America has a doctor shortage that even qualified medical school graduates can’t fill.
That’s partly because of a residency bottleneck. Residency is an essential part of a practicing physician’s training. But in 2021 there only 35,194 first-year residencies available for 42,508 new doctors, according to Vox (graph below, story here).
“At the root of the mismatch between physician supply and demand are decades-old limits on medical school enrollment and outdated rules governing the federal funding for most residency programs,” the Vox article says.
Medical schools contribute to the problem by limiting admissions to numbers far below America’s need for doctors. That resulted from “miscalculations about population growth and changes in medical care delivery” that led to “a moratorium on medical school enrollment that lasted until 2005.” There’s no quick fix for that, because expanding enrollment too quickly “could result in a surplus of medical graduates with nowhere to do their residencies.”
Somewhat oddly, medical residencies are mostly funded by Medicare and Medicaid, making America’s production of new doctors heavily dependent on federal dollars. Making things worse, the federal funding formulas work against training badly-needed primary care and rural doctors. And, “While Congress has taken some baby steps toward increasing that funding, it has yet to … create a sustainable and pandemic-resilient physician workforce.”
Did someone say pandemic? Yep, the Great Resignation hasn’t spared the medical profession. Doctors are quitting or retiring early. Why? “Burnout, fear of exposure, pandemic-related mood changes, and workload [are] all associated with intent to leave the profession,” Vox says.
Meanwhile, the U.S. can’t fill its doctor gap by importing (poaching?) doctors from other countries. States are partly to blame for requiring U.S. residencies for licensure. But also blame federal laws and bureaucracy for visa restrictions.
Is this starting to look like a dog chasing its tail?
An antiquated system, designed decades ago, needs revamping and updating. But the problem overlaps many jurisdictions, so doing that is very cumbersome, and requires more coordination than our political system is capable of.
And, given the current state of our political system, how will you get legislators preoccupied with QAnon conspiracy theories to do it?
