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AMA president sounds alarm on national physician shortage
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Oct 25, 2023

WASHINGTON – In a national address today, American Medical Association President Jesse M. Ehrenfeld, M.D., MPH, spotlighted the growing national physician shortage and corresponding health system in crisis. In remarks delivered at the National Press Club, Dr. Ehrenfeld outlined critical
strains on physicians, including enormous administrative burdens, burnout, attacks on science, increased consolidation across health care, a broken Medicare payment system, and health crises that worsen each day.

Dr. Ehrenfeld enumerated five steps to get us out of this crisis,
including specific legislation and solutions from the AMA Recovery Plan
for America’s Physicians:



“The physician shortage that we have long feared—and warned was on the horizon—is already here. It’s an urgent crisis … hitting every corner of
this country—urban and rural—with the most direct impacting hitting
families with high needs and limited means,” Dr. Ehrenfeld said in remarks
as prepared for delivery.

“Imagine walking into an emergency room in your moment of crisis—in
desperate need of a physician’s care—and finding no one there to take care
of you.

“That’s what we’re up against.

“And so while our current physician shortage is already limiting access to
care for millions of people, it’s about to get much worse.”

The complete text of the speech as prepared for delivery is below.

There is an insidious crisis going on in medicine today that is having a profound impact on our ability to care for patients, and yet isn’t
receiving the attention it deserves. This crisis is physician burnout. Let
me share three quick anecdotes—all very personal to me—that illustrate the problem.

Two years ago, a dear friend of mine and medical school classmate, an
emergency room physician in California who worked tirelessly on the
frontlines throughout COVID, took his own life. He was an energetic and
loving soul … a brilliant and caring doctor … who felt the weight of the pandemic on his shoulders. He struggled to get out from under it. I knew
he struggled, but I didn’t know how to help him. And he didn’t know how to
ask for help.

I am still deeply troubled by his death, just as I am haunted knowing
there are thousands of people in his community who can no longer receive
his care.

More recently, another exceptional physician, a woman whom I recruited to
lead the LGBTQ health clinic at Vanderbilt University Medical Center,
abruptly quit the program, no longer able to cope with political pressures
and distorted half-truths about the work she was doing. I watched her post pictures online hugging her friends and colleague’s goodbye as she packed
up her family to move to another state to practice medicine unfettered by restrictive state laws.

Sadly, she is not the first, the last or the only physician I know who has
made the difficult choice to leave a community or a state they love
because of legislative overreach, in order to practice medicine the way
they know medicine should be practiced.

And just the other day, I walked into the physicians lounge at the Medical College of Wisconsin in Milwaukee where I am an anesthesiologist. There I
saw an experienced colleague whom I know well completely break down – so clearly exhausted and overwhelmed.

This is a picture of our health care system in 2023, and it is not a happy
or uplifting one.

Physicians everywhere—across every state and specialty—continue to carry tremendous burdens that have us frustrated, burned out, abandoning hope …
and in increasingly worrying numbers, turning our backs on the profession
we’ve dedicated our lives to.

It’s estimated that more than 83 million people in the U.S. currently live
in areas without sufficient access to a primary care physician.

In large parts of Idaho and Mississippi, pregnant women can’t find OBGYNs
to care for them. Ninety percent of counties in the U.S. are without a pediatric ophthalmologist. 80 percent are without an infectious disease specialist. More than one-third of Black Americans live in cardiology
deserts.

And in Florida, my own parents lost their primary care physician because
the Medicare payment rate for doctors has plummeted over the last two
decades and pushed many independent physician practices toward financial
ruin.

The physician shortage that we have long feared—and warned was on the horizon—is already here. It’s an urgent crisis … hitting every corner of
this country—urban and rural—with the most direct impacting hitting
families with high needs and limited means.

Imagine walking into an emergency room in your moment of crisis—in
desperate need of a physician’s care—and finding no one there to take care
of you.

That’s what we’re up against.

And so while our current physician shortage is already limiting access to
care for millions of people, it’s about to get much worse.

Consider that roughly two in three doctors admitted to experiencing
burnout during the pandemic, according to a survey from the AMA, the Mayo Clinic and Stanford Medicine. That’s the highest level of burnout ever
recorded by the AMA.

Consider that one in five physicians surveyed during the pandemic said
they planned to leave medicine within the next two years, while one in
three said they’d cut back on their hours.

Consider that nearly half of all practicing physicians in the U.S. today
are over age 55. And while medical school applications are up, it can take
a decade or more to educate and train a physician.

Consider that foreign-trained physicians, called International Medical Graduates or IMGs, face enormous obstacles—such as immigration and
green-card delays—to practice medicine in the U.S.

Consider that the average young doctor now leaves medical school more than $250,000 in debt, and that this heavy debt load has huge implications for
our health system, often forcing aspiring physicians to bypass primary
care and less populated, rural areas in favor of more lucrative
specialties in or near large cities.

It’s no wonder why the American Association of Medical Colleges projects a national physician shortfall of at least 37,000—and possibly well over
100,000— over the next decade.

