Somehow, amidst the politically charged health care discussions, it seems that some have overlooked one practical thing: If the health care insurance rolls increase, as some expect, will there be enough doctors in the future? The number of graduates from U.S. medical schools has been constant at about 16,000 per year in the recent past. But our country grew by 50 million people from 1980 to 2000, and the number of new doctors has fallen as a percentage of the population. Just a year ago, the American Association of Medical Colleges (AAMC) estimated that if there are no changes in the American demographic distribution, there will be a shortfall of more than 150,000 physicians by the year 2025. The number of new students enrolled in medical schools reached a new record of 18,036 this year (up only 1.6 percent from last year). But there will not be enough. In fact, the AAMC indicates that an increase in enrollment by more than 30 percent will not make up for the growing demand. If that is an expected demand, shouldn’t there be some indication of a supply-side response?

If one thinks about the AAMC report, it seems that there may be an even greater problem than the organization has estimated. That is because few medical students are choosing primary care specialties. The growth of the aging baby boomer population means there will be an even greater shortfall. In some states, people are concerned about these issues, but there seems to be little discussion in Missouri.

In Wisconsin, it was found that they were short 374 primary care physicians this year, and by 2030, there will be a 14-percent shortfall. In Massachusetts, the state’s health care experiment resulted in 440,000 new people with health care insurance, and their problems are going to be even greater given that about 52 percent of their medical residents in training are planning to move out of state after graduation. In Connecticut, just like in many other states, there is an aging physician population among those involved in “family practice,” and doctors are finding it difficult to recruit young physicians.

Both the House and Senate bills proposed to reform the nation’s health care system speak about the need to increase the numbers of primary health care practitioners. However, if one performs a comparison, a resolution to this issue does not appear to be addressed in a direct manner in either version. The bills under discussion now seem aimed at increasing incentives to providers, but not increasing provider numbers. It takes years to train competent physicians. If these bills (or some combination of them) pass into law, and if provider incentives attract more Americans to want to become physicians, this country will still continue to have an inadequate physician supply for many years. This lag period will harm us all.

In the past some have thought that physicians induce a service demand. How that figures into our current problem was discussed elsewhere recently. But physician-induced demand does not matter when there are not enough physicians. If things continue as they are now, someday you will be old and sick and unable to find a competent physician.