A Shortage Of End-Of-Life Doctors Is Coming

Bruce Japsen

Bruce Japsen, Senior Contributor

HealthcareI write about healthcare business and policy

Doctor examining sick woman
GETTY Doctor in white uniform examining sick woman with cancer in the health center

A declining number of physicians specialized in palliative care looms and won’t recover for 25 years without major U.S. health policy changes, new research in the June issue of Health Affairs shows.

Research led by Dr. Arif Kamal at Duke University shows about one-third of palliative care clinicians are burned out and about two in five are 56 years of age or older, making a shortage almost certain to begin in less than a decade. Currently, there are about 7,600 physicians who are board certified in palliative care generally and have completed a fellowship and come from a variety of medical disciplines including pulmonology, oncology and primary care.

But those numbers of palliative care specialists, who are an integral part of a team when treating seriously ill patients, aren’t increasing in number. “Our modeling revealed an impending 'workforce valley,' with declining physician numbers that will not recover to the current level until 2045, absent policy change,” Kamal, a medical oncologist and palliative medicine specialist at Duke Cancer Center, and his fellow researchers wrote in their analysis, which covers nine pages in Health Affairs.

Physicians with an expertise in palliative care are critical given the aging population generally, but costs of care for Americans tends to increase near the end of their lives, most studies show.  And specialized palliative care is known to improve health outcomes for patients with serious illness who tend to be at the end of their lives.

Duke researchers and their colleagues used 2018 workforce data and a more than 2,000 survey of specialty hospice and palliative care clinicians last fall in their research. In all scenarios examined, Duke researchers and their colleagues uncovered a shortage that will impact those eligible for Medicare health insurance in particular who are triggering a need for more healthcare services and palliative care for the sickest of these patients. There are more than 10,000 Americans turning 65 every day and becoming eligible for Medicare.


“All scenarios demonstrated a worsening of the patient-to-physician ratio for at least 25 years (2020–45), due to an inadequate physician supply coupled with a growing cohort of Medicare beneficiaries eligible for palliative care,” the Duke researchers wrote.

Meanwhile, the workload of doctors who remain treating patients grows and leads to burnout among these specialized clinicians that is also increasingly problematic, the researchers indicate.

“Our analysis also predicted untenable current and projected workloads for specialty palliative care physicians,” the Duke researchers and colleagues wrote. “We estimated that there was one palliative care physician for 808 eligible patients, and if each patient was evaluated, on average, once every three months (in either a clinic or a hospital), each palliative care physician would need to perform 10 patient visits per day over 48 weeks per year to meet the current demand.”

The researchers recommend Congress pass the Palliative Care and Hospice Education and Training Act, which was introduced in the U.S. House of Representatives earlier this year. “Among its key provisions, the act would fund the development of physician leaders through palliative care academic career development awards, which are modeled on the federally funded Geriatrics Academic Career Award (GACA) Program,” Duke researchers and their colleagues wrote.

More broadly, physicians, teaching hospitals and medical schools have been pushing for an increase in funding for residency slots in all disciplines.

The Association of American Medical Colleges for years now has been urging Congress to lift the cap placed on Medicare funding for residency slots that has been in place since the Balanced Budget Act of 1997.

“The AAMC’s updated analysis shows that the projected physician shortage remains real and significant, with a shortfall of up to 122,000 by 2032,” said the AAMC's chief health care officer, Dr. Janis Orlowski. “To help address this shortage, there are now bipartisan bills, in both the U.S. House and Senate, that would add an additional 3,000 Medicare-supported residency positions each year for five years.”

For more information on healthcare, read Bruce Japsen's book, Inside Obamacare: From Barack And Michelle To The Affordable Care Act.