The goal of the Affordable Care Act is to provide affordable and quality healthcare coverage to more people. But do we have enough physicians to address their health concerns? This debate continues with very little conclusive evidence to prove one case or the other. Those who see a shortage of physicians attribute it to America’s aging population and its growing medical needs. On the other hand, many think that the shortage already exists, particularly in rural and inner city areas. Some others think that America has a lower ratio of physicians compared to European countries. According to a report by the American Association of Medical Colleges, there would be a shortage of 90,000 physicians across the country by 2020.

Health policy experts believe that the solution to this problem is not increasing the nation’s physician headcount. Instead, they argue that elimination of unnecessary care while improving productivity can address the issue. They propose shifting away from fee-for-service solo practices to group oriented practices, away from paper records to electronic medical records (EMR), and away from avoidable office visits to mobile and video technologies. Physicians can also improve productivity by encouraging patient self-care wherever possible.

Among the 34 member countries of the Organization for Economic Co-operation and Development (OECD), the United States ranks 30^th in total medical graduates and 20^th in practicing physicians per 1,000 people. But despite these numbers, the US ranks first in the proportion of specialists to generalists. While these figures do not settle the physician shortage debate, they provide a significant insight into the gap between US specialists and primary care providers. The important question, however, still remains; how many practicing physicians are available in the US? The cause of confusion is that not all licensed physicians practice clinical medicine and those who do, the number of hours they spend in clinical practice are unknown.

For example, in California, the American Medical Association (AMA) and the Medical Board of California differ on the number of practicing physicians by as much as 20 percent. Furthermore, the distribution of licensed doctors varies significantly across all states. California’s Greater Bay Area hosts approximately 30 percent more specialists than Los Angeles. Similarly, the number of active physicians per 100,000 people in Massachusetts is roughly twice that of Mississippi.

In the absence of conclusive data, will it be possible to determine the exact number of physicians we have? Are they too many or too few? Or just about enough?

As the number of insured people in the US grows rapidly, we will eventually face a dearth of physicians unless there is an immediate increase in their number and/or a drastic change in how the majority of physicians practice. For the sake of debate, it seems logical that we start training 90,000 new physicians. But then the costs will be enormous and the delay too big to meet America’s pressing demand for more physicians, more offices and more support staff. Simply put, the US cannot afford the number of physicians it would need in today’s healthcare delivery system.

If we want to address the ever-increasing demand for healthcare services while keeping them affordable, we need to make our system 10-20 percent more efficient. Once we achieve that, we will have enough physicians, for today and tomorrow.

We can continue debating whether or not we need more physicians but we would be better off transforming the entire care delivery process. In reality, that’s our best bet.