we've heard for years that america has a
shortage of doctors sounds like an easy
fix right we just need to train more
doctors well as with most things in life
it's not that simple dr jubal med
schoolinsiders.com according to the
double amc we can expect shortages of
between 38 000 and 124 000 physicians by
the year 2034. but why is it so
difficult to increase the number of
physicians in the u.s here are five
reasons why america has so few doctors
to start the united states has one of
the longest training pathways to
becoming a physician of any developed
country becoming a doctor in the us
requires you to complete a four-year
bachelor's degree followed by four years
of medical school and three to seven
years of residency in contrast many
european countries including the united
kingdom france germany and switzerland
do not require a bachelor's degree and
instead allow students to matriculate
into medical school right after high
school in general medical school in
these countries is five to six years in
duration after which students will
complete residency training lasting an
additional three to eight years
depending on the country and the
particular specialty if we do some
simple calculations the shortest amount
of time it would take to become a
physician in the united states after
high school is around 11 years that's
four years to get your bachelor's degree
plus four years of medical school and
three years of residency in contrast the
shortest pathway to becoming a physician
in many european countries such as
switzerland for example would be six
years of medical school followed by
three years of residency for a total of
nine years medical school admissions in
the u.s are also highly competitive
which often adds additional years to the
already long training process according
to data from the double amc double a
comb and tmd sas in any given year only
around 36 of applicants to usmd and do
schools matriculate and only around 25
of applicants to texas medical schools
matriculate although there are some
countries where it is more competitive
to become a doctor than in the us which
we discuss in our medical school
competitiveness by country video it is
not uncommon for us pre-meds to apply to
medical school multiple times before
getting accepted because medical school
applications occur once per year each
unsuccessful application cycle adds an
additional year to the already lengthy
training process next is the exorbitant
cost of medical training although
physicians in the us earn higher
salaries on average than their european
counterparts at around 242 thousand
dollars per year for primary care
physicians and 344 000 per year for
specialists the cost of becoming a
physician in the u.s is also
significantly higher as of 2022 the
average cost of medical school tuition
in the united states is approximately 55
000 per year with some schools charging
in excess of 70 000 per year at the
upper end it's no surprise then that the
average medical student graduates with
around 242 thousand dollars of student
loan debt with some students having in
excess of four hundred thousand dollars
in student debt between tuition and
living costs over four years of medical
school it's only getting more expensive
too as the average cost of medical
school rises by approximately fifteen
hundred dollars each year although there
are more pre-meds than there are medical
school spots as demonstrated by the
roughly 36 matriculation rate the cost
of medical education can be prohibitive
for many students particularly minority
students and those from lower
socioeconomic backgrounds according to
the u.s census black and hispanic
individuals are between one and a half
to two times more likely to experience
poverty than white or asian individuals
as such many of these students may be
dissuaded from pursuing medicine due to
the high cost of medical education this
is an important factor to consider as
research has shown that physicians that
come from poor or minority backgrounds
are more likely to practice in
underserved communities where the need
for physicians is the greatest perhaps
the largest factor limiting our ability
to produce more physicians however is
the limited number of residency
positions offered each year to practice
medicine as a physician in the united
states you must complete three to seven
years of residency training after
medical school the issue is that there
are more medical students graduating
each year than there are residency
positions to accommodate them during the
most recent 2022 nrmp match there were
approximately 6 400 medical students
that applied for residency that went
unmatched even after the supplemental
offer and acceptance program or soap
that's approximately 15 percent of the
total number of active applicants in
2022 these students will have to put
their training on hold for a year and do
research or some other job while they
strengthen their application for the
following cycle there's a simple
solution then we just need to increase
the number of residency spots easy right
not quite the majority of funding for
residency programs comes from medicare
the problem with this is that there were
certain caps on medicare gme funding
imposed in 1997 which have largely
frozen in place the facilities eligible
to receive funding this in turn has
greatly hindered our ability to open new
residency programs this is slowly
changing with the recent 2021
consolidated appropriations act which
will have medicare provide an additional
1 000 funded slots over 5 years starting
in 2023. however many are concerned that
the existing system still does a poor
