Featured Events

Understanding the Shortage and What it Means for You in the Future

Introduction

Patients in Southwest Florida are running into a combination of physician shortages, retirements, population growth, and health-system turnover, which can leave practices unable to provide a replacement when a doctor leaves.

Today, the Association of American Medical Colleges and the American Medical Association, the lobby for the nation’s small-town physicians, seek to increase the supply of physicians.

The effort is driven not only by a desire to improve the nation’s health, but also by many states’ attempts to address the physician shortage by enabling nurse practitioners, physician assistants, pharmacists, and other healthcare professionals to provide services previously limited to physicians.

A recent Kaufman Hall survey found that staffing shortages, dangerous workplaces, aging physicians, and the increasing politicization of medicine are also prevalent issues that adversely affect Health Care Professionals (HCP’s) and drive-up resignations.  From 2005 to 2015, the number of primary-care physicians (PCPs) in the U.S. fell by 11%, from 46.6 to 41.4 per 100,000.  This decline has continued to have adverse long-term consequences. Evidence shows that “access to primary care” improves population health, reduces health disparities, and saves healthcare dollars¹.

A 2022 study by the healthcare analysis and publishing firm Elsevier found that more than three-quarters of healthcare workers were considering leaving their professions by 2025. This projection aligns with findings from a 2020 study by the Association of American Medical Colleges, which projected a shortfall of up to 139,000 physicians by 2033².

Primary care is in crisis.

In 2023, the inaugural Primary Care Scorecard³ made clear the systemic lack of support for primary care in the United States, which is harming people’s health and weakening the US health system.⁴

A year later, in the absence of a coordinated effort among policy leaders, we see news reports of a diminishing availability of primary care physicians and longer wait times for primary care visits.⁵ Headlines such as “Primary Care Saves Lives. Here’s Why It’s Failing Americans”⁶ and “The Shrinking Number of Primary Care Physicians Is Reaching a Tipping Point”⁷ dominate lay media coverage of primary care.

Despite overwhelming evidence that access to primary care improves population health, reduces health disparities, and saves health care dollars, support for primary care continues to dwindle. As a result, the average life expectancy in the United States continues to stagnate,⁸ and health disparities in preventive services and other basic primary care services persist, accounting for 60,000 excess deaths each year.⁹

What are the Causes?

Some of the biggest factors are:

Florida doesn’t have enough physicians to meet demand.
Florida’s physician workforce reports show that a large share of practicing doctors is nearing retirement age. About 35% of Florida physicians are age 60 or older, and thousands report plans to stop providing direct patient care within the next several years.

Southwest Florida’s population has grown rapidly.
Areas such as Lee and Collier counties have seen significant growth from retirees and new residents. Demand for primary care and specialists has risen faster than the supply of physicians, creating long wait times and making it difficult for health systems to recruit replacements quickly.

Recruitment is difficult nationwide.
Healthcare organizations across Florida and the U.S. are competing for a limited pool of physicians. Primary care, pediatrics, OB-GYN, neurology, urology, cardiology, gastroenterology, and several other specialties are particularly affected. Florida medical organizations continue to warn of workforce shortages.

Burnout and career changes are contributing to departures.
Long hours, administrative burdens, reimbursement pressures, and work-life balance concerns have led some physicians to retire early, move into concierge medicine, reduce their clinical workload, or leave certain specialties altogether.

Consolidation of medical practices can create gaps.
As more physicians become employed by large health systems rather than operating independent practices, turnover can have broader effects. When a physician leaves, a health system may not have an immediate replacement available, especially in hard-to-recruit specialties. National studies have documented substantial declines in independent physician practices.

Local patients have reported repeated turnover.
While anecdotal and not definitive, evidence from Southwest Florida residents describes situations in which specialists and primary-care physicians left health systems and were not replaced for months, resulting in long appointment wait times.

What is the Situation at Lee Health?

The organization has been actively expanding its employed physician group in recent years. Lee Health has a large physician network, with around 1300 physicians and advanced practice providers (APP’s) across more than 100 locations, and a medical staff of more than 2,500.

Lee Health continues to aggressively recruit physicians and advertise opportunities across many specialties, reflecting ongoing workforce needs in the rapidly growing Southwest Florida region.

In the 2026 fiscal year, Lee Health will add approximately 250 providers to the team, with some through acquisitions (such as Florida Heart Association) and many through hiring. The graduate medical education program at Gulf Coast Medical Center has not yet started. It will grow to over 300 residents by 2033. This will help address physician shortages and build a pipeline for the future workforce. Over 60% of medical students stay in the area where they complete their residencies. This will result not only in adding to Lee Health’s family medicine clinicians but also to its specialists.

With the shift of the “annual wellness visits” toward the telehealth approach, and with more care moving to the outpatient setting, it is anticipated that this will lead to less “in-hospital care” and more “clinical” care.

So, in summary: Lee Health is growing its physician workforce and has a large medical staff, but demand in Southwest Florida is growing so rapidly that patients may still experience physician shortages and long wait times in some specialties.

What is being done now?

Expanding residency programs

The biggest bottleneck is not medical school enrollment but residency training positions. Hospitals, health systems, states, and Congress have been funding additional residency slots, and organizations like the AAMC and AHA are pushing for further expansion.

Systems such as Lee Health are creating new residency programs to build local physician pipelines.

