Why Is There a Doctor Shortage in the US?

The United States is running out of doctors — and the core reason why is stranger than you might think. It's not a lack of people who want to become physicians. It's not even a shortage of medical schools. The real cause of the US doctor shortage is a single Congressional decision made in 1997 that capped the number of federally funded medical residencies at 1990s levels — and that cap has barely moved since, even as the US population has grown by more than 73 million people. The result: thousands of fully qualified medical school graduates are blocked every year from completing their training, while 83 million Americans live in medically underserved areas with dangerously few doctors to serve them.

Take Wakulla County, Florida — home to 37,000 residents, three state parks, nearly a dozen schools, and just ten practicing physicians. That's fewer doctors per capita than Afghanistan or Haiti. And Wakulla is far from an outlier. Across the country, people drive hours for basic care, wait weeks or months for appointments, and when they finally get in front of a doctor, that doctor is seeing so many patients they barely have time to learn your name.

How Bad Will the Doctor Shortage Get by 2036?

The numbers ahead are genuinely alarming. Over the next decade, the US population is expected to grow by 15 to 20 million people. The population aged 75 and older — the heaviest consumers of healthcare — will expand by 54%. At the same time, two out of five currently practicing physicians will themselves be at least 65 years old by the end of that same period, meaning a significant wave of retirements is coming.

Add it all up, and the Association of American Medical Colleges projects a shortage of as many as 86,000 doctors by 2036. In other words, places like Wakulla County may actually have more access to healthcare today than they will for most of the next several decades. That's not a prediction designed to alarm — it's a straightforward consequence of policies that have been in place for nearly 30 years.

What Is a Medical Residency and Why Does It Matter?

Here's a fact that surprises most people: medical schools don't actually create doctors. They create doctors in training. Before any graduate can practice medicine independently, they must complete a residency — a supervised, on-the-job training program lasting a minimum of three years and as many as nine, depending on the specialty.

Residency is where the real bottleneck lives. Last year, there were roughly 47,000 applicants competing for just 37,000 residency positions. That means nearly 10,000 people — after 13 years of pre-tertiary school, 4 years of undergrad, and 4 years of medical school — were denied the right to proceed. They can't practice. They can't earn. They can only wait and hope for better luck next year, while interest compounds on an average student loan balance of $206,000. At schools like Tulane or the University of Chicago, that debt can approach or surpass $300,000.

These aren't marginal candidates, either. They already scored in the top half of all MCAT takers just to get into medical school. They survived four grueling years to earn an MD. By any reasonable standard, they are qualified. And yet the system turns them away.

What Caused the Medical Residency Bottleneck?

To understand why residencies are so scarce, you have to go back to the early 1980s. After World War II, American healthcare boomed. The GI Bill sent veterans to graduate school, the Hill-Burton Act funded hospital construction, and Congress began subsidizing residencies — recognizing that teaching hospitals sacrifice short-term efficiency for the long-term public good of training doctors.

It worked brilliantly. By the 1960s, the United States led the world in doctors per capita. But then came the backlash. A researcher named Milton Roemer observed that more hospital beds in a city correlated with longer average hospital stays — the idea being that if the beds exist, they'll be filled. This became known as Roemer's Law: "a hospital bed built is a bed filled."

In 1981, a government advisory committee warned of an impending physician surplus that would drain the economy through unnecessary procedures. Their prediction: by 2000, there would be at least 100,000 "excess" doctors. Fearful of regulatory punishment, medical schools voluntarily froze their enrollment. New hospital construction ground to a halt under Certificate of Need laws. And in 1997, Congress dealt the decisive blow — it stopped subsidizing new residents entirely. From that year forward, a hospital could only receive federal funding for as many residents as it had trained in 1996. That number has barely changed since.

