Congress seeks to ease national shortage of doctors

Wichita, Kansas, endocrinologist Richard Guthrie, 72, shown here working with Wichita State University physician's assistant student Stacy Fagan.
Wichita, Kansas, endocrinologist Richard Guthrie, 72, shown here working with Wichita State University physician's assistant student Stacy Fagan. Mike Hutmacher / Wichita Eagle / MCT

WASHINGTON — Congress is under pressure to remedy a national doctor shortage that could worsen on July 1, when physicians who treat Medicare patients get a 10 percent pay cut.

Some say the situation is dire. One-third of the nation's active doctors — or roughly 250,000 — are over 55 and likely to retire in the next decade. And while the number of applicants to U.S. medical schools is increasing, but it hasn't kept pace with the nation's growing population and graduating medical students are facing rising debt loads.

The issue is prompting bipartisan concern, particularly in rural regions.

"I haven't met a single endocrinologist from upstate New York who is either born or trained in the United States. ... You go to any one of our states, the proportion of foreign-born, foreign-trained doctors is huge," said Sen. Charles Schumer, D-N.Y.

A growing number of lawmakers want to stop the upcoming pay cut. And Congress is considering the Physician Shortage Elimination Act, which would spend millions to provide more scholarships for medical students and expand residency training programs throughout the country.

"While the president's budget does not offer any ideas for addressing the physician-payment dilemma, it is undoubtedly one of the biggest challenges that Congress faces," said Iowa Sen. Chuck Grassley, the top Republican on the Senate Finance Committee.

If Congress doesn't act soon, doctors will receive a second pay cut — of 5 percent — on Jan. 1, 2009.

The shortage already has resulted in the rapid increase in the number of nurse practitioners, advanced nurses who can do the work of most primary-care physicians, and it has caused some doctors to delay their retirements.

"Part of the reason I'm not retiring is because I'm needed," said Richard Guthrie, 72, an endocrinologist in Wichita, Kan. "Part of it is I'm having too much fun. As long as I'm in good health and there's a need ... I'll keep doing it."

Guthrie said there's a dearth of physicians in his field and a dire need for his diabetes expertise, not only in Wichita, but also in rural Kansas, where he holds outreach clinics several times a month.

He said low reimbursement rates for Medicare are contributing to a critical shortage of physicians in fields such as family medicine and endocrinology because many graduating medical students, faced with high debt, want to go into higher-paying specialty fields such as cardiology or surgery.

If Congress worsens the problem by cutting reimbursements even more, Guthrie said he may be forced to cut his busy staff.

"It's a shame and it's unnecessary," he said.

State medical societies say there could be a huge doctor shortage by 2020, with the nation short of as many as 200,000 doctors. And in the next decade, the nation's population is expected to grow by 24 percent, while more baby boomers will enter the Medicare system. All of this is creating a sense of urgency in Washington, where big money is at stake.

"It is a significant problem, which we all must address at the federal, state and local levels," said Sen. Pat Roberts, R-Kan., who fears that if the doctor shortage worsens, elderly Americans will have the greatest difficulty getting medical care.

Doctors have stepped up their lobbying efforts on Capitol Hill. They're seeking not only to scrap the pay cuts but also to get raises. A bill introduced by Sen. Debbie Stabenow, D-Mich., called the Save Medicare Act of 2008, would increase Medicare physician payments by 1.8 percent in 2009.

If Congress doesn't stop the July 1 pay cut, doctors say they'll respond by reducing staff, deferring the purchase of equipment, discontinuing nursing home visits and rural outreach, and reducing their workload and hours. Those findings are part of a American Medical Association survey of nearly 9,000 physicians. Among other things, the survey found that 60 percent of the respondents said they would limit the number of new Medicare patients they treat if their pay is cut this summer.

But the doctor shortage is fueling more interest in the medical profession. While the number of medical school applicants declined from 1997 to 2002, it has risen by 7 percent since 2003, according to the Association of American Medical Colleges. The 2007 entering class was the largest in history, with nearly 18,000 first-year enrollees.

Association of American Medical Colleges President Darrell Kirch said there's another good sign: At least 12 new medical schools are in some phase of discussion, which should help ease the shortage.

"After failing to add new capacity for 25 years, we are now responding positively to the real growth and aging of the U.S. population," Kirch said.

(Wichita Eagle staff writer Andi Atwater contributed to this report.)