Population Boom, Physician Shortage, and Indigent Healthcare: How can We Prepare?

By Kathryn Keaton

Originally published, July 2024

In 2018, an American Academy of Medical Colleges (AAMC) report projected a national shortage of up to 121,900 physicians by the year 2033.1 Just a few months ago, that number was reduced to 86,000 by 2036.2 While the trend is moving in the right direction, this improvement is based on the hypothetical but not guaranteed increase in graduate medical education spots.3 The current number of incoming primary care physicians is simply not sufficient to replace the number who are retiring, much less to grow to meet the expanding need, and that is just among primary care physicians. Other specialties have not been studied to the same extent, but the AAMC has stated this will be researched more in the coming years.4

Unfortunately, Texas ranks forty-second in primary care physician availability5 and is predicted to be short by over 20,000 primary care physicians by 2030.6 In 2021, 249 of Texas’s 254 counties reported a shortage – including Tarrant and all of its surrounding counties.7

While current and predicted physician shortages are hot topics in the medical realm, the metroplex is also making headlines with the recent and projected population boom. The latest census shows that DFW added over 150,000 residents between 2022 and 2023, and Tarrant County ranked number nine out of ten among Texas counties with the most growth in the same time frame.8 Specifically, Fort Worth had the greatest increase in population of all cities in the state between 2020 and 2023, with a growth rate of 5.3 percent,9 and Fort Worth’s population will likely surpass one million by the end of 2024.10

The Fort Worth Chamber recognizes that “transportation, mobility, water, and energy infrastructure” need to be prioritized11 and has recently announced the new “Moving a Million” project to streamline transportation issues,12 but the looming collision of the impending physician shortage and continuing population boom seems to be unaddressed or unacknowledged – maybe even unrecognized.

“The urgency is now,” said Gerald Harmon, MD, past president of the American Medical Association, in a 2022 podcast.13 And for Fort Worth and all of Tarrant County, projections show that our healthcare access will only get worse as the physician shortage and the population growth gap widens.

Leonard Glass, MD, formerly of the University of California San Diego School of Medicine, recognized the coming physician shortage when he founded Physician Retraining and Reentry.14 In partnership with the medical school faculty, this national program has been addressing this issue since 2013 by creating an online training pathway for physicians who may have left the profession or let their license lapse. They also provide training for surgeons who may no longer be able to perform procedures but who are fully capable of performing primary care duties. The program website lists five major impacts of the physician shortage. One of those five is a growth of healthcare disparities, especially among communities who already face barriers to obtaining basic healthcare.15

Tarrant County has a well-documented network of free and charitable clinics that serve mostly uninsured patients. These clinics, along with JPS resources, bridge this gap – which is mostly primary care – in our community. But as with any charitable endeavor, resources are limited. Lori Kennedy, director of healthcare services at Cornerstone Assistance Network’s clinic, says that the organization is seeing the impact of physician and advanced practitioner shortages firsthand. “The need is up, but volunteer numbers are down,” she says. She encourages retiring doctors to hold on to their licenses for at least a year after retirement. “Sometimes after a year, doctors realize they miss seeing patients and want to do a little volunteer work.” Clinics like Cornerstone rely on volunteer physicians, and retired or almost-retired physicians make up most of this volunteer base.

Linda Siy, MD, a family medicine physician, says that the Tarrant County indigent population needs are handled through specific resources and safety net programs. “The need will grow, and the population will feel the strain,” she says, “and so will our safety net programs.”

While Ms. Kennedy and Dr. Siy share their concerns from a primary care perspective, Project Access is beginning to notice that patients across many specialties are having to wait 3–4 weeks for an initial phone call and often several more weeks before the next new patient appointment opening. This is in no way a slight to our volunteers – our dedicated volunteers and their offices treat PATC referrals in the same way they would any other funded patient.