The experiment failed spectacularly. Demand for healthcare didn't slow down. It kept growing. Americans in the post-war decades weren't abusing the system — they were finally getting the care they'd always needed. Constraining supply didn't reduce demand; it just meant more people went without. Between 1980 and 2005, the US population grew by 68 million. The number of medical schools and enrolled students stayed virtually unchanged.

How Does the Medical Residency Match Actually Work?

For the roughly 47,000 graduates who do compete for residency spots each year, the process is its own kind of ordeal. There is exactly one opportunity per year, called the Match. Hospitals interview and rank candidates; candidates rank hospitals. On a single day each March, everyone learns their fate. There is no negotiating. There is no comparing offers. Even the most qualified applicant cannot leverage competing programs against each other or ask for a higher salary. The hospital holds all the cards.

And hospitals have used that leverage extensively. Doctors almost universally describe residency as the most stressful period of their professional lives — 60 to 80-hour weeks, chronic sleep deprivation, and emotionally crushing stakes. The system was designed this way, in part, because cheap resident labor suits hospital economics just fine. With Congress having created an artificial scarcity of subsidized positions, the hospitals grandfathered in by the 1996 cutoff have enjoyed nearly 30 years of guaranteed funding and an endless supply of desperate, overqualified applicants willing to accept almost any terms.

Why Does the US Have So Few Primary Care Doctors?

The residency bottleneck doesn't just reduce the total number of doctors — it distorts which kinds of doctors enter the system. With medical school debt averaging over $200,000 (and climbing), aspiring physicians rationally gravitate toward high-paying specialties like cardiology or surgery, where incomes can exceed $500,000 annually. Primary care physicians go through nearly the same grueling process yet earn a fraction of that — and are forced to cycle through so many patients per day that meaningful relationships are nearly impossible.

The result: the United States has a roughly normal number of specialists per capita compared to other wealthy nations, but ranks last among OECD countries in the number of generalist physicians. Need an aortic valve replacement? America is genuinely world-class. Have a sore throat and need antibiotics? Good luck getting an appointment within the month. The downstream effect is that treatable conditions go undetected until they've quietly escalated into serious — and vastly more expensive — emergencies.

Geography compounds the problem further. Congress didn't just freeze the number of subsidized residencies in 1997 — it also froze their geographic distribution. Since roughly 56% of doctors end up practicing within 100 miles of where they completed their residency, cities whose populations have doubled or tripled since then — Las Vegas, Austin, Orlando — are critically underserved. Meanwhile, cities with stable populations from the 1990s, like Pittsburgh and Richmond, are comparatively well-supplied. Sunbelt states with large and rapidly aging populations have been hit especially hard.

What Could Actually Fix the US Doctor Shortage?

The simplest fix is also the most obvious: unfreeze the residency subsidies. The American Medical Association has been pushing for this for years. Simply increasing the number of federally funded residency slots — and adjusting their geographic distribution to reflect where Americans actually live today — would go a long way. In 2023 alone, the US spent $21 billion on resident subsidies. The money is already in the system; it's just being allocated based on 30-year-old data.

But there are smarter, more targeted options too:

  • Redirect subsidies toward primary care, particularly in rural and underserved areas, to address the specialist-generalist imbalance.
  • Tie funding to individual residents rather than hospitals, reducing the leverage hospitals hold over trainees and introducing at least some market competition into the process.
  • Create expedited licensing pathways for foreign-trained doctors, many of whom are US citizens currently forced to redo their entire residency from scratch.
  • Offer combined 6-year undergraduate and medical school programs, as most of the developed world already does, cutting costs and time without sacrificing quality.
  • Expand the scope of practice for nurse practitioners, allowing qualified nurses to handle more primary care, especially in rural communities facing acute shortages.

Any one of these changes could make a meaningful dent. All of them together could transform the system. The frustrating reality is that none of them require new science or untested ideas — they require political will. And so far, Congress has managed to add just 1,200 new subsidized residency positions since 1997. At that pace, Wakulla County and the 83 million Americans like it may be waiting a very long time.