An Evaluation of the Vulnerable Physician Workforce in the USA During the Coronavirus Disease-19 Pandemic
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BACKGROUND
The coronavirus disease-19 (COVID-19) pandemic threatens to overwhelm the healthcare resources of the country1 and also poses a personal hazard to healthcare workers, including physicians.2 Physicians are at an elevated risk of acquiring the disease through exposure to patients who may be symptomatic with the disease or its asymptomatic carriers across the spectrum of clinical specialties. Notably, the physician workforce is not only at risk of losing time spent in clinical care due to these exposures but also at a personal risk from a severe disease that requires hospitalization and is associated with high morbidity and mortality. Notably, physicians 60 years of age and older are at a particularly elevated risk, with 80% of deaths in China concentrated in this age group.3, 4 In the early experience in the USA, nearly half of all hospitalizations and intensive care unit admissions and nearly 80% of deaths have occurred in this age group as well.4 To address the potential impact of excluding physicians with a high risk of adverse outcomes based on age, we evaluated the current patterns of age of licensed physicians across the USA.
METHODS
We used the 2018 database of physicians from the Federation of State Medical Boards (FSMB) that includes all actively licensed physicians across the USA.5 The FSMB maintains a database of all licensed physicians in each of the states and US territories compiled during the licensing process, which are sampled biennially and publicly reported.5 We extracted publicly available summary data for the physician age in 5-year age bins, nationally and across each of the states. Both at a national and the state level, we used descriptive statistics for the age distribution of physicians and assessed the number and proportion of physicians in each state who would be at elevated risk due to age (age > 60 years). We used Stata 16 (College Station, TX) for all analyses.
Received March 26, 2020 Accepted April 13, 2020
RESULTS
Of the 985,026 licensed physicians in the USA, 235,857 or 23.9% were aged 25–40 years, 447,052 or 45.4% are 40– 60 years, 191,794 or 19.5% were 60–70 years, and 106,121 or 10.8% were 70 years or older. Age was not reported in 4202 or 0.4% of physicians. Overall, 297,915 or 30.2% of physicians were 60 years of age or older, 246,167 (25.0%) 65 years and older, and 106,121 (10.8%) 70 years or older. States in the USA reported that a median of 5470 licensed physicians (interquartile range [IQR], 2394 to 10,108) were 60 years of age or older. Notably, states of North Dakota (n = 1180) and Vermont (n = 1215) had the lowest and California (n = 50,786) and New York (n = 31,582) the highest number of physicians over the age of 60 years (Fig. 1). Across states, the median proportion of physicians aged 60 years and older was 28.9% (IQR, 27.2%, 31.4%) and ranged between 25.9% for Nebraska and 32.6% for New Mexico (Fig. 2).
DISCUSSION
Nearly 1 in 3 licensed physicians in the USA and each of the states are over the age of 60 years, representing nearly 300,000 currently l
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