Why is this happening?

Ask physicians and they’ll tell you:

An increasingly impersonal and bureaucratic health care system that
places enormous administrative hassles and burdens in our lap each
day, and leaves us feeling powerless to make any meaningful change.

Physicians today, on average, spend about two hours on paperwork for
every one hour we spend with patients.


An attack on science that undermines trust in our medical
institutions, and too often leads to threats and hostility directed at
us and other health care workers.


Government intrusion into health care decisions and aggressive efforts
in many states to criminalize care supported by science and evidence.

Increasing consolidation across health care that is giving more power
to our nation’s largest hospitals, health systems and insurers, and
less autonomy and fewer choices to patients and doctors.

Widening health disparities for historically marginalized communities,
by race and by gender, between wealthy and low-income, and people
living in urban and rural settings.

The twin health crises of firearm violence and drug overdose.

And for the last 20 years, a shrinking Medicare reimbursement rate for
physicians that has pushed many small, independent practices to the
brink of financial collapse and jeopardized care for millions of
America’s seniors.

I want to pause on that last point for just a moment because while
physicians understand the financial pain of our current Medicare model, I
don’t think the public at-large is aware… nor do they know just how much
they have at stake in our unsustainable Medicare system.

When you adjust for inflation, the payment rate to physicians who care for Medicare patients has dropped 26 percent since 2001, which was my first
year of medical school, with additional cuts planned next year. 26
percent!

I don’t know many businesses in any industry that could withstand a 26
percent drop in revenue and still survive—much less an industry like ours
which is so essential to the health and well-being of our nation.
Meanwhile, we’ve seen high inflation, rising personnel costs, and
increased practice costs that exacerbate these payment cuts.

Considering what my colleagues went through during the pandemic, this kind
of financial blow is simply unconscionable, and it requires immediate
attention from Congress before even more payment reductions kick in at the
end of the year.

Congress must take action. Today.

Why is this an issue for patients to worry about?

Because when doctors lack the resources they need to keep their practices
open, they close their offices. Or they reduce their hours. Or they make
do with antiquated technology and equipment, or fewer support staff. Or
they limit the number of new Medicare patients they take, or stop seeing Medicare patients altogether.

Either way, it’s patients who suffer, especially older adults, or those
with limited mobility who may lose access to essential care … who may have
to wait months longer to get an appointment … or who may have to travel
much further away to see a doctor they don’t know.

As I mentioned, this is the situation my parents faced with their own
primary care physician. They are in their 70s and, like many their age,
they suffer from a variety of chronic diseases and have mobility
limitations.

Too many seniors, like my parents, have gotten the same letter notifying
them that their doctor was no longer able to see Medicare patients. This usually leads to a frustrating and frantic search for a replacement and
too often harm, as delays occur, things get missed in the transition, and patients often end up having to travel farther to receive necessary
services.

Sadly, this is a story that is playing out all over America. It’s
affecting parents and grandparents, anyone who relies on Medicare for
their doctor’s care … and all of us who care for them and their
well-being.

So, how can we fix this?

Our nation’s physician shortage is a complex challenge that doesn’t allow
for quick and easy solutions. But it is not hopeless.

In fact, there are five steps we must take – solutions with bipartisan
bills pending in Congress right now – that would make a huge difference in
our ability to hold onto the physicians we have… and strengthen our
physician workforce so that our nation can better respond to an aging population, and the next public health crisis we will eventually face.

Step one is giving doctors the financial support they so desperately need
to take care of us. This is critical for our colleagues in private
practice that are the backbone of our nation’s health care system,
reaching millions of Americans in rural communities whose health often
suffers because they already lack access to care and have few options if
the local physician closes down.

We need Congress to pass the bipartisan bill that was introduced in the
House of Representatives earlier this year, the Strengthening Medicare for Patients and Providers Act, H.R. 2474, which would do what the AMA has
long advocated for … provide physicians with annual payment updates to
account for practice cost inflations as reflected in the Medicare Economic Index.

This would simply put physicians on equal footing as inpatient and
outpatient hospitals, skilled nursing facilities and others who receive
payment through Medicare.

We need Congress to pass meaningful Medicare payment reform … that step is essential.

Step two is reducing administrative burdens like the overused, inefficient prior authorization process that insurers use to try to control costs.

Physicians and their staff spend an average of two business days a week completing prior authorization paperwork, including submissions and
appeals when insurers inappropriately deny care for treatments already in
wide use. This onerous process not only frustrates doctors and drives up
health care costs, it’s downright demoralizing for patients.

Nearly 80 percent of physicians in one AMA survey say they’ve had patients abandon treatment due to prior authorization struggles with health
insurers. And two-thirds said prior auth delays led to additional office visits, another factor driving up health care costs.

This issue also lies in the hands of Congress with the bipartisan
Improving Seniors’ Timely Access to Care Act, which would expand prior
auth reforms finalized by CMS. It’s also in the hands of the Biden Administration, which can significantly improve the prior authorization landscape if it finalizes proposed regulations … and in the hands of state legislatures, many of which are considering their own reform measures.

