The Challenges of Health Care Reform


This blog post is the first in the Supply, Demand and Medicine series on health care reform.

When the Super Bowl was held at Cowboys Stadium (now AT&T Stadium) in Arlington, Texas a couple of years ago, football fans may remember that the NFL famously, or rather infamously, sold more tickets for the game than there were available seats.

So while some fans were thrilled to be holding the hottest ticket of the year, often after having spent thousands of dollars, they never actually got to attend the game.

With the implementation of health care reform, many observers both inside and outside the industry question whether the U.S. health care system will soon find itself in a similar circumstance.

Tens of millions of Americans will soon be gaining insurance (their ticket), many for the first time, but that doesn’t change the fact that we still have a limited number of physicians, nurses, hospitals and clinics to care for people.

And it’s not just more people with health coverage that will accelerate demand for health care services in the coming years. Our aging population along with the increasing prevalence of chronic conditions, particularly obesity and diabetes, also will add tremendous weight to the demand side of the supply and demand equation.


According to American Association of Medical Colleges (AAMC), there are a little more than 700,000 physicians in the country.

By 2025, AAMC projections indicate the U.S. will be approximately 130,000 physicians short of what’s needed to meet the surge in the demand.

Projections by other organizations have had similar findings.

Given that it takes seven to 10 years (or more in some specialties) to train a physician or surgeon, the challenge may seem insurmountable.

In Training

A 2012 New York Times article reported that about one-third of the physician workforce is age 55 or older. The AAMC estimates that 250,000 active physicians will retire by 2020.

As in any industry, the only way to offset these losses and increase numbers is by training more physicians than leave the workforce. The good news is that we are doing just that.

First-year enrollment at medical schools (conferring both MD and DO degrees) is projected to reach 26,709 by the 2016–2017 academic, an increase of 37 percent over 2002–2003. Class sizes are getting larger at existing schools and more medical schools are opening. This is a trend that must continue.

However, creating more physicians alone will not come anywhere close to effectively meeting future demand for health care. New models of delivery may help.

About the author

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Dr. Couch currently serves as President of the Baylor Scott & White Quality Alliance, an integrated network of more than 3,700 physicians, 43 hospitals, 31 surgery centers, 29 skilled nursing facilities, 10 home health agencies, three hospices and additional points of care aligned with Baylor Scott & White Health.

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The Challenges of Health Care Reform