Colorado will need 50 new general medicine doctors and 20 new obstetricians each year for the next decade to keep up with health care demands and an aging physician population.
Overall, the state’s need for family doctors and obstetricians will increase by 28 percent by 2014, according to estimates from the Colorado Department of Labor and Employment, based on retirement, turnover and increased demand for health care.
In its biennial survey of doctors who renewed their medical licenses in 2005, the Colorado Health Institute discovered a troubling fact about medical care: the high number of doctors — 35 percent — who are 55 or older.
The study parallels the nation’s demographics of aging doctors.
“The baby boomer generation is getting older, and the number of people nearing retirement age is unprecedented,” said Pam Hanes, president of CHI. “It’s something to keep an eye on — we’re tracking with national trends, which also show aging of the physician work force.
The physician shortage will be felt most acutely in areas that already suffer from lack of doctors, nurses and health care support services: Colorado’s rural eastern plains and western slope.
“Doctors tend to choose urban and suburban practice areas,” she said. “So the people who will feel the future shortage are the same ones who are feeling it now.”
But Hanes hesitates to say that there will definitely be a shortage of doctors, and she doesn’t want to put numbers on how many doctors the state will need to meet the increasing demand for medical care.
“One thing about this field of research is that the supply and demand equation is an imperfect science,” Hanes said. “But the national data also shows that there will be a shortage — the changing demographics in the nation are going to bring a burden of chronic disease, and we’ll need more doctors to address that.”
The survey showed something else that the association will continue to track: the number of specialists compared to general practitioners or family medicine doctors. Sixty-one percent of doctors said they practice some sort of specialty. That leaves an aging population, families and children without access to a primary care doctor, Hanes said.
“This specialty distribution closely corresponds to national estimates,” the survey said. “COGME (Council on Graduate Medical Education) has recommended a 50/50 split between primary care and other specialists … and recommended that physician specialty distribution should reflect demand factors at the stub-state level.”
Nationally, the number of physicians practicing with specialties and sub-specialties has increased, according to the American Medical Association.
“In 2004 there were 359,000 active primary care physicians, compared to 153,000 in 1975,” according to the study. “Primary care physicians as a percentage of the total active work force increased only moderately — from 42 percent to 45 percent.”
Health care analysts have focused on the lack of doctors who practice in primary care areas, but with the rapidly aging population, that dichotomy is changing — mostly because of the prevalence of chronic disease.
“The aging of the population will mean an increased number of specialty doctors who address chronic disease because those diseases will become more prevalent,” Hanes said. “Some diseases could be managed by primary care doctors, but as more doctors specialize, they will have to go to a specialist.”
The problem is one of supply and demand. Doctors and the general population are aging and they’re also living longer with chronic disease.
“This reflects the trend nationwide, so it’s worth watching,” Hanes said. “Some changes need to be made in health care. They need to be teaching people more about geriatrics, more about chronic disease management. These are the issues we’ll be facing in the future.”
Aging doctors tend to spend less time with patients, according to the survey, which means that in rural areas, at least, a doctor’s time becomes even more valuable.
“Rural areas are going to need to respond to this,” Hanes said. “And they are. One of the things we see is that people who grew up in rural areas tend to go back there to practice. So there are ‘grow your own’ programs to encourage people to go back to those rural areas after they graduate.”
One encouraging aspect is the number of students enrolled to become osteopathic doctors, she said. Physicians with D.O. degrees — instead of M.D.s — tend to become primary care providers, she said.
But other health care analysts do not believe the doctor shortage will be serious — or that there will be a shortage.
“Medical schools are still getting record applications,” said Sheila Carlon, a health care administration professor at Regis University. “They’re turning people away. There’s a steady stream of people in the pipeline. In my opinion, there won’t be a shortage. There might be pockets in very urban areas of large cities, or in rural areas where we’ll continue to have few doctors.”
The politics of health care is a larger problem for practicing physicians, she said. Cuts in reimbursement levels and high malpractice insurance premiums are leading doctors to retire early or leave the field.
“That’s the more worrisome aspect of health care,” she said. “Medicare just cut the reimbursement rate for ambulatory surgical centers that do gastroenterology to 65 percent of what hospitals receive. Doctors in those centers are going to be leaving. That’s going to leave a gap in care.”
But aging is still an issue, Carlon said. Many doctors are refusing to take new Medicare patients, and older doctors can be frustrated by the bureaucratic red tape from a myriad of sources.
Overall, Carlon said, there is no cause for alarm.
“For at least the last 20 years, people have been anticipating doctor shortages,” she said. “There’s never been one. It’s not anything like you see in the nursing shortage. Doctors aren’t going to the critical shortage — that’s going to be nurses. It’s just not going to be as bad as what they think.”