All content 2000 THE MIAMI HERALD


Sunday, December 10, 2000
Section: Front
Edition: Final
Page: 41A
BY SETH BORENSTEIN, Herald Washington Bureau

As baby boomers age and get sicker over the next three decades there will not be enough lung doctors, cardiologists, intensive care physicians, anesthesiologists and other specialists to care for them, new studies show.

A top federal healthcare official calls the problem ``a looming healthcare crisis.'' It reflects a major miscalculation by medical care planners, experts say.


``We have not paid attention to the physician work force,'' said Dr. Mark Kelley, chief medical officer and executive vice president of the Henry Ford Health System, a group of Detroit hospitals.

``Everyone says we're going to run out of money for Medicare, but no one talks about who is going to take care of these patients.''

Three studies say there won't be enough key specialty doctors for those patients:

* In Wednesday's Journal of the America Medical Association, Kelley and four colleagues report that the number of pulmonologists and doctors who specialize in intensive care will decline slightly by 2030. But demand for such services is projected to rise 66 percent for intensive care doctors and about 50 percent for pulmonologists.

* On Monday, physicians, healthcare policy officials and state lawmakers will gather in Washington to confront new projections of an imminent shortage of dentists, anesthesiologists, and other specialists and healthcare workers.

* A study a year ago by the American College of Cardiology predicted that demand for cardiologists will outstrip supply. Experts predict that as baby boomers reach prime heart disease age, the need for cardiologists will increase 66 percent by the year 2030 and 93 percent by 2050. The number of cardiologists is expected to increase only 1 percent a year.

As recently as 1994, the Council on Graduate Medical Education, a federal department set up by Congress to monitor the healthcare work force, said there were too many specialty doctors. Now it is rethinking its stand.

In the vanguard are pessimists such as Dr. Claude Earl Fox, chief of the federal Health Resources and Services Administration, who will deliver a speech at Monday's Health Workforce 2000 Conference titled ``A Looming Health Care Crisis in America? Workforce Shortages Limit Access to Care.''

``There are several specialties that are facing shortages,'' said Ed Salsberg, director of the Center for Health Workforce Studies at the State University of New York at Albany. His study, which will be featured Monday in Washington, has found imminent shortages in anesthesiologists, allergists and gerontologists, he said.

Salsberg and Kelley offered three explanations for the coming shortage of specialists:

* The aging population. In a decade, the first baby boomers will reach 65, an age when health often worsens, putting the bulge of the U.S. population more at risk for heart and lung diseases, as well as cancer.

* The medical community. It decided a decade ago that America had too many specialists and not enough general physicians, so more students went into general practice.

* A faulty assumption. Planners expected managed healthcare - HMOs and the like - to restrict the use of specialists. But that didn't happen. People demanded to go to specialists, such as cardiologists when they had heart problems, Kelley said.

``If you look at the want ads of professional journals, there are pages and pages,'' he said.

The new studies call for shifting the emphasis to more specialists and fewer generalists, and for increasing insurance reimbursements to doctors.