job at creating new residency programs
for a variety of other reasons to start
the majority of residency programs are
in large metropolitan areas where the
cost of living is high as such each
dollar spent on funding residency
programs doesn't go as far as it would
if these programs were in areas with
lower cost of living it would make much
more sense to establish residency
programs in rural communities where care
could be delivered more efficiently to
the patients that need it most despite
this residency programs are much more
abundant in large metropolitan areas
compared to rural areas this is largely
a consequence of large teaching
hospitals in metropolitan areas having
more leverage with private insurers to
gain higher reimbursement rates for
residents residents implicitly finance a
portion of their training through their
contributions to patient care as such
there's often less financial risk to
hospitals starting residency programs in
these big metropolitan areas as they
often receive higher reimbursement rates
for services provided by residents in
addition there is often more financial
incentive to fund specialized residency
programs as opposed to primary care
specialties despite the latter being in
greater need as reimbursement rates for
specialists tend to be much higher for
these reasons just throwing more money
at the problem of the limited number of
residency positions may not be
sufficient that being said increasing
the number of physicians trained in the
u.s is only one solution to the
physician shortage another solution is
to import physicians from other
countries to practice in the united
states the issue is that there is a lot
of red tape that foreign trained
physicians must navigate in order to
practice medicine in the united states
in many states foreign trained
physicians are required to take the
usmle step exams and repeat residency
training which can be a huge barrier to
entry for physicians who have been
practicing for many years and are well
established in their specialty according
to a 2020 article in the annals of
internal medicine international medical
graduates or imgs constitute about 25 of
all actively participating specialists
in the united states and most work in
rural and underserved areas throughout
the country this may sound like a lot
however many imgs are only here on
temporary h-1b and j-1 visas while
completing residency training imgs that
hold a j-1 visa are required to return
to their home country for two years
after completing their residency or
finish a three-year waiver position in
an underserved area before they can
apply for permanent status or a green
card img's holding an h-1b visa may
apply for a green card and permanent
residence after they complete their
residency that being said just because
they are eligible for a green card does
not mean that they will receive one
green cards issued under the
employment-based category such as for
residents have a total cap of only 140
000 green cards per year with a fixed
cap of 7 allotted to each country in
addition imgs do not receive any
preferential treatment in obtaining
their green card for being a physician
and even after receiving a green card
there are multiple hoops to jump through
to practice as a physician permanently
in the u.s lastly a growing and aging
population combined with an aging
workforce of doctors nearing retirement
has further exacerbated the issue of
physician shortages the double amc
estimates that within the next decade
more than two out of every five
practicing physicians will be over the
age of 65. in addition physician burnout
is a huge issue within medicine which
has been further exacerbated over the
past few years as a result of the coven
19 pandemic these issues may lead some
physicians to decrease their hours or
even leave the profession as a whole
earlier than anticipated further
straining our physician workforce this
is another big reason why we need to
take steps toward increasing the number
of physicians in the united states the
long hours and difficult schedules that
resident physicians and attendants work
are not a matter of necessity but rather
a byproduct of our lack of physicians
some physicians oppose training more
medical students and residents or
recruiting foreign doctors as they fear
it will decrease their salaries although
this is a reasonable concern having more
doctors is likely to make life better
for us doctors by sacrificing a bit of
pay they may be able to avoid 60 plus
hour work weeks and having to spend
nights and weekends on call that being
said the one area that we need to remain
cautious about as we take steps to
address the physician shortage is the
rising cost of medical education if the
cost of medical education continues to
increase at the current rate and
salaries for physicians start to
decrease we may end up with a generation
of physicians with massive debt that
they struggle to pay back this is one of
many factors that we will need to
consider as we work to solve this
problem as you can see solving the issue
of physician shortages in the u.s is not
just a matter of training more doctors
it is a complex issue with many
different factors that will require an
equally complex and multifactorial
approach we need leaders and policy
makers to take a good hard look at the
state of medical education and
physicians in the u.s and start making
steps toward addressing issues like the
rising cost of medical education
physician burnout and the lack of
residency positions only then will we be
able to meet the growing demand for
physicians in the united states if you
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