About a year ago, a couple of economists found that because she doesn’t make enough money, the typical female primary-care physician would have been financially better off if she had become a physician’s assistant instead. Their argument was that these women doctors simply didn’t work enough hours to pay off the cost of their medical training. Women doctors sought a better work-life balance and often took extended time off to take care of their children. Male doctors, by contrast, worked enough hours — more than 50 hours a week compared with the 44 hours a week for women — to pay off their up-front investment in medical school and related training.
This study came to mind when I learned that the United States doesn’t have enough doctors to care for everyone who needs health care, and this problem is only going to get worse. Specifically, America faces a projected overall shortage of 130,600 physicians (including 65,800 primary care physicians) by 2025, according to the American Academy of Medical Colleges. This shortage is caused by the increased demand created by the up to 50 million uninsured people who may now decide to seek health care due to the Affordable Care Act, and to the fall in the supply of physician services that is partly due to changes in the physician workforce.
As an example, nearly 40 percent of young women doctors chose to work part-time in 2010, according to a survey conducted by the American Medical Group Association. Since most primary-care physicians are women, these decisions to work part-time have profound implications for the country’s ability to meet the demand for health-care services.
Another pressure comes from the tremendous cost of becoming a doctor. A graduate in the class of 2014 will have spent $286,806 for four years of study at a private medical school and $218,898 for an education at a public medical school, according to the Association of American Medical Colleges.
Medical school expenses aren’t the end of the story, as doctors must complete a residency and internship before completing their medical training. It’s not too surprising to learn that 80 percent of medical school graduates are more than $100,000 in debt, with nearly 20 percent having more than $250,000 accumulated debt.
Doctors, of course, start to pay down their debt once they set up practice. Those who specialize can expect to make about $388,000 a year, while those who become internists or go into family practice or pediatrics will make just over $200,000 a year, according to the Medical Group Management Association, which released its annual report on physician compensation and production in June.
The looming shortage of physicians, especially in the primary care area, coupled with the rising demand for medical services, poses a severe challenge for the American health-care system.
One solution is to recognize that a significant amount of health care can be performed by nurses, nurse practitioners and physician assistants. Physician assistants typically work fewer hours than physicians — about 40 hours a week compared to 60 hours a week for a physician — making it attractive for many medical professionals. Joseph Antos, an economist at the American Enterprise Institute, highlighted this solution when he told me that allowing nurses and others more authority to provide patient care is “another step that is long overdue” in dealing with the physician shortage.
There’s another innovative solution to the shortage — allow robots to handle many of the routine, low-skilled medical tasks so that doctors’ time can be freed up for more complicated medical issues.
University of California at Berkeley economics professor Brad DeLong has noted that robots can now do lots of things that only humans could do, such as manipulating fine objects and interacting with humans. There’s one area, however, where humans seem destined to maintain an advantage over robots, and that’s “thinking of new things to do, and thinking of better ways to do things,” according to DeLong. In the medical profession, this line of thinking means that robots should be hired to do the routine stuff, like analyzing blood tests, while humans should use their skill to for conducting research to devise new medical treatments or, importantly, to use patient interaction to think of better ways to treat the patient.
For the moment, however, it seems that Dr. Robot’s time may have arrived. A piece in the Atlantic suggested that it would be a lot easier to find and train nurses and physician assistants to use robots than to find and train doctors to do these tasks. They would cost less than a doctor as well.
Allowing this innovation would not only increase the supply of health-care services and thus help alleviate the physician shortage, but it would also allow Dr. Mom to reach her desired work-life balance as well as reduce the cost of providing health-care services. Doing so would help make health care affordable, as suggested by the title of President Obama’s signature legislative achievement.