatry

 

But ethnic diversity is still low among physicians in training.

The nation’s medical schools need more diversity. The factors that create racial and ethnic inequities in other areas of society impact medical education also.

In 2019-2020, white students made up the majority of medical students although both the number and percentage have decreased, while the number of all other groups has increased.

Based on self identification, the Association of American Medical Colleges reports students are

  • White-46,205
  • American Indian/Alaska Native -199
  • Asian-20, 836
  • Black /African American-6,783
  • Hispanic, Latino, Spanish Origin-6,063
  • Native Hawaiian/Pacific Islander-76
  • Other-1,776
  • Multiple-8,621
  • Unknown-892
a male doctor using a tablet while working

 

After medical school, graduates enter residency training for a specialty. Medical residents, both male and female, are still predominantly white. Based on self-identification, race and ethnic origin of medical residents in 2019 is

  • White-76,964
  • Black-8009
  • Hispanic(any race)- 11,860
  • Asian-37,477
  • Multiracial- 4740
  • Unknown/other-13,135
  • Native American/Alaskan-190
  • Native Hawaiian/Pacific Islander-101
Female doctor looking at an xray

Citizenship of physicians in training

Through its certification program, the Educational Commission for Foreign Medical Graduates (ECFMG) evaluates students who attend a non U.S. medical school.

After ECFMG certification, physicians who wish to practice medicine in the United States must complete an accredited residency training program in the United States or Canada. This process will take at least 3 years. The physician will have to complete a residency program regardless of the training he or she has received overseas.

In 2019, 71% of 140,000 resident physicians were native born U.S. citizens. The rest were

  • Naturalized citizens- 8%
  • Permanent residents- 5%
  • Various permits-7%
  • Refugee/displaced persons-0.1%
  • Unknown status -7%

Goals of new physicians

“Most students, including minority, disadvantaged, and marginalized students, enter medical school pursuing a lifelong dream of practicing medicine with little sense of projected incomes or what specialty they would like to pursue.

Most specialty choices are likely based on social, educational, and health care experiences; experiences in medical school; and the prospect of a 30-plus-year career in an area of medicine that provides a level of personal comfort, support, and fulfillment.”

Thomas B. Free Medical School Tuition: Will It Accomplish Its Goals? JAMA. 2019;321(2):143–144. doi:10.1001/jama.2018.19457

 

The specialization of medical care- the good and the bad

On Match Day, occurring mid March every year,  graduating medical students learn which  residency program they will enter through the National Resident Matching Program , which “matches” them with available positions in residencies at medical centers all over the United States. A kind of medical “matchmaking” you could call it.

For many students, Match Day has become a quasi graduation celebration, with friends and family in attendance to share the “reveal”. In 2020 due to the viral pandemic, they had to settle for celebrating virtually.

This matching process determines who will care for our medical needs in the next 30-40 years; our family physicians, internists, pediatricians, general surgeons, obstetricians, and the multitude of other medical specialties. Most doctors will continue in the same specialty their entire career, although some  switch after a few or many years.

a female physician talking to a male patient

 

Some medical students know what speciality they want to pursue before they enter medical school, while others decide after trying the different types of medicine while students. We still have the traditional specialities that most students enter- (there are also many subspecialities under each of these categories.)

Primary care 

  • Family medicine
  • Internal medicine -(adult medicine)
  • Pediatrics-children and adolescents
  • Obstetrics/Gynecology- care of women’s health and pregnancy

Surgical specialities

  • General Surgery-  surgery on skin and internal organs
  • Orthopedics-bones and joints
  • Otorhinolaryngology- ear, nose, throat
  • Ophthalmology-eyes
  • Neurosurgery-the brain, spine, nerves
  • Plastic and Reconstructive surgery
  • Cardiac and vascular surgery

Others 

  • Dermatology-skin
  • Psychiatry-mental health
  • Anesthesiology-surgical sedation and pain relief
  • Emergency medicine- emergencies and trauma
  • Radiology- xrays and other imaging-CT, MRI, US
  • Pathology-laboratory medicine
  • Allergy
  • Physical medicine and rehabilitation
  • Oncology-treatment of cancer
  • Integrative and complementary medicine

As medical care has become more complex and technological, so have the specialties of physicians. This has produced a plethora of new highly specialized fields of practice.