About a dozen states have already passed comprehensive prior auth reforms
this year, many based on AMA model bills, but much more needs to happen.

Reforming our antiquated Medicare payment system and fixing the broken
prior authorization process are two pillars of our AMA Recovery Plan for America’s Physicians that we released last year, and which remains the
focus of our state and federal advocacy efforts.

Step three in addressing our physician shortfall is securing passage in Congress of three bipartisan bills that seek to expand residency training options, provide greater student loan support, and create smoother
pathways for foreign-trained physicians, who already comprise about
one-quarter of our nation’s physician workforce.

This is particularly important to address shortages in medically
underserved areas of the country.

The AMA supports the Conrad 30 and the Physician Access Reauthorization
Act bills now in Congress, which would make necessary improvements to the
J-1 visa waiver programs to address physician shortages, especially in
rural and underserved areas, but also promote a more diversified
workforce. The Conrad 30 bill also provides worker protections to prevent doctors from being mistreated.

We also strongly support the Healthcare Workforce Resilience Act, which
would recapture 15,000 unused employment-based physician immigrant visas …
the Retirement Parity for Student Loans Act, which allows retirement plans
to make voluntary matching contributions to physicians during residency …

… and the Physician Shortage GME Cap Flex Act, which expands residency
training programs in primary care or other specialties that are facing shortages.

Step four is to stop criminalizing health care that is widely recognized
as safe, and that is backed by science and many years of evidence.

Predictably, the U.S. Supreme Court’s decision last year to overturn Roe
v. Wade has radically changed the health care landscape in America—for
both patients and physicians.

Fourteen states have enacted outright bans on abortion, and seven others
have enacted partial bans.

Unrelated to the SCOTUS decision but just as damaging, 22 states have
enacted laws restricting or banning gender-affirming care.

Let me be clear: These efforts—fueled by misinformation and a heated
attack on science and evidence-based care—have forced government into the
most intimate and difficult decisions a person can make. They have sown confusion for physicians and patients and opened deep political rifts
between neighboring states. They have made physicians—and other health
care workers—the target of attacks and intimidation.

They have caused aspiring young physicians to reconsider where they will
attend medical school and where they will ultimately practice. And they
have needlessly jeopardized the health of millions of Americans.

Step five is making sure that physicians aren’t punished for taking care
of their mental health needs.

Every physician I know has a friend or colleague affected by burnout, or
has themself confronted symptoms of emotional exhaustion or detachment
from their work.

Physicians, in fact, die by suicide at twice the rate of the general population, an alarming statistic that puts my classmate’s struggles into context.

It's important to say that not all feelings of professional burnout lead
to thoughts of suicide, but the fall out can still have widespread and
lasting repercussions for doctors and patients alike. The roots of
physician burnout go much deeper than every day frustrations we all
experience and, instead, point to systemic issues in our health care
system that are highlighted in our Recovery Plan for Physicians.

What’s worse is that physicians are often reluctant to seek help for their mental health over fears that it will jeopardize their license or
employment because of outdated and stigmatizing language on medical board
and health system application forms that ask about a past diagnosis.

In fact, four in 10 physicians in a recent Medscape survey said they have
not sought mental health treatment because they worry about their medical
board or employer finding out and potential repercussions. Seeking
therapeutic interventions early helps protect against crisis situations
later.

So, while the AMA and others are pushing for legislative fixes to address
the drivers of burnout … while we’re working in collaboration with
national medical licensing and credentialing organizations on this issue … we’re also urging states and physician employers to audit their own
licensing and credentialing applications and remove questions that ask
about past diagnoses of a mental illness or substance use disorder, or
past counseling to help with one.

In its place, we encourage medical boards, hospitals, and health systems
to focus on whether a current health condition, such as depression exists
that, if left untreated, would adversely affect patient safety. And once outdated language is changed, we must be intentional about promoting these revisions far and wide so that physicians know it’s safe to prioritize
their own mental health.

Seeking care for burnout, mental illness, or a substance use disorder is a
sign of strength — an act that takes courage and deserves our health
system’s unconditional support. And, in fact, the health of our patients,
and our nation, depends on more physicians seeking help for their mental
health and well-being before they abandon medicine altogether.

Our nation’s physician shortage is not a problem to set aside and deal
with tomorrow. It is an urgent problem we need to address today.

We must take action to create a stronger and more resilient physician
workforce to care for an ever-changing nation.

We must ensure that you, me, and everyone else in America has a physician
to care for them, or a parent, or a family member, in their time of need.

Most of these solutions have bills pending in Congress with strong
bipartisan support, and momentum growing in many states to put other
safeguards in place.

There isn’t much that our two major political parties see eye to eye on
right now, but on these issues they do. We just need the will—and the urgency—to get it done. We need leaders in Congress to step forward and
make this happen.

Sadly, every day we wait the size of this public health crisis grows.

We need action today.

Thank you.

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