Lung Health News, Fall 2007 / Winter 2008
A looming shortage of pulmonary and critical care doctors has healthcare professionals concerned about patient care. A study released in 2000 predicted that demand for services would outpace the supply of these medical specialists by 2007.
“The predictions were quite correct and unfortunately, many underestimated the significance of that report,” says Philip Gold, MD, chief of the Division of Pulmonary and Critical Care Medicine at Loma Linda University Medical Center. He is also an active member of the California Thoracic Society, the American Lung Association of California’s medical section.
The study was commissioned by the American Thoracic Society and other groups concerned about the quality of pulmonary and critical care medicine in the United States. It was published in the December 6, 2000, issue of the Journal of the American Medical Association and was the first study of its kind to include aging “baby boomers” in its results, which are a significant factor because as we age we require more medical services.
Care of the critically ill and management of pulmonary disease are two of the largest specialties in medicine. While there is concern about physician and nursing shortages across the boards, these specialties may be hardest hit.
Smoking-related diseases like chronic obstructive pulmonary disease (COPD) and emphysema tend to affect people as they age, which means COPD rates will continue to increase as our population ages.
“The rise of COPD is just one of the many problems we’ll need to address,” says Lawrence Kline, DO, senior consultant in the Division of Pulmonary and Critical Care Medicine at Scripps Clinic and an American Lung Association of California volunteer. “We will see a lot of pulmonary disease in the baby boomer group as smoking and occupational exposures start to affect their health.We have to build our capacity so we can be prepared for more patients with breathing disorders.”
SEVERAL FACTORS IMPACT NUMBER OF SPECIALISTS
“The problem is fairly widespread,” says Andrew Ries, MD, associate dean and professor at the University of California, San Diego School of Medicine, and member of the California Thoracic Society. “It has always been a challenge finding specialists in rural areas, but now we are seeing this problem everywhere.”
Besides the rising need for services by our aging population, several factors are contributing to the shortage of pulmonary and critical care specialists. A key issue is that too few doctors are being trained in those areas. Twenty years ago, healthcare analysts predicted a surplus of specialists and doctors were encouraged to become general practitioners. In California, restrictions were placed on training slots and certification programs to limit the number of specialists.
“The drummed up enthusiasm for more general care practitioners proved to be shortsighted,” Dr. Gold says.
Another important factor is the recognition that critical care specialists vastly improve the quality of care patients receive. A number of studies have shown that critical care teams save lives and reduce costs.The strength of these studies was so compelling organizations like the LeapFrog Group, a business consortium that studies ways to reduce healthcare costs, have required hospitals in its network to have board-certified critical care specialists in the hospital at all times and others are following suit.
“We are not training enough people to meet that demand,” Dr. Ries says.
In addition, some of the more experienced critical care specialists are retiring. Caring for the sickest patients is physically and emotionally draining, often requiring doctors to work around the clock.
“It’s a very stressful environment,” Dr. Ries explains. “You are constantly dealing with life or death issues.”
The American Thoracic Society is working to bring what some are calling a crisis to the forefront, including supporting legislation that would increase the number of training programs.
“We have been working on the issue of physician shortages for quite some time,” says Gary Ewart, director of Government Relations for the American Thoracic Society. “Unfortunately, no one solution is going to fix this problem.”
