{"id":328,"date":"2026-07-30T09:39:12","date_gmt":"2026-07-30T09:39:12","guid":{"rendered":"https:\/\/usabusinesschronicle.com\/?p=328"},"modified":"2026-07-30T09:39:12","modified_gmt":"2026-07-30T09:39:12","slug":"the-doctor-shortage-is-here-and-getting-worse","status":"publish","type":"post","link":"https:\/\/usabusinesschronicle.com\/?p=328","title":{"rendered":"The Doctor Shortage Is Here\u2014and Getting Worse"},"content":{"rendered":"
\n

In 2025, my wife and I took a summer road trip along France\u2019s Brittany coast, a region renowned for its timeless villages with their spired churches, quiet squares, caf\u00e9s, and boulangeries. Yet, one detail kept piercing the postcard charm: the same billboard on many village outskirts, pleading\u202f\u201cCherche m\u00e9decin !\u201d<\/em>\u202f(\u201cWe need a doctor!\u201d).\u202f\u00a0<\/p>\n

Read more Businesses Should Step Up to Defend Democracy<\/a><\/p>\n

We are both physicians, and the signs landed with a quiet force: not just a local plea, but a glimpse into the anxiety of small, doctorless communities. France is suffering from a physician shortage\u2014the result of doctors retiring, an aging population with greater needs, and a stubborn maldistribution of providers away from small towns and villages. This is France today, but it may also be America\u2019s tomorrow if we do not begin treating our physician workforce as a strategic national asset. \u00a0<\/p>\n

According to the U.S. Health Resources and Services Administration, the U.S. is projected to have a shortfall of roughly\u202f187,000 physicians\u202fby the mid-2030s, with nearly half of the deficit in primary care. As in France, rural, small towns as well as more racially\/ethnically diverse communities will be the worst off.\u00a0<\/p>\n

This is not alarmism. It is simple demographics.\u00a0<\/p>\n

America is experiencing a once-in-a-generation convergence of demographic forces. Over the next decade, the population aged 65 and older, currently responsible for some 40 percent of health care spending, will grow by more than one-third, sharply increasing the need for chronic-care management, cancer treatment, cardiovascular care, and cognitive-decline services. Meanwhile, the current physician workforce is aging out. Nearly half of all practicing physicians are over 55 and approaching retirement. Many will reduce their hours or leave the workforce just as patient needs crest. Add the rising complexity of modern medicine (more subspecialization, more care coordination), and the gap between supply and demand becomes a chasm\u2014meaning longer wait times, travel distance, and difficulty finding the right physician in the right place.\u202f\u00a0<\/p>\n

Training a physician in the U.S. takes 11 to 15 years\u202fafter high school. Even if medical schools expanded overnight, we would not feel the effects for more than a decade. In fact, medical schools have already done their part: admissions have risen 30 percent\u202fsince 2002.\u00a0<\/p>\n

Now, the greatest bottleneck appears to be at the residency training level.\u00a0<\/p>\n

In 1997, Congress capped federal funding for residency positions through Medicare\u2019s Graduate Medical Education (GME) program. Nearly 30 years later, America\u2019s population has grown by 70 million people while the number of federally funded residency slots has barely moved. The most direct fix is to increase GME funding so hospitals can train more residents. The Resident Physician Shortage Reduction Act, introduced in 2023, would add 2,000 federally funded slots each year\u2014a meaningful start\u2014but it remains stuck in committee without a vote.\u00a0<\/p>\n

Another option is hardly radical: allow more doctors who trained abroad to come here and practice. Already, an estimated 20 percent of current practicing physicians are both foreign-born and internationally trained. In some states, like Florida, New York, and New Jersey, that number rises to 30 percent.\u202f\u00a0<\/p>\n

The U.S. currently issues about\u202f3,700 H-1B visas to foreign-trained physicians each year and another\u202f3,000 J-1 visas\u202ffor residency training. Most remain in the U.S. permanently, often serving in underserved areas.\u00a0<\/p>\n

Yet at the very moment U.S. states most need these physicians, federal policy is moving in the opposite direction, beginning with increasingly restrictive immigration procedures. A recent New York Times<\/em> article highlighted over 100 physicians who have been caught up in the immigration dragnet and suspended from practicing. Add to that, lawmakers have proposed raising the H-1B visa fee to $100,000\u2014a cost that would make training or relocating to the U.S. all but impossible for nearly every foreign medical graduate. There are roughly 7,000 highly trained physicians per year who may simply go elsewhere as other countries aggressively recruit them with relocation assistance and guaranteed placements.\u00a0<\/p>\n

Workforce Multipliers We Can Deploy Now<\/strong>\u00a0<\/p>\n

Even with better training pipelines and smoother immigration pathways, physician supply will lag. We need to rethink how care is delivered.\u00a0<\/p>\n

