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According to the U.S. Department of Health and Human Services, about 20% of the nation's population - a hefty 60 million - lives in parts of the country designated by the government as having a shortage of health professionals. On a global scale, the U.S. averages 2.3 doctors per 1,000 residents, well below the 2.9 recommended by the Organization for Economic Cooperation and Development and adhered to by most industrialized nations. Additionally, although there are about 800,000 active physicians - up from 500,000 two decades ago - there is still not enough to fill the needs of a population that is both growing and aging. As a result, millions of Americans are finding their access to convenient and quality health care is limited. People wait weeks for appointments, emergency departments have lines out the door, and doctors are working longer hours for less.

In other words, the supply - 25,000 new doctors every year - is not keeping up with the growing demand. The public expects good, innovative health care, but U.S. medical schools are not producing enough physicians to provide it. The prognosis for the foreseeable future is grim. The new crop of physicians will just about compensate for those retiring every year. Within a decade, however, a large number of licensed doctors will no longer be practicing, creating a hard-to-fill void. Studies show that an estimated 3,000 to 10, 000 more physicians are needed per year to boost the ranks of active doctors to a level that meets the needs of the population at large along with the increasing number of retirees. But producing more doctors is not as simple as it may sound. A 2007 American Podiatric Medical Association study of the podiatric workforce confirmed that the number of podiatrists graduating and practicing over the next 10 years will be insufficient to meet a projected surge in demand for foot-care services. With an increasingly older, heavier and diabetic population, the number of graduating podiatrists will need to triple in the coming years to keep up with the needs of the population. And without an uptick in graduating podiatrists, other physicians will be required to increase their case load of foot-related services.

The key to resolving the personnel shortage is to focus on increasing the number and quality of applicants to podiatric schools and easing the financial burden that often plagues new podiatrists, many if not most of whom graduate deeply in debt. Some incentives include:

 

Increase Medicare payments and mandate private insurance reimbursements for all podiatrists regardless of geographic region. This increase can be paid for with a reduction in payments to other specialists so that income begins to balance or equalize. Podiatrists are near the bottom end of the earnings scale relative to other specialists.



Increase the number of students enrolled in medical school. There has been a drop in interest in podiatric medicine since the mid-1990s. The number of graduates from podiatric medical schools in the U.S. declined from 680 in 1995-96 to 331 in 2006-07. Moreover, many students who apply to medical school every year are denied entrance, further constricting the future supply of doctors.

Place limits on malpractice suits. Make them high enough to make a difference, but low enough that insurance rates are manageable. This will keep podiatrists from leaving the profession due to the cost of insurance and the threat of frivolous lawsuits.

Provide educational loan subsidies and more merit-based academic grants to encourage and increase medical school enrollment. It is essential that legislative and regulatory efforts are boosted to ensure that all debt-relief programs and other avenues of debt reduction are made available. With U.S. podiatrists required to obtain an undergraduate degree, a medical degree, state and national licensing, and a two-to-three-year residency, something must be done to help offset their financial burdens.

Make no mistake: a doctor shortage will have lasting consequences on the American public. The good news is that U.S. physicians are among the best in the world. The bad news is that there are not enough of them to go around.

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