The Affordable Care Act is the most important piece of federal health care legislation since the Social Security Act of 1965 established the Medicare program. It assures that 32 million Americans will have access to health insurance for the first time. But who will care for these people?

Our health care system was plagued by a severe and worsening physician shortage even before the new law took effect. In fact, a 2008 study by the Health Resources and Services Administration projected shortages of 35,000 surgeons and 27,000 medical specialists within 10 years, and that’s not even counting expected shortfalls among primary care practitioners like those in Family Practice and Obstetrics.

Those 32 million newly insured people will create an unprecedented surge in demand for physician services, exacerbating this shortfall by at least 50%, according to a new report by the Association of American Medical Colleges.

The report estimates that by 2015—which is one year after the major provisions of the Affordable Care Act take effect—the US will be short a whopping 63,000 physicians—including both PCPs and specialists. Previous analyses had pegged the shortage at 39,600 physicians.

Nearly half the shortfall, 33,100 to be exact, involves specialists like cardiologists, oncologists and emergency medicine experts. For certain specialties like urology and thoracic surgery, the number of physicians is actually expected to decrease.

The report adds that the shortage will get worse in the following 10 years. For example, by 2020, our nation will be short by 45,000 primary care physicians, and 46,000 few specialists.

The physician shortfall will be exacerbated by demographic trends. The number of Americans who are at least 65 years old (a group known to require more medical care than younger folks) will increase by 36% during the upcoming decade, according to the Census Bureau. The graying of the US population is also expected to mean that nearly a third of today’s practicing physicians will retire within the next 10 years, according to the AAMC report.

The physician shortfall will hurt everyone, but the AAMC projects that the impact will be particularly severe on medically underserved populations where finding a doctor is already quite difficult. The population in question includes nearly 20% of Americans living in inner-city and rural areas where shortages of health professionals are already acute.

Offsetting this trend to some degree is the fact that (provisions in the Affordable Care Act aside) the number of medical school students will increase by about 7,000 graduates per year during the next decade. Unfortunately, according to the AAMC this increase doesn’t keep up with the projected surge in demand for physician services.

What should we do?

While team-based approaches like “medical homes” can ameliorate the looming crisis to some degree, few believe they will eliminate it.

Recognizing this, the AAMC recommends that Congress should mandate at least a 15% increase in residency training slots which would add 4,000 physicians per year to the pipeline. This surge is not contemplated by the Affordable Care Act, which in the most optimistic of projections will add approximately 350 physicians per year for the next decade via small primary care grants and the reshuffling of residency programs.

The only way to reach the AAMC’s proposed target of 4,000 new physicians per year, it seems, would be for Congress to overturn a 1997 law that froze Medicare-funded residency positions and increase by at least 15% the number of GME positions funded by Medicare. However with Congress mired in partisan gridlock and public opinion now pretty entrenched against new spending programs, this seems like a long shot at best.

Beyond this, the options are relatively slim and controversial. We either agree to increase the numbers of foreign medical graduates or expand the scope of practice for nurse practitioners so they can help shoulder the burden of an accelerating demand for medical services.

To those who would disagree with these latter solutions, which can work, I ask, “What alternatives do you propose?”

Glenn Laffel is a cardiologist who blogs at Pizaazz.

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