A major part of the answer lies in expanding the numbers and scope of practice of nurse practitioners (NPs)\u202fand\u202fphysician assistants (PAs). Trained in a fraction of the time and at lower cost, they can independently manage much of the routine and chronic care. In primary care, NPs and PAs are a major force multiplier, accounting for over 40 percent of all patient care visits. Most states are in the process of granting or have already granted full practice authority to NPs. PAs remain legally tied to physician supervision through practice agreements, but this, too, is changing as a number of states liberalize these oversight requirements. Physicians remain essential\u2014particularly for complex conditions\u2014but a team-based model allows each clinician to practice at the top of their training.\u00a0<\/p>\n

Read more A Better Celebration of America at 250<\/a><\/p>\n

Technology, too, can expand effective supply. And here, it is easy to slip into AI evangelism. Yet, the most transformative tools aren\u2019t futuristic AI diagnosticians but more prosaic advances: AI medical scribes that reliably generate clinical notes, automated prior authorization, telehealth follow-ups, and structured care pathways for chronic diseases. Each reduces administrative load and frees physicians for direct patient care. In a shortage, productivity is supply.\u00a0<\/p>\n

France\u2019s Experiments\u2014Bold and Controversial<\/strong>\u00a0<\/p>\n

France is further down this road, and its response is instructive.\u00a0<\/p>\n

Facing a rising wave of medical deserts, the French parliament has shown rare unity, passing measures that challenge long-standing norms of physician autonomy. The new \u201cSolidarity Missions\u201d program asks general practitioners in well-served areas to spend\u202ftwo days per month\u202fworking in one of 151 designated underserved regions, with financial incentives and\u2014if voluntary uptake proves insufficient\u2014the possibility of mandatory participation.\u00a0<\/p>\n

In April 2025, France empowered its Regional Health Agencies to regulate where physicians can set up practice. In some regions, a new doctor may open a practice only when another retires; in high-need areas, authorization is automatic. Those who relocate receive stipends, expedited credentialing, and assistance with setting up their practices. Meanwhile, the country has eased decades-old limits on medical school admissions and streamlined the path for foreign-trained doctors willing to serve in shortage areas.\u00a0<\/p>\n

These measures have sparked fierce debate. Many French physicians see them as an intrusion on their long-held freedom to choose where and how to practice. But the government\u2019s message is blunt: the \u2018soft\u2019 policy of volunteerism and incentives has failed, and the status quo is untenable. National emergencies require national responses.\u00a0<\/p>\n

Lessons for the U.S.<\/strong>\u00a0<\/p>\n

The parallels between today\u2019s France and tomorrow\u2019s America are striking: an aging population, an aging physician workforce, deep regional inequities in access to care. Yet the U.S. faces additional constraints: no unified payer system, no centralized workforce authority, and little appetite for mandatory service requirements.\u00a0<\/p>\n

The lesson from France is not to copy its policies wholesale. Rather, it is to recognize the physician workforce as a\u202fstrategic national asset\u2014one that cannot be left to market drift, congressional neglect, or happenstance.\u00a0<\/p>\n

A realistic roadmap here in California where I work would blend four elements and offer a model for other states:<\/p>\n

(1)<\/strong>\u202fexpanding residency positions through state and\/or federal initiatives;
(2)<\/strong>\u202fstreamlining immigration pathways for foreign-born and trained medical graduates;
(3)<\/strong>\u202fexpanding numbers and granting full practice authority to NPs and PAs where appropriate; and
(4)<\/strong>\u202f Deploying technology that meaningfully improves physician productivity by eliminating administrative friction\u2014automating documentation, billing, and ordering\u2014so physicians can devote more time and attention to their patients. \u00a0<\/p>\n

None of this is simple, and, most notably, the politics of the moment doesn\u2019t favor easier immigration. But demographic math does not bend. And this moment of stalemate on immigration and so many other issues will pass. For would be 2028 presidential candidates looking to make an impression in key early primary states like Iowa, New Hampshire, South Carolina, and Nevada, this could be a winning issue. \u00a0<\/p>\n

France\u2019s billboards are a warning of what happens when needs outpace supply and governments are forced into emergency measures. America still has time to act\u2014to treat physician availability as a strategic imperative rather than an afterthought. Whether we heed the warning before our own \u201cWe need a doctor!\u201d signs appear on our state highways is a choice we can still make.<\/p>\n

Read more An American\u2019s Unrequited Love for Iran<\/a><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

America should start treating its physician workforce as the strategic national asset it is before it\u2019s too late.<\/p>\n","protected":false},"author":1,"featured_media":327,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,16,8,18,19,2],"tags":[136],"class_list":["post-328","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-books","category-health-care","category-higher-education","category-law-and-justice","category-newsletter","category-politics","tag-tagged-demographics-h-1b-program-health-care-immigration-enforcement-medical-school-medicare-regional-inequality-rural-health-care"],"yoast_head":"\nThe Doctor Shortage Is Here\u2014and Getting Worse - USA Business Chronicle<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/usabusinesschronicle.com\/?p=328\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The Doctor Shortage Is Here\u2014and Getting Worse - 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