A 2021 Merritt Hawkins article reports increasing physician shortfalls in the U.S. while pointing out that almost 50 percent of all currently practicing physicians are older than 55. In some medical specialties, the “greater-than-55” physician numbers are between 60 to 90+ percent.

Similar findings have been confirmed in an updated January 2023 Becker’s Hospital Review article. These recent reports estimate that there will be a shortfall of between 54,000 and 139,000 U.S. physicians by 2033. To add to the problem, the U.S. does not currently train enough physicians to meet even existing demand, much less the coming bulge as 76 million baby boomers continue to develop increasing health care needs.

Health care worker “imports”

For decades, the U.S. has relied on importing physicians and nurses from other countries to fill our increasing demands. Part of the rationale for this importation is that it leaves most of the burden of the expensive training costs for physicians and nurses to other countries. Since 1997, Congress has not agreed on a pathway to further fund graduate medical education. (Read the writer’s further comments here.) Congress in 2021 finally agreed to fund 1000 new resident positions – not nearly enough.

However, with an increasing worldwide shortage of physicians, other countries, such as the European Union, are now out-competing us in recruiting these same “importable” physicians and nurses. (Read the writer’s further comments here.)

Workplace dissatisfaction leading to further shortfalls

We now face an even greater shortfall as more of our mid-career physicians and other health care workers report dissatisfaction with the status of their current health care workplace and have quit health care for other careers. Up to 20 percent of the U.S. health care workforce is reported to have already left health care (up to 4 to 5 million workers), with more on the way out.

An AI solution?

We have seen that artificial (AI) intelligence systems such as ChatGPT can now pass College exams and medical licensing tests, carry on interactive conversations with humans, answer complicated medical and other questions, independently generate content, and write articles such as exam essays. AI bots are now conducting initial interactive jobseeker interviews “and make a decision right then.”
AI can now better identify abnormalities in ECGs and imaging studies than many “expert” physician readers. In addition, AI systems such as ChatGPT are showing exponential growth and adoption in all sectors.

In a recent op-ed piece, Dr. Robert Pearl discusses five ways ChatGPT and similar AI systems will change health care forever. These are:

1. By becoming exponentially faster and more powerful
2. By emulating how doctors make clinical decisions
3. By providing around-the-clock medical assistance
4. By preventing medical errors
5. By helping all doctors perform like the best doctors

If human workforce and workplace issues continue to go unaddressed?

Though our physician and nursing workforce issues are potentially fixable — what if the U.S. remains unable to summon a unified political/economic/health care will to work together to find a human solution — as they have failed to do over the past 20 years? With many hospitals and health care systems struggling financially, there is growing frustration among many corporate and private equity health care leaders over the worsening shortfall in physicians and other health care workers and the long-term failure to produce solutions.

Private equity companies have already replaced physicians with non-physician providers and obtained financial successes. What rate-limiting steps would have to be overcome or bypassed by motivated companies to use AI for various previously physician-driven functions? Perhaps the future of health care delivery is in AI — and sooner than we think.

Harry Severance is an emergency physician.