Physician’s guide to healthcare reform

THE MOST RECENT FIGURES released by the Centers for Medicare and Medicaid Services (CMS) show that health care spending in the United States grew 7.5% in 2023 to $4.9 trillion, or $14,570 per person. 

The share of the GDPspent on health care was 17.6%, a drop from 19.7% in 2020 during the pandemic. 

Between 2019 and 2020, federal spending on health care increased 36% to pay for the Provider Relief Fund, the Paycheck Protection Program and added expenses for public health. Those added expenses have stopped. 

Spending by service and product 

The largest portion of health care expending is for hospitals (31%), followed by physicians and clinical services (20%) and retail prescription drugs (9%). 

Within the health care categories, rates of growth, as well as dollar amounts, were high for hospitals, prescription drugs and nursing facilities: between 9.5% and 11.4%. Payments for physicians and clinical services grew at a lower rate (7.4%). 

Projections for 2032 

CMS projects that spending on all categories of health care providers will increase between now and 2032. The proportion GDPspent on health care is likely to increase back to pandemic levels. 

As might be expected, per-person spending on people over 65 is more than the spending on the younger population. Spending on a person over 65 is five times more than spending on a typical child and 2.5 times the spending on those 18-64. 

The cost of health care also varies significantly by state. Using 2020 figures for personal health care spending in the general population (excluding some costs of government administration), New York was the highest ($14,007 per person) and Utah was the lowest ($7,522 per person). 

Growth in the health care workforce 

Between 2010 and 2023, the number of active physicians in the U.S. grew 19% to a total of about 1 million. 

Projection of physician shortages 

The Association of American Medical Colleges projects a shortage of physicians by 2036. The projections of shortages for the country vary markedly—from 13,500 to 86,000, depending on underlying assumptions and variables. 

One of the most important variables is the federal government’s willingness to fund graduate medical education (residency positions). Increased funding will reduce shortages. The report adds, “In the absence of such funding increases, the projected shortfalls would be much more severe.” 

The need for more physicians will be even larger, according to the report, if “communities historically underserved by our health care system had fewer access barriers.” 

The greatest projected need for physicians is in primary care and surgical specialties. In medical specialties, there are fewer shortages, and in some cases, surpluses of physicians. 

Medical specialties in which there are expected to be a surplus of physicians are critical care and pulmonary medicine, emergency medicine and endocrinology, according to the National Center for Health Workforce Analysis. 

Budgetary priorities of the Trump administration will affect training of physicians and funds available for patient care, particularly under government programs. •