An older, sicker US will need more specialists, study says

BMJ 2013; 347 doi: (Published 07 November 2013) Cite this as: BMJ 2013;347:f6711
  1. Michael McCarthy
  1. 1Seattle

To meet the needs of its aging population the United States will need to train more healthcare providers in general and more specialists in particular, a new study has found.

In the study, researchers at IHS, a Colorado based market analytics company, used a mathematical model that takes account of such factors as demographics, disease prevalence, and use of healthcare services to predict the demand for healthcare services in the US in 2050.

The study, by Timothy M Dall, managing director for healthcare and pharma at IHS, and colleagues appears in the November issue of Health Affairs.1

Although the US population is projected to grow by 9.5% from 2013 to 2025, the population aged 65 or older will grow by nearly 45%, the researchers noted.

With this increase in the proportion of elderly people there will be a marked increase in the prevalence of chronic diseases requiring specialty services, they wrote. The proportion of the population with diagnosed diabetes, for example, is projected to grow by 21% and the proportion with cardiovascular disease by 27%.

These changes in demographics and disease prevalence, together with rising numbers of people with insurance as a result of the Affordable Care Act, will boost the demand for primary care and specialty care, the researchers said. The number of visits by adults to primary care offices will rise by 14% by 2050, for example, but numbers of visits to some specialties will rise even more: by 18% in cardiology and rheumatology, for example, and by 17% in neurology and dermatology.

Barring a change in patients’ use of healthcare services or in the way healthcare is delivered, the demand for primary care physicians, including geriatricians, should grow by 14%, the researchers estimated, but demand for neurological services, radiology, and general surgery was projected to rise by 18%, cardiology by 20%, and vascular surgery by 31%.

Demand for general pediatric services, on the other hand, was projected to grow by only 6%, reflecting the projected low growth of the US child population.

Although some have argued that the US already had too many specialists, the wait times that patients currently experience indicate that already there may not be enough supply to meet the growing demand, the researchers noted.

For example, the wait time to see a neurologist for a new patient visit currently runs to nearly 35 days, for a routine gynecological exam by an obstetrician/gynecologist 27.5 days, and a skin exam by a dermatologist 22 days.

“Failure to train sufficient numbers of specialists could exacerbate already long wait times, reduce access to care for some of the nation’s most vulnerable patients, and reduce patients’ quality of life,” the researchers concluded.


Cite this as: BMJ 2013;347:f6711