The AMA predicts a shortage of medical specialists by the next decade
STEVE INSKEEP, HOST:
Hospitals across this country are facing a shortage of specialty doctors. And for what it's worth, the American Medical Association extended those trend lines into the future and found that if nothing changes - this is just a forecast - but if nothing changes, the country would be short 77,000 specialists in years to come. Lesley McClurg from our member station KQED reports.
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LESLIE MCCLURG, BYLINE: Doctors race between patients at Queen of the Valley Medical Center in Napa County, north of San Francisco. It's 3 p.m. on a busy Monday in the ER. Dr. Naomi Marks is diagnosing a woman grimacing in pain.
NAOMI MARKS: So I got the results of your MRI.
MCCLURG: Marks tells the patient her pancreas is infected. The woman is nauseous and complaining that her belly and back are on fire. She can't sit up.
MARKS: So from the moment we spoke, I've been trying to reach a GI doctor at another hospital.
UNIDENTIFIED PATIENT: OK. Sure.
MCCLURG: A GI doc is a gastroenterologist, or specialist focused on the digestive system. This hospital doesn't have one on staff or on call. So Marks is calling large facilities up and down the state, looking for a hospital with a specialist and an open bed. There's no formal process for this.
MARKS: So I'll keep you updated.
UNIDENTIFIED PATIENT: OK.
MARKS: And we have more pain medications if you need.
MCCLURG: Marks says it's not uncommon for really sick patients to wait three or four, even five days for a transfer. That's hard on patients, says Dr. Andrew Fenton. He's the hospital's chief of staff.
ANDREW FENTON: If you're a sick patient, you're trying to convalesce, and you're in the emergency department, and the lights are on, and there's alarms beeping, it's just - it's not the correct place.
MCCLURG: And he says patients can deteriorate or even die waiting for the specialized care they need. For example, when a stone from a gallbladder infection must be removed, if a specialist isn't available to do it, the infection can become septic and lethal. The same is true if a patient has an aneurysm bleed and a neurosurgeon isn't available. All across the country, there are not enough specialty doctors - especially docs willing to work on-call shifts inside hospitals.
FENTON: We recently lost ENT. We used to have ear, nose and throat call. They're gone now. We don't have ophthalmology. We don't have plastic surgery, oral maxillofacial surgery.
MCCLURG: Meanwhile, the ER is completely full. The hallway is lined with patients waiting on gurneys. One bleeds from a head injury. Another has lacerations on his face. Doctors have even transformed a small office near the waiting room into an exam room to evaluate more patients.
FENTON: It looks a little bit like a MASH unit right now when you come into the ER. It's not pretty.
MCCLURG: Bottlenecks inside the ER are not new, and neither are staff shortages. But both have been exacerbated by the pandemic.
DONALDO HERNANDEZ: It's hard. It will get nothing but worse.
MCCLURG: That's Dr. Donaldo Hernandez. He is the president of the California Medical Association. Even he can't get in to see a specialist. Hernandez needs to see a gastroenterologist for some preventive care. He called his health plan recently. The next available appointment is four months out.
HERNANDEZ: The system was broken before the pandemic. It's in shards now.
MCCLURG: The issue is hitting some specialties and some states harder than others, but...
JESSE EHRENFELD: The problem is national.
MCCLURG: That's Dr. Jesse Ehrenfeld. He's the president of the American Medical Association.
EHRENFELD: We're seeing, obviously, this play out in all sorts of ways across the country.
MCCLURG: He says the shortages start with medical school. The number of students in training is not rising fast enough to fill empty slots. In 1997, Congress capped the number of residency slots and froze funding. That's hardly changed since.
EHRENFELD: We just don't have the physician workforce we need today, and we definitely don't have the physician workforce that we're going to need tomorrow if we don't take action now to solve this training problem.
MCCLURG: Pending legislation could improve the situation, but states will also likely have to get creative. For example, there's a city in Northern California desperately short of mental health specialists. So the county is partnering with a nonprofit to launch a local psychiatric residency program to fill the need.
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MCCLURG: Back inside the emergency department in Napa County, hours have passed. ER doc Naomi Marks still doesn't have good news for the woman with pancreatitis.
MARKS: It could take her days to go someplace.
MCCLURG: Marks wishes there was more she could do, but she has to move on to her next patient, waiting on a gurney in the hallway. For NPR News, I'm Lesley McClurg in Napa County.
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