  • Sleep medicine
  • Medical genetics and genomics
  • Pain management
  • Geriatrics- care of the elderly
  • Palliative care-managing diseases that cannot be cured and are likely terminal
  • Hospital medicine-care of patients admitted to a hospital
  • Critical care medicine-care of patients in an ICU (intensive care unit)
  • Aerospace medicine
  • Wound management
  • Medical informatics – use of computers and medical software in medicine
  • Bariatrics- treatment of obesity with or without surgery
  • Sports medicine-treatment of athletic injuries and fitness training
  • Transplant medicine- surgery to transplant organs and after care
  • Addiction medicine

A 2018 viewpoint in JAMA suggested that we need a new specialty, virtual medicine, to describe physicians who treat patients through a virtual medium, telemedicine or  web based, on a computer or a mobile app.

The onset of the SARS-CoV-2 pandemic forced physicians to find alternate ways of delivering care. Even emergency rooms and urgent care clinics were forced to redesign their work flow to care for ill and injured patients while not enabling spread of the virus to staff and other patients.

The risk of contagion halted most non-emergent in person care but physicians’ offices soon implemented alternate means of reaching out to patients-curb side consults, telephone, and virtual visits using smart phones and computers.

Health plans, including Medicare, supported these alternate delivery services with loosened restrictions on paying for virtual care.

Both patients and doctors benefited by this new model which seems destined to persist past the pandemic.

THE SURPRISING NEW DOCTORS CARING FOR YOU
photo from Lightstock.com(affiliate link) graphic created with Canva. This post is an update of a previous post of this title.

 

 

 

The problem-overspecialization in medical care

According to the New England Journal of Medicine,

“the progress of biomedical science is a major factor in the emergence of new subspecialities. There are some patients who benefit from highly focused knowledge and skills.”

All of these specialities mean more medical  knowledge and experience will be  available to both treat and prevent a diverse and growing  variety of disorders.

Today’s new specialist has high degree of expertise in their field, making them better able to treat your problem in the most efficient, effective, safest way.

But with a more narrow focus of experience, that doctor may be less familiar with other aspects of your medical status.

You may find your specialist recommends more testing, which may lead to more treatment some of which may not necessarily improve outcomes.

More specialized testing and treatments may increase the cost of medical care.

Dr. Sandeep Jauhar addresses this issue in this article from Time.

One Patient, Too Many Doctors: The Terrible Expense of Overspecialization

The challenge-increasing the primary care workforce

Primary care physicians can close this gap by coordinating care, especially for complex patients.

4,335 medical students and graduates matched to family medicine residency programs in 2020, the most in family medicine’s history as a specialty, and 487 more than 2019.

Family physicians make up the majority of the primary care physician workforce and mirror the geographic distribution of the U.S. population—practicing in rural and urban underserved communities

“Public health issues like the pandemic the world is experiencing now underscore the importance of a strong foundation in primary care at the front lines surveilling and treating the community.”

Gary LeRoy, MD, president of the American Academy of Family Physicians.
graphic provided by the American Academy of Family Physicians

 

I specialize in Family Medicine

I’ve often been asked ,”Why didn’t you specialize?” My answer, “I did. I specialize in Family Medicine.”

Once called “general practice”, Family Medicine is now a recognized specialty, requiring a residency and certification by  the American Board of Family Medicine.

 

Lightstock photos

Unless otherwise stated, the doctor photos in the post are from the Lightstock.com collection . Get a free 30 day trial at this affiliate link. (This blog can earn a commission if you buy photos which helps support the mission of Watercress Words.)

exploring the HEART of health care education

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

my regards, Dr. Aletha 

 

Voting for healthcare in 2020-who will you choose

Register to vote before your state’s deadline. Please exercise your right to vote and make your voice heard. If you are concerned about the risk of contracting coronavirus at a polling site, explore other options in your community. With proper precautions in person voting can be safe.

The 2020 Presidential election is underway. Even though the polls don’t open until November 3, many are already voting by mail or absentee. The candidates Donald Trump and Joe Biden debated several important issues in their September 29 meeting, including the country’s COVID-19 management. Two more debates are scheduled in October but the status is unclear now that Mr. Trump has been hospitalized with COVID-19. The Vice Presidential candidates’ debate is still scheduled as of October 5.

Election 2008-ObamaCare

Health care was a major issue in the 2008 election and proved to be momentous. In his campaign, the Democratic candidate, Barack Obama, promised health care reform and as President he delivered with the passage of the Affordable Care Act, the first time Americans have had universal health care. This election’s candidates also make promises about health care.

Election 2016

In a post from 2016 I compared the then candidates’ health care proposals. I thought it would be interesting to look back at what Mr. Trump said then, along side what his opponent Mrs. Clinton said. As you well know, Mr. Trump defeated Mrs. Clinton , although she won the popular vote.

The White House
The White House, home of the President (photo from the Lightstock website )

This summary of  what each candidate proposed came from their official websites. I didn’t add my opinion or commentary, nor endorsement of either one.

