Part One

The United States Population Ages, Straining Our Health Care System

The United States population is getting older, a shift that will increase demand on the nation’s health care system.

The baby boomer generation, generally defined as those born between 1946 and 1964, currently accounts for about 29 percent of the U.S. population. Those Americans will begin reaching retirement age in 2010, and the U.S. Census Bureau expects the number of people age 65 and older to double by 2030.

The proportion of the population aged 65 or older is projected to increase from 12.4 percent in 2000 to almost 20 percent by 2030. (Chart 1)

An older population would increase the demand for health services. As Americans are living longer, they are requiring more care. The federal Centers for Disease Control and Prevention reported in 2004 that the average 75-year-old has three chronic health problems and uses five prescription medications. (Chart 2)

About 80 percent of those currently 65 or older have at least one chronic condition – such as cancer, heart disease or diabetes. Older Americans also use more health care services, the CDC said in its 2004 report, noting that while representing about 13 percent of the population, persons 65 or older account for almost half of physician visits and hospital stays. (Chart 3)

Health Care Work Force Shortage Compounds Problem of Increased Demand

At the same time that the older population is growing and health care demand is increasing, there is a shortage of health care professionals. This deficit is predicted to grow more serious because of the population shift, as well as baby boomer-aged health care professionals retiring.

The Council on Graduate Medical Education (COGME), the national advisory body that tracks the supply and distribution of physicians, has predicted that the demand for medical care will significantly outweigh the supply of physicians by 2020. While conventional wisdom through the 1990s predicted a surplus of physicians by 2000, more recent studies have said the trend was reversing itself and a doctor shortfall could appear by the early 2000s. (Chart 4)

COGME has called on the nation’s medical schools to increase enrollment to help meet the rising health care demand. Other proposals include an increase in the number of medical residency slots to further increase the supply of practicing physicians.

Shortages of nurses, pharmacists and many other health care professionals already exist, with demand outpacing supply at a rate predicted to accelerate as the population ages. By 2000, the U.S. Department of Health and Human Services was reporting the demand for registered nurses (RNs) was already outpacing the supply by about 6 percent. That shortage was projected to double by 2010.

Crippling the ability of nursing schools to respond to the shortage, the American Association of Colleges of Nursing reported, were problems expanding enrollment because of a shortage of faculty, along with clinical sites, classroom space and budget constraints.

The demand for pharmacists has been driven by rapid growth in prescriptions and the movement of pharmacists into new areas of health care. Despite the addition of new pharmacy schools, the supply of pharmacy graduates was not projected to meet demand through at least 2010.

The rising demand for prescription drugs coincides with an expanding role in public health for the pharmacist, from operating community immunization programs to disease management for chronic diseases like asthma and diabetes.

Thousands of pharmacist vacancies were reported across the country in 2005 by a study from the National Association of Chain Drug Stores. A 2002 report by the Pharmacy Manpower Project predicted that by 2020, there will be 157,000 vacant pharmacist jobs in the U.S.

Doctors, nurses and pharmacists make up only a part of the health care professions. A variety of allied health care professions, from clinical laboratory workers to respiratory therapists and from emergency medical responders to genetic counselors also are experiencing shortages attributable to many of the same factors – population shifts and increased demand for services.

In July 2005, the Health Resources and Services Administration said clinical managers and educators were concerned about a growing shortage of laboratory workers, including medical technologists and cytotechnologists. The aging population, improvements in health care technology, and increases in the number of available clinical laboratory tests were seen as factors in the rising demand for workers that was not being met. The shortfall was in part because of a decrease in the number of education programs, mainly in hospitals, due to limited budgets.

A similar refrain can be heard concerning respiratory therapists: an aging population and increasing incidence of cardiopulmonary diseases is compounded by a supply of graduates not meeting current demands.

As the shortages are projected to worsen in the coming years, academic health centers and training programs across the United States are working to develop strategies to increase the supply of health care workers for the future.