How to Solve the Doctor Shortage

The nation will face a shortage of between 46,000 and 90,000 physicians by 2025, according to a report released in January by the Association of American Medical Colleges. The study, which is the first comprehensive national analysis that takes into account both demographics and recent changes to care delivery and payment methods, projects shortages in both primary and specialty care, with specialty shortages particularly acute. 

“The doctor shortage is real — it’s significant — and it’s particularly serious for the kind of medical care that our aging population is going to need,” said AAMC President and CEO Darrell G. Kirch, M.D.

The study, conducted for the AAMC by the life sciences division of IHS Inc., a global information company, presents projections in ranges that reflect the potential impact of a variety of health care delivery and policy scenarios, including the rapid growth in non-physician clinicians and new payment and delivery models such as patient-centered medical homes and accountable care organizations.

Projections for individual specialties were aggregated into four broad categories: primary care, medical specialties, surgical specialties and “other” specialties. Within the overall projected physician shortage, the study estimates a shortage of 12,500 to 31,100 primary care physicians, and a shortfall of 28,200 to 63,700 non-primary care physicians, most notably among surgical specialists.

“The trends from these data are clear — the physician shortage will grow over the next 10 years under every likely scenario,” said Kirch. “Because training a doctor takes between five and 10 years, we must act now, in 2015, if we are going to avoid serious physician shortages in 2025.

The solution, Kirch said, “requires a multi-pronged approach: continuing to innovate and be more efficient in the way care is delivered, as well as increased federal support for graduate medical education to train at least 3,000 more doctors a year to meet the health care needs of our nation’s growing and aging population.”

To view the complete report, visit Jan. 25, 2015

Respiratory Viruses Most Common Cause of Kids’ Pneumonia

Respiratory viruses, not bacterial infections, are the most commonly detected causes of community-acquired pneumonia in children, according to new research released Feb. 26 in the New England Journal of Medicine.

The multicenter Etiology of Pneumonia in the Community (EPIC) study was a prospective, population-based study of community-acquired pneumonia hospitalizations among children in the United States that sought to address critical gaps in the knowledge about pneumonia. The study showed that the burden of pneumonia-related hospitalization is highest among children younger than 5 years of age.

Researchers’ key findings revealed that 81 percent of cases examined were caused by viral infections, while only 8 percent were caused by bacterial infections and 7 percent were both viral and bacterial. That knowledge could be a catalyst for researchers to further investigate new and better ways to treat or prevent respiratory viruses, such as respiratory syncytial virus (RSV), which can lead to pneumonia.

“What this tells us is that viruses are important causes of pneumonia. But it also tells us that with the routinely administered pneumococcal and haemophilus vaccines given to children, that we have virtually eliminated most bacteria as causes of pneumonia.” said Kathryn Edwards, M.D., study co-author, professor of pediatrics, director of the Vanderbilt Vaccine Research Program, and the Sarah H. Sell and Cornelius Vanderbilt Chair.

“Pneumonia is a leading cause of hospitalization and is nearly always treated with antibiotics, but results from the EPIC study indicate we could drastically reduce antibiotic use overall, and when we do use antibiotics, we could do a much better job of limiting the use of broad-spectrum antibiotics,” Williams said. “Unfortunately, differentiating viral from bacterial causes of pneumonia is not always clear.  We are now trying to unravel that mystery to better understand the best way to treat pneumonia, when to use antibiotics, what antibiotics to use, and how to prevent it.”

The yearly costs of pneumonia among children in the U.S. are estimated at $1 billion. Researchers have been working to better understand the causes, effects and treatments of pneumonia.

The study authors wrote, “Effective antiviral vaccines or treatments, particularly for RSV infection, could have a mitigating effect on pneumonia in children.”

IUPUI Research Discovers Gene Variants Associated with Diabetes

Using Indiana University’s supercomputing capabilities, researchers have discovered rare and low-frequency gene variants associated with diabetes, a finding that adds to the understanding of the disease's genetic causes, said Jennifer Wessel, an assistant professor of genomic epidemiology in the IU Richard M. Fairbanks School of Public Health and IU School of Medicine at Indiana University-Purdue University Indianapolis.

Wessel is first author of "Low-frequency and rare exome chip variants associate with fasting glucose and type 2 diabetes susceptibility," which was recently published in the journal Nature Communications.

“For people like me, who are focused on prevention, the finding is exciting because I can use this information, along with all the other variants that have been found and will be found in the future, to help predict which one of us is more likely to develop diabetes,” Wessel said. “As we improve our understanding of the biology of the disease, we will be better able to figure out how to treat the disease.”

The process used to discover the new findings was innovative. Combining data from 23 epidemiology studies from around the world, involving 60,564 non-diabetic individuals, researchers for the first time used the HumanExome BeadChip, a specially designed genetic variation chip, to search for rare and low-frequency gene variants across the human genome, Wessel said. Rare variants occur less than 1 percent of the time, while low-frequency variants occur between 1 and 5 percent of the time.

Previously, genome-wide association studies had been used to identify common variants, or variants that occur more than 5 percent of the time, associated with common diseases and traits. The cause of diabetes is about half genetics and half lifestyle choices.

Indiana University supercomputing capabilities were used to analyze the massive amount of data, which included single-variant and gene-based analyses of the non-diabetic individuals and 16,491 individuals with type 2 diabetes and 81,877 controls.  

“The idea was to go after the low-frequency and rare variants and see if that helps explain part of explaining the genetic variation of diseases like diabetes that we are interested in,” Wessel said.

“We found a low-frequency variant in GLP1R, which was found to lower glucose levels and risk for diabetes through lower early insulin secretion,” Wessel said.

Researchers had never found any variants in this gene associated with diabetes or glucose levels, and it is the first time a low-frequency variant has been found that is associated with diabetes and glucose levels, she said. According to Wessel, IU’s supercomputer made it possible to analyze the massive amount of data that is needed for current genetic discovery research.