Shortages are rampant throughout healthcare staffs—so extreme that there is a projected shortage of more than three million essential low-wage health workers in the next five years, according to the U.S. Department of Health and Human Services. The problem, however, doesn’t stop with lower-wage positions: There is also a huge shortage of physicians, a problem that contributes to overall health- care burnout.
According to the Association of American Medical Colleges,1 the United States could see a shortage of 54,100-139,000 physicians by 2033. Many reasons for the shortage are being bandied about, but most experts surmise that the require- ments and journey to becoming a physician play a large part in the problem. On top of this, there is currently only a 37% acceptance rate2 for premed students seeking entrance to medical school. A main reason for this low acceptance is a high MCAT failure rate. With several causes for the physician shortage, schools, students, and medical-industry experts will have to address the issue soon if they hope to curb it.
Delays in Care
Anecdotal evidence is mounting about the long waits to see a specialist, or issues regarding family physicians not taking new patients. During the recent RSV and influen- za3 spike among children, many people reported waiting for hours—sometimes over a day—in emergency rooms to have their children seen by a staff worn thin.
Delays in care—whether prompted by the doctor shortage or other factors like affordability—are already having some devastating effects. Mortality rates in the United States are higher than those of peer countries, and the overall life expectancy4 of the U.S. population has dipped. Some may be quick to blame COVID-19 for these statistics, but studies show5 that the writing was on the wall for the U.S. long before the pandemic. Chronic health conditions such as diabetes have become more prevalent and require a lot of the healthcare industry’s already strained resources. More family physicians are needed for preventative care and specialists are needed for regular targeted follow-ups. All of this exacerbates the physician shortage.
The Road to Becoming a Doctor
On average, a medical student can expect to pay between
$157,000 and $254,0006 for medical school. Add to that any undergraduate cost, and the investment can be out of reach for many students. Even though physicians can eventually expect higher-than-average salaries, massive student-loan debt can cripple medical students financially for many years after graduation and residency.
Admissions are historically competitive, and the current ratio of applicants to admissions7 is about 16:1. Although graduation rates are relatively high for medical-school students (likely due to the overall investment), standing at roughly 81% to 84%8 overall, there is no guarantee that a student will complete their residency after they graduate.
According to studies, an average of 55%9 of doctors com- plete their required residency programs. This means just under half of would-be doctors do not go on to practice, contributing greatly to the supply-and-demand problem in the medical field. Even as the number of medical school graduates has risen, an outdated and ineffective residency-application software program was filtering out talented students, leaving many without residencies and deep in debt. According to one study, roughly 10,000 “chronically unmatched” doctors in the United States are floundering without jobs or residency appointments, being kept away due to a technical discrepancy. Students who study abroad fare even worse, with only 61%10 of those students eventually matching to a residency program in the United States.
This issue of discriminatory and technically inept practic- es in the matching process contributes significantly to the problem of physician shortages. Talented doctors are being kept from practicing, even if they are able and willing to do so. Without a residency, doctors cannot qualify for a medi- cal license. Still, residency directors continue to defend the idea of software filters that remove candidates for reasons such as the length of time between medical school gradua- tion and residency application, or a foreign-school diploma.
With thousands of applicants for a set number of residency placements, directors are counting on this software to do the legwork of reading applications and sorting out who should be disqualified—even if there is no merit to the dis- qualification.
Solving the Problem
If the physician shortage is going to be solved, those with the power to change it will have to start thinking outside the box. No single solution will put the country back on the right track, but a number of answers can certainly help lessen the blow.
The issue of supply and demand concerning residency spots should be one of the first issues addressed. The need for increased funding for hospital systems to allow them to open more residency spots has already been discussed among government and private medical groups. However, the small changes brought by the trickle of funding have not kept up with the population demands in the medical field. Increasing numbers of graduates apply for residencies each year, and there need to be more openings for them.
With the cost of medical school remaining one of the main contributors to the physician shortage, government officials have also proposed federal funding programs that would help alleviate some of the cost burden for new doctors.
Technology is increasing the availability of doctors, espe- cially telemedicine. Further investment and innovation in medical technology will increase access to doctors, thereby allowing more doctors to practice with a wider patient base. Currently, telemedicine is being used to ease burdens placed on overscheduled physicians, especially in urgent-care facil- ities and emergency rooms.
Many medical organizations are expanding the available care team for patients. Millions of patients still regularly choose to see nurse practitioners or physician assistants as their primary medical contact. This multidisciplinary approach is helping many healthy systems serve more patients.
The concept of international medical schools needs to be revisited and rethought, as well. Residency programs reg- ularly discriminate against students who received degrees from international schools, even if those schools carry the same credentials and stringent requirements as schools in the U.S. If we are going to solve the doctor shortage crisis, we need to give students broader options.
Going Forward
The physician-shortage issue will not be solved overnight. However, many government entities, healthcare facilities, and schools have made great strides in dealing with this issue head-on, helping doctors connect with patients. The more work that is done to curb the physician shortage, the better health outcomes will be. Therefore, mitigation strate- gies benefit everyone in the United States—not just hopeful doctors. The time to act is now, and with a multifaceted approach to the supply-and-demand problem, significant positive changes will arise.
