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Sally C. Pipes is president, CEO, and Thomas W. Smith fellow in health care policy at the Pacific Research Institute. This column first appeared in the Chicago Tribune.
The pandemic has laid bare a crisis we’ve ignored for far too long — our chronic doctor shortage. According to the Association of American Medical Colleges, the United States faces a shortfall of up to 124,000 physicians over the next decade.
This is a supply problem, as the demand for care will only go up. So we must create more doctors — by expanding medical school capacity and increasing the number of residency slots where budding doctors can complete their training.
The causes of this looming shortage are many. Over half of doctors in this country are 55 or older and heading for retirement. Our aging population is increasing the overall demand for medical care.
Burnout is also becoming a bigger problem. Even before the pandemic, long hours, stifling bureaucracy and a lack of autonomy had been causing many doctors to hang up their stethoscopes early. The horrors and stresses of COVID-19 pushed many more out of active practice.
The shortage does not hit all Americans equally. Rural areas and poorer communities are more likely to lack the physicians they need.
We’re in this mess, in part, because of policies that ensued from a flawed, four-decade-old federal government report. In 1981, the Graduate Medical Education National Advisory Committee concluded that America would have a large surplus of physicians. The committee said that medical school enrollment had increased too much during the ’60s and ’70s.
The report is one reason why no new M.D.-granting medical schools were established until after the new millennium.
By 2006, the Association of American Medical Colleges issued its own report claiming that new medical schools were needed to avoid an impending doctor shortage.
Today, we’re graduating far too few doctors. Only 36.2 percent of those who apply to medical school end up matriculating, according to AAMC data from 2021-22.
The United States cuts a sorry figure in the data for medical graduates per 100,000 people among developed countries. In 2019, Ireland topped the list with 24.8 medical graduates for every 100,000 inhabitants. That year, the United States had just 8.1 per 100,000 people. Italy, Slovakia, Belgium and the Czech Republic all had twice as many medical graduates per capita in 2019 as we did.
Medical school admissions are, of course, supposed to be competitive. But how many people are denied the chance to become doctors simply because there aren’t enough desks — not because they wouldn’t make great physicians?
Medical school applications have been increasing for decades — by two-thirds since 2005. Last year, a record 62,000 prospective students applied.Acceptance rates are stunningly low, with only 7 of every 100 applicants admitted on average. At Harvard, the figure is 2.8.
There’s no escaping it — more slots are desperately needed.
Money is targeting student enrollment. The University of Utah will use a $110 million donation to increase each class’ size from 125 to 155, as well as to raise the number of residency slots it offers to finish training doctors.
There’s more. UMass Medical School received a “transformational” $175 million gift from the Morningside Foundation. Western Michigan University’s Medical School has received gifts totaling $300 million that could lead to a transformational growth in its student body.
Rowan University in New Jersey recently received an $85 million donation for a new osteopathic school of medicine. Belmont University in Tennessee got $10 million from its board of trustees chair to bolster its med school, and Wake Forest secured $25 million from the Howard R. Levine Foundation to go toward a brand-new medical school in Charlotte.
We could also use more residency slots, the postgraduate sites where medical graduates complete their training. This past December, the federal government committed to fund 200 new slots per year over five years through Medicare. It’s the largest increase in Medicare-funded residencies in more than a quarter-century.
Private philanthropists and other organizations dedicated to improving health care should seriously consider augmenting efforts like this one by funding residencies themselves.
Given the scope of the doctor shortage, we need many more actors to join the fight. This is a crisis we can stop.