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.)

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The surprising new doctors caring for you

Who will be your next doctor? What will your future doctor look like?

Your doctor within the next 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, while some currently in practice will change to a non-clinical job, retire, or die.

Who will be your next doctor? What will your future doctor look like?

Find out at the updated version of this post-here is the link.

Meet the new doctors caring for you soon

Your doctor within the next 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, while some doctors currently in practice will change to a non-clinical job, retire, or die.

More women physicians are coming

For the academic year 2016-2017,  83,000 students, attended United States medical schools ,  slightly more males than female. However, in 2017, the entering class of medical students was slightly over 50% female, for the first time ever.

CELEBRATE WOMEN IN MEDICINE MONTH#WIMmonth

According to the Association of American Medical Colleges, since 2015 the number of women students has increased by 9% while the number of men has decreased by 2 %.

And already, the majority of  young practicing physicians-under age 40 years old-are female.

So you are likely to be treated by a female physician eventually, if you haven’t already,  especially if you go to a primary care doctor. Gynecology and pediatrics  residency programs are now overwhelmingly comprised of female residents.

Ethnic diversity is still low but is improving

Entering classes at the nation’s medical schools continue to diversify.

From 2015 to 2017, black or African American students increased by 12.6%, and those  who were Hispanic, Latino, or of Spanish origin rose by 15.4%.

a male doctor holding a tablet

However,  medical students and residents, both male and female, are still predominantly white. The ethnic percentages of most other students is far below their representation in the general population. Based on self-identification, race and ethnic origin of medical residents includes

  • White-60%
  • Black- 7%
  • Hispanic(any race)- 6%
  • Asian-26%
  • Multiracial- 3%
  • Unknown/other-7%
  • Native American/Alaskan/Pacific Island -less than 1%

How many U.S. physicians are foreign born ?

Will your physician come from another country?

Female doctor looking at an xray

70% of  U.S. medical residents are native citizens,  8% are naturalized citizens and 6% are permanent residents. ( adds to less  than 100% due to some status’ unknown.) 

Credentials of today’s physicians

The average grade point of entering medical students was 3.56.

77% had done some type of volunteer medical service .

77% have experience in medical research.

These statistics gleaned from JAMA, December 19, 2017 

Goals of new physicians

An Association of American Medical Colleges  annual survey of entering medical students found:

  • More students indicated that having a work-life balance rather than a “stable, secure future” or the “ability to pay off debt” was an “essential consideration” in their career paths after medical school.
  • Nearly 30% of new medical students indicated plans to eventually work in an underserved area.

The specialization of medical care- the good and the bad

March 16 was Match Day. Not a match as in color choice for an outfit nor a match as in finding a spouse, but the concept is similar.

On Match Day,  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.

Why should you care? 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 speciality their entire career, although some  switch after a few or many years.

doctor talking to a woman
Ted Epperly, M.D., consults a patient at his practice in Boise, Idaho.photo compliments American Academy of Family Physicians

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 recent 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.

Consider that in the early 1970s, there were only 20 medical specialties !

THE SURPRISING NEW DOCTORS CARING FOR YOU
photo from Lightstock.com(affiliate link) graphic created with Canva

What this means for you as a patient

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 will have a high degree of expertise in their field, making them better able to treat your problem in the most efficient, effective, safest way.

You may find your doctor recommends more testing which may lead to more treatment than might otherwise have happened; 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

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

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

So, to close this gap, primary care physicians have become increasingly important to oversee and coordinate care, especially for complex patients.

So there was good news in the Match this year. The upward trend in students matching into family medicine continued for the ninth consecutive year . In 2018 more students matched into family medicine than in any  previous year, 3,535 compared to 3,237 in 2017. 

“The number and proportion of U.S. medical graduates going into family medicine is the strongest indicator of the future of the primary care workforce because family medicine is the only specialty completely devoted to primary care,”

said Michael Munger, MD, president of the American Academy of Family Physicians.

Michael Munger, M.D., consults a patient at his medical office in Overland Park, Kan.
Michael Munger, M.D., consults a patient at his medical office in Overland Park, Kan. Photo compliments of American Academy of Family Physicians

My specialty-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.

Dr. Sandeep Jauhar wrote about his first year as a resident in

Intern: A Doctor’s Initiation

“In Jauhar’s wise memoir of his two-year ordeal of doubt and sleep deprivation at a New York hospital, he takes readers to the heart of every young physician’s hardest test: to become a doctor yet remain a human being.” ― Time

Lightstock photos

Unless otherwise stated, the doctor photos in the post are from the Lightstock.com collection . Get 5 free downloads at this affiliate link. (This blog can earn a commission if you buy photos which helps support the mission of Watercress Words.)

Thank you for joining me to explore the surprising new doctors caring for you. I hope you’ve learned something. Please contact me about topics you want to read about.

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my regards, Dr. Aletha