I also looked at the healthcare views of two third party candidates, one of whom is a physician; comparing all proposals, you will see that Americans hold widely differing opinions about health and health care.

There are affiliate links in this post, if you follow them and make a purchase, this blog may receive a commission.

Republican- Donald J. Trump, Chairman and President,

The Trump Organization

 “Healthcare Reform to Make America Great Again”

Mr. Trump believes the Affordable Care Act, which he refers to as Obamacare, is an “economic burden” to the country. He says it has caused

  • Runaway costs,
  • Websites that don’t work,
  • Greater rationing of care
  • Higher premiums
  • Less competition
  • Fewer choices

He recommends a

“series of reforms that follow free market principles and restore economic freedom and certainty” , which will

“broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.”

As President, Mr. Trump will request Congress to
  1. Completely repeat Obamacare, eliminate the individual mandate to buy health insurance.
  2. Modify existing law that inhibits the sale of health insurance across state lines.
  3. Allow individuals to fully deduct health insurance premium payments from their tax returns.
  4. Allow individuals to use Health Savings Accounts (HSAs), which should be tax free, allowed to accumulate, and become part of one’s estate at death.
  5. Require price transparency from all healthcare providers.
  6. Block-grant Medicaid to the states.
  7. Remove barriers to entry into free markets for drug providers, allowing consumers access to imported, safe and dependable drugs from overseas.

Also under his health care plan, Mr. Trump includes

  • Enforcing immigration laws
  • Eliminating fraud and waste
  • Energizing our economy
  • Reform our mental health programs and institutions
Oval Office replica
replica of the Oval Office at the Reagan Presidential Library, Simi valley, California

Democrat-Hillary Rodham Clinton, lawyer;

former First Lady, Senator, and Secretary of State

“Universal, quality, affordable health care for everyone in America”

  1. Maintain and expand the Affordable Care Act
  2. Bring down out-of-pocket costs for copays, deductibles and prescription drugs
  3. Expand access to care for low income groups, immigrants and rural populations.
  4. Defend access to reproductive health care.
As President, Mrs. Clinton will work with Congress to

Fight addiction and substance abuse with prevention, treatment and recovery programs and reforming the criminal justice system handling of offenders.

Set a goal to prevent, treat and cure Alzheimer’s Disease by 2025. Help those affected and their families get the care they need.

Create an AIDS/HIV policy to increase research, expand treatment options, increase health care financial options for those affected, and eliminate discriminatory laws.

Develop an “autism initiative” to expand insurance coverage, increase funding for research, early identification and intervention, employment opportunities, and school safety.

Commit to fully implement the Americans with Disabilities Act, and increase support for persons with disabilities and their families.

Under the heading of health Mrs. Clinton includes her positions and proposals for

  • Climate change
  • Women’s rights and opportunity
  • Support for veterans, the military and their families
  • Paid family and medical leave
couches in room with Presidential seal on the floor
another view of the Oval Office replica

Green Party – Jill Stein, M.D., physician, activist

Dr. Stein favors

“Medicare for all”, single payer health care system for everyone, with no premiums, co-pays or  deductibles.

Eliminate private health insurance.

Decrease prescription drug costs

Full access to contraceptive and reproductive care, including morning after contraception

Invest in community health infrastructure- organic food, renewable energy

Prioritize prevention by encouraging physical activity, improving nutrition and minimizing environmental pollution

Libertarian- Gary Johnson, businessman, former Governor of New Mexico

Mr. Johnson’s website had little information about his health care proposals, so I am also including items from the Libertarian party’s website.

 The party supports

a free-market healthcare system where the individual is free to choose everything related to health care- insurance, doctors, treatments, medication, end-of-life care

the ability to purchase health insurance across state lines

abortion as a private decision up to the individual’s conscience and not regulated by the government

Mr. Johnson

opposes mandatory vaccination

supports the legalization and regulation of marijuana.

exploring the HEART of healthcare

I snapped the photos of the “Oval Office” during a tour of the Reagan Presidential Library a few years go. I have also visited the Nixon and Kennedy Libraries. These surprised and intrigued me-visually compelling ways to review their terms of office from a historical perspective. I wonder what the future Trump library will unfold?

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

                              Dr. Aletha 

And if you have not registered to vote, please do so before your state’s deadline. And once registered, please exercise your right to vote and make your voice heard.

If you are concerned about the risk of contracting coronavirus at a polling site, explore other options in your community. With proper precautions in person voting can be safe. these include.

  • mask wearing
  • social distance at least 6 feet
  • outdoor locations when possible
  • handwashing
  • staying home if exposed or sick