Despite these differences, a review of the literature on physician dissatisfaction suggests that the gender shift in medicine is not responsible for the growing level of dissatisfaction.
Is there a shortage of physicians?
After much talk of an impending physician shortage, many medical schools have increased class size, and a number of new medical schools recently opened or are on their way to opening. The Association of American Medical Colleges recommends that medical school class size increase 30% by 2015.32
Some experts believe that there will be a dearth of generalist physicians; others think that specialists will be in short supply.
Possible causes of the shortage
The coming physician shortage has been attributed to a number of variables, including:
- an aging population, which will require a greater level of health care
- aging physicians, with as many as 30% of the current workforce expected to retire during the next 5 to 10 years
- an increase in the number of female physicians who work fewer hours than their male counterparts
- an increase in physicians from Generations X and Y, who place greater emphasis on lifestyle and personal time.33
Cooper, who has written extensively on physician workforce numbers, believes that placement of the Medicare-funded graduate medical education (GME) position cap approximately 10 years ago has been the major driver of the physician shortage. Improvement will come, he says, only when this cap is lifted or altered.34
Are there enough doctors?
The number of physicians per capita is at its highest point in 50 years in the United States, yet the Council of Graduate Medical Education predicts a 10% shortfall by 2020.35 When regions with a high supply of physicians are compared with regions with a low supply, outcomes are the same, and patients do not perceive any physician shortfall.36,37 It is interesting that, in regions where there is a high supply of physicians, physicians perceive there to be greater difficulty in providing the quality of care they desire for their patients.38
A greater supply of physicians leads to more tests and procedures and higher costs.37 Goodman and Fisher believe that having more specialists decreases the flexibility of the physician workforce. They also believe that the GME cap should be maintained, funding should be reallocated to the more cognitive specialties, and the current payment system should be reformed.35 (Any physician who has attended a hospital medical executive committee meeting knows that reallocation of resources to cognitive specialties will never happen: Hospitals want more surgical procedures to boost their bottom line.)
A review of the many studies and opinions published about current work-force numbers and future needs makes it obvious that very little evidence exists to support any of the recommendations made by experts. Almost all studies mention adding to the workforce with minimal discussion about how to keep the current workforce from leaving—a much better use of resources.
Age is the determining factor
The Baby Boomer generation (born between 1946 and 1964), which had largely controlled all aspects of medicine, especially leadership roles, is rapidly being replaced by physicians from Generations X and Y (born between 1965 and 1980, and 1981 and 2001, respectively), who value personal time and lifestyle much more than “Boomers” have.13
These younger physicians demand flexibility and variety in their careers. They grow dissatisfied when these aspects of their work lives fall out of their control. And when it comes to choosing a specialty in which to practice, these physicians see a balanced lifestyle as the key variable.13
Much of the discussion of dissatisfaction in medicine has contrasted Baby Boomers with subsequent generations. The Boomer physician typically has a traditional marriage, with the spouse doing most of the parenting and managing household duties. The Boomer physician is more likely to be male, work long hours, and see professional life as the overall driving force of daily existence.
However, the perception that a Boomer physician is immune to career dissatisfaction is incorrect. Dissatisfaction and departure from practice are directly related to age, with those who are 50 or older more likely to experience them.14 In another study, age and dissatisfaction were the principal factors positively associated with intention to leave practice.15
For Generations X and Y, time is the overarching issue
Generations X and Y physicians are an equal mix of genders, with the majority of couples having dual careers. Their desire for balanced work and family life has made time the primary issue in rising dissatisfaction with medicine. There is less time for each patient encounter, more time required for documentation to justify reimbursement, more time necessary to deal with practice management, and less time to handle family issues—especially personal well-being.16 These issues have also contributed to rising dissatisfaction among Baby Boomers.