The United States could soon face a healthcare crisis: there won’t be enough doctors for everyone.
According to the Association of American Medical Colleges, the U.S. will face a shortage of up to 86,000 physicians by 2036. Some of the reasons for this shortage include a 34.1% growth of patients 65 and older – who have increased healthcare needs – a large portion of the physician workforce reaching retirement age, and a growing population in general. The physician shortage spans all specialties, including primary care.
There’s also another trend happening at the same time; the heavy workload culture long embraced by American physicians is being challenged by today’s doctors. Coming of age when medicine is corporatized and achieving work-life balance is a primary goal, many younger doctors seek a shorter workweek.
Regardless of what one thinks of this change in ethos, when doctors shorten their hours, there are major ramifications for patients. It will be that much harder for people to see primary care physicians, or PCPs, of which there are already too few. Changes in the practice of medicine have also resulted in more physicians leaving the profession or retiring early.
Despite the fact that ChatGPT more accurately diagnosed medical conditions than doctors in one small study, AI will not fulfill the role of doctors. It can be a useful tool, but it cannot provide the oversight or the medical care and humanity that physicians deliver with every patient encounter.
And what about advanced practitioners stepping into the void? While physician assistants (PAs) and nurse practitioners can address some medical care, physicians are still required to direct and deliver much of it.
Researchers at Stanford have found that life expectancy grows when there are more PCPs in the field, and other studies show that greater PCP supply is associated with lower mortality. Yet close to a third of Americans don’t have a PCP, according to a 2023 report by the National Association of Community Health Centers.
It’s not hard to see why. When there aren’t enough PCPs, patients often find themselves having to wait weeks – or even months – to get an appointment. Some patients in rural locations have to miss work to drive long distances to see the PCP of their choice for a rushed checkup. Many resort to using the ER as their de facto doctor, pushing the costs onto the public and providing reactive rather than preventive care. Individuals suffer from shorter life expectancies, and society bears the increased health care costs.
The solution sounds simple: bring more doctors into the workforce. But to increase the supply of physicians, we need a sufficient number of qualified students applying to medical school, more medical school seats, and more residency slots. It can’t happen without all three.
The first two are not yet an issue, as the U.S. has only experienced a small decline in national medical school applications, and the number of first-year medical students in U.S. has more than doubled in the last 15 years, mostly through the addition of new medical school campuses. But not so with the shortage of internships and residencies, which, as the president of a major university system with multiple medical schools, I find particularly frustrating. We cannot bring in more students than we can ultimately train. Too few training slots have been medical education’s bugaboo for years.
In the U.S., Medicare primarily funds residency training. While a few highly profitable hospitals are capable of self-funding additional slots, most hospitals lack the resources to do this and are limited by available Medicare funding.
To avoid the physician shortage crisis, Congress needs to take immediate action and fund more residency slots.
In recent years, there has been some funding allocated, but much more is needed. In 2021, 1,000 additional slots were funded (the first expansion since 1995), and in 2023, 200 were funded for certain specialties. The 1,200 combined residencies fall far short of the roughly 2,500 students who don’t match with a hospital upon completing medical school and the increasing needs in the future.
This past May, a bipartisan group made up of eight members of the Senate Finance Committee introduced a policy outline that would increase Medicare-supported residency programs to address the growing doctor shortage. The Resident Physician Shortage Reduction Act proposes to add 2,000 new slots each year for seven years, including 25 percent of slots for PCPs.
Although there is pressure on the healthcare budget — with the U.S. already operating on a severe budget deficit — Congress needs to consider this Medicare expansion as an investment in the health of the American people. In financial terms, more PCPs means fewer visits to the ER, and less public money spent on paying for it. And in human terms, more PCPs means improving the health and life expectancy of Americans, something that is of the utmost importance to us all. An aging population, combined with doctors working less and a lack of residency options creates a perfect storm we need to address. The health of our nation depends on it.
Alan Kadish, M.D.
Dr. Alan Kadish is a cardiologist and president of Touro University.
