The physician shortage — particularly in primary care — has reached crisis levels, yet little is being done to reverse the trend.
The U.S. was forecast to see a shortage of up to 64,000 physicians by the end of 2024 and a shortage of 86,000 by 2036, according to a McKinsey new release of its survey of physicians' view of the shortage. Of the 631 physicians surveyed, 35% indicate they are likely to leave their current roles in the next five years. Of these, 60% expect to leave clinical practice entirely.
Pradnya Mitroo, MD, president of Fresno (Calif.) Digestive Health, joined Becker's to discuss the bleak outlook for primary care and the changes she's like to see.
"It does feel pretty doom and gloom," she said. "It’s really affecting us, especially since we’re in a rural and underserved area. It’s already difficult to recruit physicians here, and it can take months for patients to find a primary care doctor."
The situation is expected to worsen as the physician workforce ages.
In 2023, physicians 65 and older were 23.4% of the active clinical workforce, according to a report from the Association of American Medical Colleges. Data show that more than a third of currently active physicians will reach retirement age within the next decade, if they have not already.
"Honestly, in the next five years, I think the majority of primary care will be handled by nurse practitioners and PAs," Dr. Mitroo said. "There will be very few physicians left in primary care."
She noted that among her colleagues in family and internal medicine, there is little optimism about any forthcoming solutions.
"I don’t think the general public fully grasps how serious this is," she said, citing reimbursement cuts as a major factor.
"Since I started practicing in 2007, Medicare reimbursements have been cut by about 30%," she said. "It's devastating for primary care physicians because their reimbursement is based solely on E/M codes. Private practice in primary care is essentially disappearing because these doctors can’t secure good insurance contracts."
While gastroenterologists and other specialists can offset declining reimbursements with procedural revenue, primary care physicians lack such options.
As a result, many are being forced to join corporate medical groups, MSOs or transition to concierge medicine, creating a two-tiered system where wealthier patients receive physician-led care while others face long wait times or rely on midlevel providers, Dr. Mitroo said.
Despite increasing wait times for appointments, the severity of the physician shortage remains largely unnoticed by the public.
"I was recently in the Bay Area talking to some friends in the tech industry — many in leadership positions. They were shocked. They knew wait times were getting longer, but they didn’t realize just how bad things have gotten," she said.
To reverse the primary care exodus, Dr. Mitroo believes loan forgiveness programs are insufficient. Instead, she advocates for making medical school tuition-free for those who commit to primary care.
“Instead of just offering loan forgiveness, there should be a program where medical school is free for those who commit to primary care — not just in federally qualified health centers or underserved areas, but everywhere," she said.
She suggests that if a physician decided to leave primary care later, they would then have to pay back their education costs. This approach could provide a real incentive to keep physicians in the field.
As primary care compensation continues to decline, the physician shortage will only accelerate unless major policy changes are enacted.