Florida's population is growing faster than its physician workforce
Florida’s population is growing faster than its physician workforce. Filling the gap will require a range of responses, from better use of technology to more residencies to expanding the care provided by non-physicians.
The Issue: Silver Tsunami
In 2019, Florida was short about 3,835 doctors based on the state’s ability to provide a level of care consistent with the national average. Modeling scenarios — which factor in an array of variables, including population health characteristics, demographic shifts, emergency room and clinic utilization rates, and physician workforce trends — predict that by 2035, the shortfall will grow to roughly 17,924 physicians who will only be able to meet about 77% of the demand for their services, according to a recent report by data analysis firm IHS Markit commissioned by the Safety Net Hospital Alliance of Florida and the Florida Hospital Association.
The looming shortfall is largely because of the so-called “silver tsunami.” Florida’s growing population — its growing elderly population, in particular — is driving up demand for medical services. The population under 18 is projected to grow about 18% between 2019 and 2035, while the number of Floridians who are 65 and over will grow by more than 50%.
Meanwhile, Florida’s doctors are aging. Nearly 35% of the state’s physicians are 60 years and older — and more than 9% of the 55,809 providing direct care to patients plan to retire within the next five years. In five Florida counties, a quarter or more of physicians plan to retire by 2026.
The COVID-19 pandemic accelerated the exodus. A third of all doctors say they plan to reduce work hours, and one in five plans to leave the practice entirely because of COVID- 19-related stress and burnout, according to a study recently published inMayo Clinic Proceedings. “We absolutely have people who were at or close to retirement who have said, ‘Maybe I would have lasted another three to five years, but I don’t see a need to do that, so I’m going to exit now,’ ” says Dr. Marvin Dewar, senior associate dean at the University of Florida and CEO and chief medical officer of UF Health Physicians, the clinical practice arm of UF’s College of Medicine.
Filling the void
Florida has taken steps to add to the supply of doctors. The number of students enrolled in medical schools in Florida increased from 3,454 in 2010 to 6,064 in 2020- 21 — more than twice the rate of increase for the United States as a whole. But data suggest that only about half of the state’s medical school graduates go on to practice medicine in the state, making it impossible for the 1,300 or so students who graduate from Florida medical schools each year to fill the 18,000-doctor hole.
It’s been conventional wisdom for some time that the most effective way to expand Florida’s physician workforce is to create more residency slots — the intensive, post-graduate training experience that medical school graduates need to become full-fledged, licensed physicians. “The biggest predictor of where a physician is going to stay in practice is where they did their residency training,” says Dewar. That training typically takes places in hospitals and clinics and typically lasts for three years but can last up to seven years for certain specialties.
But new residency programs take time and money to create — a new residency program that Lakeland Regional Health started working on eight years ago will have about $13 million in unfunded startup costs, according to an appropriations request made to the Florida Senate — and those on the frontlines say it will take a patchwork of solutions to meet Florida’s medical needs. “Just growing the number of residencies is not going to solve the 18,000-doctor shortage. I think it is going to take far more creative and far more innovative thinking in addressing that access,” says Dr. Venkat Prasad, chief clinical officer of community-based care at Lee Health.
“Whether it’s technology, virtual care, using advanced practice providers in an appropriate manner or team-based care — where you can care for a larger number of patients by having a team of pharmacists, dietitians and other ancillaries helping to take care of the patient — it cannot be all one physician, one patient,” he says.
Filling the Ranks
- The Problem
By 2035, the state will need 74,784 doctors to keep up with the demands of a growing and aging population, but it’s only on track to have 56,859 doctors, leaving the state nearly 18,000 doctors short.
If nothing gives, consumers will likely face increasing difficulty finding a physician, along with longer wait times and shorter appointments. Some fear that more patients may defer care or decide to use emergency rooms for routine care.
- Create more doctors by expanding and funding more residency slots and medical school capacity.
- Attract more physicians from other states and countries with continued use of incentives (such as loan forgiveness) to attract doctors to regions with the most need.
- Change models of care to use technology (such as telemedicine) and non-physician providers — such as advanced practice practitioners, physician assistants and pharmacists — to fill gaps in primary care.
Not Enough Doctors
- Modeling scenarios predict that by 2035, Florida will have a doctor shortfall of about 17,924 — covering about 77% of demand for their services.
- More than 5,100 Florida doctors (9.2%) plan to retire within the next five years. The greatest number are retiring from the following specialties:
55,809 — Active physicians in Florida
69% — Male
55.1% — White
17.7% — Hispanic
13.2% — Asian
5.6% — Black
54 — Average age. Twice as many doctors are 60 years or older (19,359) than are under 40 (8,115)
$209,690 — Average annual wage for an internist in Florida
$244,830 — Average salary for surgeons
The top three specialty groups — internal medicine, family medicine and pediatrics — comprise slightly more than 50% of Florida’s total physician workforce.
36% — Active physicians in Florida who are graduates of overseas medical schools (including Caribbean medical schools). That percentage of overseas-trained doctors trails only the percentage in New York and New Jersey.
51.7% — Ten years ago, about 25% of Florida doctors were women. Today, women comprise nearly one-third of the doctor workforce, and the pipeline is growing. In 2021 — more than half (51.7%) of the 936 graduates of Florida’s allopathic (M.D.-granting) medical schools were women.
Sources: Florida’s 2021 Physician Workforce Annual Report; Association of American Medical Colleges; U.S. Bureau of Labor Statistics