The Conversation

By Rochelle Walensky, Harvard Kennedy School and Nicole McCann, Boston University

Americans are increasingly waiting weeks or even months to get an appointment to see a health care specialist.

This delay comes at a time when the population of aging adults is rising dramatically. By 2050, the number of adults over 85 is expected to triple, which will intensify the strain on an already stretched health care system. We wrote about this worsening challenge and its implications for the health care workforce in a January 2025 report in the New England Journal of Medicine.

We are health care scholars who are acutely aware of the severe shortfall of specialists in America’s health care system. One of us, Rochelle Walensky, witnessed the consequences of this shortage firsthand as the director of the Centers for Disease Control and Prevention from January 2020 to June 2023, during the critical early years of the pandemic.

The COVID-19 pandemic brought the physician and overall health care workforce shortage to the forefront. Amid the excess daily deaths in the U.S. from COVID-19, many people died of potentially preventable deaths due to delayed care for heart attacks, deferred cancer screenings and overwhelmed emergency departments and intensive care units.

Even before the pandemic, 80% of U.S. counties lacked a single infectious disease physician. Before going to the CDC, I – Dr. Walensky – was chief of the Division of Infectious Diseases at Massachusetts General Hospital. When COVID-19 hit our hospitals, we were in desperate need of more infectious disease expertise. I was just one of them.

At the local level, these infectious disease-trained subspecialists provide essential services when it comes to preventing and controlling transmissible outbreaks, carrying out diagnostic testing, developing treatment guidelines, informing hospital capacity planning and offering resources for community outreach. Each of these experts plays a vital role at the bedside and in systems management toward effective clinical, hospital and community responses to infectious disease outbreaks.

Uneven health care outcomes and access

For decades, experts have warned of an impending decline in the physician workforce.

Now, Americans across all regions, specialties and socioeconomic backgrounds are experiencing that decline firsthand or personally.

The National Center for Health Workforce Analysis projects a national shortage of 140,000 physicians by 2036, with that shortfall spanning multiple specialties, including primary care, obstetrics, cardiology and geriatrics.

However, some geographic areas in the country – especially some of those with the poorest health – are disproportionately affected. The brunt of the effect will be felt in rural areas: An estimated 56% shortage is predicted in nonmetro areas, versus only 6% in metro areas.

States such as Massachusetts, New York and Maryland boast the highest density of physicians per 100,000 people, while states such as Idaho, Mississippi and Oklahoma rank among those with the lowest. And even in states with the highest physician density, demand may still overwhelm access.

Although doctor shortages do not necessarily cause poor health outcomes, regions with fewer physicians tend to have lower life expectancy. The mean life expectancy in Mississippi is six years lower than that of Hawaii and more than four years below the national average. This underscores the substantial differences in health outcomes depending on where you live in the U.S.

Notably, areas with fewer doctors also see higher rates of chronic conditions such as chronic pulmonary disease, diabetes and poor mental health. This crisis is further exacerbated by the aging baby boomer population, which places increasing demand on an already strained health care system due to rising rates – especially among those over 85 – of multiple chronic diseases, complex health care needs and the concurrent use of multiple medications.

How the US reached this point

Some of these workforce challenges stem from the unintended consequences of policy changes that were originally aimed at improving the rigor of medical education or curtailing a once-anticipated physician glut.

For example, the 1910 Flexner Report was commissioned to restructure American medical education with the goals of standardizing curricula and improving quality. While the report succeeded at those goals, it was shortsighted in important ways. For instance, it recommended closing rather than strengthening 89 of the 155 existing medical schools at the time. This created medical school deserts that persist in some U.S. regions to this day.

Additionally, the report further divided the study of medicine, focused on disease, from the study of public health, which is focused on health care systems, populations and society. This separation has led to siloed communication and data systems that continue to hinder coordinated responses to public health crises.

Decades after the Flexner Report, in 1980, policymakers anticipated a physician oversupply based on medical school enrollment projections and government investments in the medical workforce. In response, funding constraints were introduced by Congress to limit residency and fellowship training slots available after medical school.

But by the early 2000s, discussions shifted to concerns about physician shortages. Despite the calls for reforms to address the issues more than a decade ago, the funding and training constraints have remained largely unchanged. These have created a persistent bottleneck in postgraduate medical training that requires acts of Congress to reverse. https://www.youtube.com/embed/RiFgZKzSUCo?wmode=transparent&start=0 Primary care doctors provide continuity for patients; without them, people tend to experience more complex health care needs and poorer outcomes.

Forces shaping the physician bottleneck

In the wake of the Dobbs vs. Jackson Women’s Health Organization decision, states with restrictive abortion policies are now facing an emerging and troubling workforce challenge: It may get more difficult to recruit and retain tomorrow’s medical school grads.

Research surveys suggest that 82% of future physicians, not just obstetricians, prefer to train and work in states that uphold abortion access. While it may seem obvious that obstetricians would want to avoid the increasing liabilities associated with the Dobbs decision, another point is less obvious: Most medical trainees are between the ages of 25 and 35, prime childbearing years, and may themselves want access to a full range of obstetric care.

And given that 20% of physicians are married to other physicians and an additional 25% to other health professionals, marriage within the health care workforce may also play a substantial role. A physician choosing not to practice in one of the 14 states with limited abortion access, many of which already rank among the poorest in health outcomes and lowest in physician densities, may not only take their expertise but also their partner’s elsewhere.

Shifting the trajectory

The doctor shortage requires a combination of solutions, starting with addressing the high cost of medical education and training. Medical school enrollment has increased by only 10% over the past decade, far insufficient to address both the shortage today and the projected growth of the aging population needing care.

In addition, many students carry large amounts of debt, which frequently limits who can pursue the profession. And existing scholarship and compensation programs have been only modestly effective in incentivizing providers to work in high-need areas.

In our New England Journal of Medicine report, we laid out several specific strategies that could help address the shortages and the potential workforce crisis. For instance:

Rather than the traditional medical education model – four years of broad medical training followed by three to seven years of residency – medical schools could offer more specialized training pathways. These streamlined programs would focus on the skills needed for specific medical specialties, potentially reducing training duration and costs.

Reforming physician compensation could also help address imbalances in the health care system. Specialists and subspecialists typically earn substantially more than primary care doctors, despite the high demand for primary care. Raising primary care salaries and offering incentives, such as student loan forgiveness for physicians in high-need areas, could encourage more doctors to practice where they are needed most.

Additionally, addressing physician burnout is crucial, particularly in primary care, where administrative burdens such as billing and charting contribute to stress and attrition. Reducing these burdens, potentially through novel AI-driven solutions, could allow doctors to focus more on patient care and less on paperwork.

These are just an assortment of strategies we propose, and time is of the essence. One thing is certain: The U.S. urgently needs more doctors, and everyone’s health depends on it.

Rochelle Walensky, Bayer Fellow in Health and Biotech, American Academy in Berlin, Senior Fellow in the Women and Public Policy Program, Harvard Kennedy School and Nicole McCann, PhD Candidate in Health Services and Policy Research, Boston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.