Demand for doctors is far outstripping supply. The United States will face a shortage of up to 124,000 physicians by 2034, according to projections out this month from the Association of American Medical Colleges.
Already, many Americans are struggling to get the care they need. About 35% of patients had trouble finding a doctor in the past several years, according to a 2019 survey. That’s up from 25% in 2015. This physician shortage disproportionately affects Americans in rural and historically neglected urban areas.
Medical schools are taking steps to graduate more physicians. Med school enrollment has grown 33% since 2002.
But post-graduate residencies, which newly minted MDs and DOs must complete before they can practice medicine, haven’t grown in tandem. The number of residency spots has increased about 1% each year since 1996, even as demand for care has exploded. That’s largely a function of the Balanced Budget Act of 1997, which capped federal funding for residencies.
By 2019, almost half of medical schools reported that they were concerned about their incoming students’ chances of securing residency positions after graduation.
This past December, Congress passed legislation funding 1,000 new graduate medical education positions. And earlier this month, lawmakers in both the House and Senate introduced legislation that would fund 1,600 more residencies.
There are certainly worse things the government could spend money on than graduate medical education. But a thousand new residencies won’t solve this crisis.
Private interests, especially those with an interest in improving access to health care, should consider how they can help narrow the doctor shortage.
Some philanthropists and charitable organizations have already made tackling the doctor shortage a priority. Last year, the Arkansas Colleges of Health Education partnered with the Degen Foundation to develop a new 48-slot residency program in the underserved Arkansas River Valley. In 2018, the Grunin Foundation donated $1 million to support Ocean Medical Center’s new residency program in New Jersey.
In 2016, the Walmart Foundation donated $750,000 to support the Northwest Arkansas Community Internal Medicine Residency Program. The charitable arm of the world’s largest retailer found a way to enhance the community’s quality of life and retain top medical talent in their home state of Arkansas.
In 2019, foundations donated over $75 billion to charitable causes, and corporations contributed another $21 billion. Diverting even half a percent of that money into medical residencies would go a long way towards fixing the doctor shortage—and the resulting health disparities that so many foundations and businesses want to solve.
Policymakers, meanwhile, should make sure that the rules governing the healthcare labor market serve to increase the supply of care available to patients. Doing so is a cost-free way to narrow the doctor shortage.
For instance, at the start of the pandemic, the federal government eased restrictions on telehealth services, such as remote appointments. Making regulatory rollbacks like these permanent would give patients affordable, convenient access to doctors—even if they live in remote rural areas or underserved urban areas.
Similarly, reforming licensure requirements to allow doctors to practice across state lines would make it easier for them to go where they’re needed most. Thirty states and the District of Columbia have joined the Interstate Medical Licensure Compact, which streamlines the licensure process for doctors to essentially allow a doctor licensed in one state to practice in any other state that’s a member of the compact. The other states should join.
Expanding scope-of-practice laws for physician assistants and nurse practitioners would allow them to provide many routine services currently performed by doctors. If all states allowed nurse practitioners to practice to the full extent of their abilities, the number of Americans facing primary care shortages would decline by 70%, according to an analysis from UnitedHealth Group.
It will take the best efforts of the public and private sectors to narrow the physician shortage—and ensure that every American has convenient access to a doctor.
Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on Twitter @sallypipes.