Historically, the number of physicians in the United States has been deliberately limited in an attempt to avoid massive physician surpluses—but now, there is a growing shortage of doctors, which negatively affects the country's health care system and people's health, Derek Thompson writes for The Atlantic.

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How the U.S. capped its physician supply

According to Thompson, the United States has one of the lowest number of physicians per capita, largely due to deliberate efforts to limit the overall physician workforce.

"There's a huge scarcity of primary care doctors, like pediatricians, and many of us are operating in a scarcity framework without enough resources," said Elizabeth Erickson, a professor at Duke University's School of Medicine.

In 1981, a report from the Graduate Medical Education National Advisory Committee concluded that the country would soon face a massive physician surplus and recommended actions to limit the number of new domestic physicians, as well as immigrant physicians. In response to the report, the federal government reduced funding for both medical school scholarships and residency training programs.

In addition, U.S. medical schools enacted a moratorium from 1980 to 2005, which limited the number of new medical schools and restricted medical school class sizes. Although the U.S. population grew by 60 million people during that period, the number of medical school graduates remained mostly stagnant and has not completely rebounded even after the moratorium ended, Thompson writes.

Separately, the process to become a physician in the United States is more arduous and expensive than other peer countries, particularly those in Europe. According to Thompson, the United States requires doctors to earn a four-year bachelor's degree, as well as attend four years of medical school, but most European countries have one continuous six-year medical program instead. In addition, many medical school graduates have between $200,000 and $400,000 in student loans when they enter the workforce.

However, American doctors' longer training periods have not translated into better health for Americans as a whole, Thompson writes. In fact, a recent study found that Americans die earlier than their European counterparts at every age and income level.

Ways to address the U.S. physician shortage

Growing the physician workforce over the next few years will be critical, Thompson writes, not only to deal with the effects of the current Covid-19 pandemic, but also to care for the United States' older and aging population. In 2018, the Association of American Medical Colleges predicted that the United States would be short between 43,000 and 121,000 physicians by 2030.

According to Robert Orr, a policy analyst who studies health care policy at the Niskanen Center, one way to increase the number of physicians is to expand medical residency programs. "This might be the key bottleneck," he said. More funding for residency programs would allow medical schools to grow, which will mean more medical students and, ultimately, more doctors.

Aside from just increasing the number of doctors, states could also increase the total supply of care available, Thompson writes. For example, states could allow more nurse practitioners to substitute for doctors and expand telemedicine services, particularly to rural and underserved areas.

The United States also needs to build its health care infrastructure, such as clinics and hospitals, as it works to expand its physician workforce. "We need a system of health care development banks that issue guaranteed loans for infrastructure projects," Orr said. "That's how the health care system was originally built up until the 1980s, with government-backed finance."

Although Thompson notes that there are several potential downsides of having too many doctors, including lower physician wages and more student debt, he ultimately argues that "[s]ick, aging, and buckling under two years of pandemic mayhem, America desperately needs more physicians." (Thompson, The Atlantic, 2/14; Orr, Niskanen Center, 9/8/2020)