By EMANUEL SARKEES
Most people assume that when they need a doctor, a doctor will be available. That assumption is getting harder to hold onto. Right now, more than 83 million Americans live in highlighted Health Professional Shortage Areas, which is the government’s official notice that where they live does not have enough physicians to meet basic healthcare demand. That is not a projection of something yet to come. It is the situation today, and the numbers are moving in the wrong direction.
The Association of American Medical Colleges projects the United States will face a shortage of up to 86,000 physicians by 2036. The National Center for Health Workforce Analysis puts it even higher, projecting a shortage of 124,180 physicians by 2027 and 187,130 by 2037. The two organizations use different methods but they land in the same place. The country is training, retaining, and deploying far fewer physicians than its growing and aging population needs.
What makes this worth paying attention to right now is not just the size of the problem. It is the fact that this shortage was not some unavoidable outcome. It was built, step by step, and then never was corrected before the damage became permanent.
How the System Built This Problem
The most important driver that most people have never heard of is the residency cap. In 1997, Congress froze the number of Medicare funded graduate medical education positions, which are the residency slots that medical school graduates need to complete before they can practice independently. The system largely preserved the existing distribution of residency positions, which also resulted in preserving an imbalance in the physician workforce. Adding more residency positions does not guarantee that new physicians will enter the primary care specialties or communities where they are actually needed. The result is not a shortage of physicians, but a mismatch between the specialties being trained and what types of physicians the country needs. Medical school enrollment has grown since then. Residency slots have not kept pace. The result is a bottleneck where qualified graduates cannot finish their training because there are not enough funded positions available. Without more residency funding, the final step in the physician training stays limited no matter how many students start medical school.
Medical debt makes the problem worse in a way that directly shapes where physicians end up practicing. The average medical school graduate carries more than $216,000 in student loan debt by the time they finish their education. By the time residency and fellowship training wraps up, which can be six to eight years later, that number has often grown. When a new physician is carrying a quarter million dollars in debt, the decision about where to practice is not made on the factor of where patients need the most help. It is made for the reimbursement system where primary care physicians earn significantly less than procedural specialists, and where rural practices operate on margins that make competitive salaries hard to offer. This is not a flaw in individual physicians. It is math, and the system sets it up this way.
Burnout is the third piece to the puzzle.
Physicians are 82.3% more likely to experience burnout than workers in other occupations, and the reasons are not hard to find: administrative burden, prior authorization paperwork, electronic health record documentation, and a reimbursement system that has seen physician payment rates drop more than 33% since 2001 when adjusted for inflation. Nearly one in five physicians currently plans to reduce hours or leave practice entirely within two years. When a physician leaves a rural community, the patients left behind get distributed among whoever remains, which increases burnout for those physicians too and makes the community even less appealing to new physicians. The cycle feeds itself, and it is already playing out right now in communities across the country.
Who Is Already Feeling It
Rural America is getting hit the hardest. Rural areas have roughly 30 physicians per 100,000 people compared to 263 per 100,000 in urban areas. In Southern states the ratio is worse, with one physician per 3,411 rural residents. More than half of rural physicians are currently over 50, and projections show a 23% decline in rural physicians by 2030 as that generation retires. The number of rural family physicians already dropped 11% between 2017 and 2023. For at least the next 12 years, rural areas are projected to have only about 66% of the primary care physicians they actually need.
The shortage is not spread evenly across specialties either. The surgical shortage may be less visible to patients than a shortage of primary care physicians, but it can still create significant barriers to care. A projection given by the American College of Surgeons estimates that the United States could face a shortage of 10,000-20,000 surgeons by 2036. At the high end, surgeons will account for up to 74% of the total physician shortfall. This shortage may not necessarily mean that patients cannot find a surgeon, but it may appear through longer wait times for procedures, limited access to specialized surgical care, and greater difficulty accessing surgeons in rural and underserved communities. Surgical training is expensive, takes years, is limited by the same residency caps, and is increasingly ugly to graduates who look at the liability exposure and the pay relative to other options. More than 80% of US counties currently lack an infectious disease specialist. 90% lack a pediatric ophthalmologist. More than 33% of Black Americans live in what researchers are calling a cardiology desert. These are not gaps that are coming someday. They are gaps affecting patients right now.
This connects to the same pattern that runs through every access problem in American healthcare. The communities dealing with the sharpest physician shortages are the same communities with the highest uninsured rates, the highest rates of chronic disease, and the least able to absorb a system that keeps directing resources toward where the money is and away from where the need actually is.
What Is Being Done
There is legislative movement happening. The Resident Physician Shortage Reduction Act, introduced in 2025 with bipartisan support, would add 14,000 Medicare-funded residency positions over seven years, with priority going to rural hospitals and shortage areas. The bill also caps new positions at 75 per hospital so large academic medical centers cannot absorb everything.
The Specialty Physicians Advancing Rural Care Act would create a loan repayment program for specialty physicians who commit to six years of service in rural shortage areas, which directly targets the debt problem pushing physicians toward cities in the first place.
These are real steps and they matter. But 14,000 new positions over seven years set against a projected shortfall of 86,000 to 187,000 physicians is a down payment, and not a fix. And there is a threat moving in a different direction at the same time. Proposed changes under the One Big Beautiful Bill Act would cap federal student loans for medical school at $200,000 and eliminate Grad PLUS loans entirely, pushing students into private lending at higher rates. If medical school becomes financially out of reach for more qualified applicants, the problem gets worse before the legislative solutions have any chance of working.
What Needs to Actually Change
Fixing this requires going after all three drivers at the same time, not one at a time.
The residency cap needs to be lifted significantly and sustainably. Adding 14,000 slots over seven years is a start. The scale of the shortfall requires a much bigger and more sustained commitment to graduate medical education funding, with obvious priority going to primary care, psychiatry, and rural medicine where the gap between supply and need is already doing the most damage.
Medical school debt needs to be restructured rather than made worse. Loan forgiveness programs tied to service in shortage areas, interest free deferment during residency, and repayment structures that account for the income gap between primary care and specialty medicine would actually change where new physicians choose to practice. Cutting loan access does exactly the opposite.
Burnout has to be treated as a crisis, not a personal issue for individual physicians to work through on their own. Reducing prior authorization requirements, fixing the electronic health record issues, and reversing the long decline in Medicare reimbursement rates are all directly connected to whether physicians stay in practice or leave it early.
The United States is not running short of people who want to become doctors. It is running short of doctors because the system made training too expensive, practicing where help is needed most too financially punishing, and staying in medicine too administratively exhausting to sustain. That is a policy failure. And unlike a lot of things in healthcare, policy failures are something that can be corrected when the people responsible for fixing them decide to treat what is already happening as the crisis is, rather than waiting for the outcomes to get bad enough that ignoring them is no longer an option.
Emanuel Sarkees is a high school student with a strong interest in medicine, healthcare, and innovations that improve patient care and access to treatment.