The problem of the physician shortage and its exacerbation by our population boom has to be solved on many levels from the city and county management, healthcare infrastructure, medical education, and the business sector. The alarm bells are sounding, and hopefully healthcare access is a topic of discussion during this time of growth.

The average physician is not going to be involved in these strategic planning discussions, but you can still make a difference starting today. Our charitable clinic network is always in need of primary care volunteers, and they even take care of malpractice coverage when needed.

Of course, PATC always needs your help too. One of the beautiful things about PATC is that YOU are in control of how many patients you see per year, and you don’t have to leave your practice to see them – they are scheduled in the course of your normal workday and any surgeries are done where you are already credentialed.

We know this won’t solve all of Tarrant County’s problems. Physicians alone cannot fix this issue – this will have to be addressed by the local municipalities. Unless dramatic action is taken, physician shortages will still get worse and wait times will continue to increase as the population grows. But we as a physician-led charitable program can pave the way, showing our community that we will do everything within our power to help those in need.

References:

1. Patrick Boyle, “U.S. Physician Shortage Growing,” AAMC, June 26, 2020, https://www.aamc.org/news/us-physician-shortage-growing.

2. “New AAMC Report Shows Continuing Projected Physician Shortage,” AAMC, March 21, 2024, https://www.aamc.org/news/press-releases/new-aamc-report-shows-continuing-projected-physician-shortage.

3. Global Data Plc, The Complexities of Physician Supply and Demand: Projections From 2021 to 2036 (Washington D.C.: AAMC, 2024), vi.

4. Global Data Plc, The Complexities of Physician Supply and Demand: Projections From 2021 to 2036 (Washington D.C.: AAMC, 2024), x.

5. “Texas Physician Shortage Facts,” Cicero Institute, April 3, 2024, https://ciceroinstitute.org/research/texas-physician-shortage-facts/.

6. “Physician Shortages State-By-State,” Physician Retraining and Reentry, March 23, 2022, https://prrprogram.com/physician-shortages-state-by-state/.

7. Bonnie Petrie, “Texas Primary Care Doctor Shortage Spikes during the Pandemic; Rural Texans Hit Hardest,” Texas Public Radio, November 17, 2021, https://www.tpr.org/public-health/2021-11-17/texas-primary.

8. “More Counties Saw Population Gains in 2023,” United States Census Bureau, March 18, 2024, https://www.census.gov/newsroom/press-releases/2024/population-estimates-more-counties-population-gains-2023.html.

9. “Fort Worth Soars: Unpacking the Latest Demographic Surge and Future Projections in North Texas,” Fort Worth Chamber, December 4, 2023, https://www.fortworthchamber.com/fort-worth-soars-unpacking-the-latest-demographic-surge-and-future-projections-in-north-texas/.

10. “Population,” City of Fort Worth, accessed June 6, 2024, https://www.fortworthtexas.gov/about/population.

11. “Fort Worth Soars: Unpacking the Latest Demographic Surge and Future Projections in North Texas,” Fort Worth Chamber, December 4, 2023, https://www.fortworthchamber.com/fort-worth-soars-unpacking-the-latest-demographic-surge-and-future-projections-in-north-texas/.

12. “Moving a Million,” Fort Worth Transportation Plan, accessed June 6, 2024, https://www.movingamillion.org/.

13. “Doctor Shortages Are Here— Time to Act, Drs. Harmon and Orlowski Weigh In,” AMA Moving Medicine, accessed June 6, 2024, https://ama-moving-medicine.simplecast.com/episodes/doctor-shortages-are-here-time-to-act-drs-harmon-and-orlowski-weigh-in.

14. “The PRR Program,” Physician Retraining and Reentry, accessed June 6, 2024, https://prrprogram.com/.

15. “How the Primary Care Physician Shortage Impacts Healthcare,” Physician Retraining and Reentry, September 29, 2023, https://prrprogram.com/how-the-primary-care-physician-shortage-impacts-healthcare/.