Greater use of nurse practitioners (NPs) and physician assistants (PAs)
Many routine primary-care visits, follow-ups, chronic disease management, and urgent-care encounters are increasingly handled by NPs and PAs working independently or in physician-led teams. This trend is already well underway and is expected to continue.

Telemedicine
Telehealth allows physicians to cover larger geographic areas and reach rural communities more efficiently. While it doesn’t create more doctors, it improves physician productivity and access.

AI and automation
The most significant change may be AI-assisted medicine. Current systems already help with documentation, chart review, coding, prior authorizations, and patient messaging. The goal is to free physicians from administrative work and allow them to spend more time on clinical care.

Team-based care
Healthcare organizations increasingly use teams of physicians, NPs, PAs, pharmacists, behavioral health specialists, care coordinators, and AI tools rather than relying solely on physicians.

What will be the “Norm “by 2035?

The U.S. is projected to face a shortage of up to about 86,000 physicians by 2035 despite current efforts.

That means the “normal” healthcare visit in 2035 may look something like this:

1. An AI system gathers your history before the appointment.
2. An NP or PA performs the initial evaluation.
3. The physician reviews complex findings, confirms diagnoses, and directs treatment.
4. Follow-up occurs virtually unless a physical examination or procedure is needed.

In other words, the future is unlikely to be “more doctors everywhere.” It is more likely that there will be fewer physician-only encounters and more physician-led care teams supported by AI and advanced practice providers.

In brief the expectation is:

For Lee Health and Florida specifically

Florida faces a particularly difficult challenge because:

• The state’s population is growing rapidly.
• The population is aging faster than the national average.
• Older adults require substantially more healthcare services.
• Southwest Florida (Fort Myers, Cape Coral, Estero, Naples) continues to attract retirees.

As a result, systems like Lee Health will likely continue to expand residency programs, hire more NPs/PAs, increase telehealth use, and deploy AI tools aggressively.

What can the public do about it? 

A broader and more realistic perspective is that the likely future is not about AI replacing physicians. Rather, it is about empowering physicians to care for more patients by effectively leveraging AI to manage information management, data analysis, administrative tasks, and other routine functions.  In this evolving model, physicians remain at the center of clinical decision-making, while technology enhances efficiency, expands access to care, and allows more time for meaningful interaction.

At the same time, patients will play an increasingly active role in managing their own health. This includes becoming comfortable with routine self-monitoring, utilizing approved in-home testing when appropriate, and communicating effectively through digital tools such as MyChart and other secure patient portals. Patients who can navigate these technologies and share timely, accurate information with their healthcare teams will be better positioned to receive responsive, personalized care

The healthcare system of the future is likely to be a partnership—combining the expertise and judgment of physicians, the capabilities of advanced technology, and the active engagement of informed patients working together to achieve better health outcomes. 

IMPORTANT: Engage Estero shares this as information for readers to begin their own research and consultation with medical professionals. It is not intended to be medical advice. Consult with your healthcare team before beginning, changing, or stopping any prescribed treatment.

References:

1. Sanjay Basu, Seth A. Berkowitz, Robert L. Phillips, Asaf Bitton, Bruce E. Landon, and Russell S. Phillips, “Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015,” JAMA Intern Med., 179(4): 506–514, April 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450307/#:~:text=Owing%20to%20disproportionate%20losses%20of,%25%20CI%2C%200.0%2D108.6%20per
2. 28) Patrick Boyle, “US physician shortage growing,” American Association of Medical College, June 26, 2020, https://www.aamc.org/news-insights/US-physician-shortage-growing

3 THE HEALTH OF US PRIMARY CARE: 2024 SCORECARD REPORT No One Can See You Now: Five Reasons Why Access to Primary Care Is Getting Worse (and What Needs to Change) https://www.milbank.org/publications/the-health-of-us-primary-care-2024-scorecard-report-no-one-can-see-you-now/

4. Jabbarpour Y, Petterson S, Jetty A, Byun H. The health of US primary care: a baseline scorecard tracking support for high-quality primary care. The Milbank Memorial Fund and The Physicians Foundation. https://www.milbank.org/publications/health-of-us-primary-care-a-baseline-scorecard. Published February 2023. Accessed January 30, 2024.
5. Heath S. Average patient appointment wait time is 26 days in 2022. Patient Engagement HIT website. https://patientengagementhit.com/news/averagepatient-appointment-wait-time-is-26-days-in-2022. Published September 15, 2022. Accessed November 7, 2023.
6. Sellers FS. Primary care saves lives. Here’s why it’s failing Americans. Washington Post. November 9, 2023. https://www.washingtonpost.com/health/2023/10/17/primary-care-saves-lives. Accessed December 13, 2023.
7. Rosenthal E. The shrinking number of primary care physicians is reaching a tipping point. KFF Health News. https://kffhealthnews.org/news/article/lack-of-primary-care-tipping-point. Published September 8, 2023. Accessed December 13, 2023.
8. Arias E, Tejada-Vera B, Kochanek KD, Ahmad FB. Provisional life expectancy estimates for 2021. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/vsrr/vsrr023.pdf. Published August 2022. Accessed January 30, 2024.
9. Ndugga N, Artiga S. Disparities in health and health care: 5 key questions and answers. KFF. https://www.kff.org/racial-equity-and-health-policy/issuebrief/disparities-in-health-and-health-care-5-key-question-and-answers. Published April 21, 2023. Accessed November 7, 2023.