Data published in 2021 by the Association of American Medical Colleges estimates that the U.S. could experience a shortage of 37,800 to 124,000 physicians by 2033. Rural America is struggling, as the majority of graduate training facilities are disproportionately located in metropolitan areas. This geographic imbalance directs doctors and residents away from already underserved and marginalized populations, leading to poorer health care access and increased morbidity and mortality rates. The National Resident Matching Program (NRMP) reports that over 41,000 applicants were denied residency training positions in the past five years (averaging 8,316 per year). This is primarily due to the Balanced Budget Act of 1997, an avoidable policy that has constrained funding for new training positions for over 25 years. However, solutions are available.
The health of individuals living in rural and underserved regions of America is inadequately managed and neglected. This problem is multifactorial, and no single solution will suffice. Nevertheless, there are actions the government can take to support these communities. Passing H.R.2256 (117th Congress), the Resident Physician Shortage Reduction Act of 2021, and its Senate companion bill, S.834, would create 14,000 new residency positions over seven years. This would enable qualified, unmatched physicians to begin their training and reduce the workforce burden within as few as three years. At least half of these new positions should be designated for primary care roles, particularly with a focus on rural areas and social determinants of health. However, this alone will not guarantee physicians’ long-term commitment to these communities. Metropolitan areas often lure them with higher salaries and diverse opportunities. Financial incentives can encourage physicians who grew up in rural areas to stay and serve their underserved communities.
Focusing solely on congressional changes is not the only option. Allowing states to take responsibility opens up more opportunities. For instance, Missouri has introduced a new licensure for assistant physicians (not to be confused with physician assistants), which permits unmatched physicians to work independently (under supervised autonomy) in underserved areas (Health Professional Shortage Areas or HPSAs) while reporting to a board-certified physician. This innovative approach enables unmatched graduates without recent clinical experience to acquire hands-on clinical knowledge in a safe environment, making them competitive applicants for future matches.
Until our representatives collaborate across party lines to improve their constituents’ health and health care, the health care crisis and physician shortages will continue to worsen.
Joshua Nealy is a physician.