In 2019, the Association of American Medical Colleges published data stating the United States will see a physician shortage of nearly 122,000 physicians[mfn]https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage[/mfn]. This reflects the need for physicians in both primary and specialty care.
The US physician shortage is a hot topic of conversation not only among healthcare workers but also among the general population. It arises whenever there are discussions of the increasing need for healthcare services in this country.
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Both the rise of chronic disease as well as the increasing demands for preventive services are drivers of this need. In addition, given the impact of the COVID-19 pandemic on healthcare workers, it is likely that the problem will only get worse[mfn]https://www.aamc.org/news-insights/us-physician-shortage-growing[/mfn].
Physician shortage or a physician training shortage?
In reality, the term physician shortage is a misnomer. It is a veil used to hide the cracks in the system. We believe that there is no physician shortage. Rather, there is a ‘training of physician’ shortage. Let us explain.
To practice medicine in the United States, one must first get accepted to medical school which is no easy feat. And then complete four (or more) years of medical school – two preclinical and two clinical. Afterward, medical school graduates must try to land a residency spot in their chosen specialty.
Graphic created by the authors from information in reference[mfn]https://www.fsmb.org/siteassets/usmle-step3/pdfs/pathway-to-licensure.pdf[/mfn].
In 1997, when there was a predicted surplus of physicians, Congress put a cap on residency spots by introducing the Balanced Budget Act of 1997[mfn]https://www.aamc.org/news-insights/gme[/mfn]. Twenty years later, that predicted surplus morphed into an evident shortage of trained physicians.
The process of getting a residency is time-consuming and costly
To apply for residency, candidates pay thousands of dollars for licensing exams (USMLEs), application fees, and registration to participate in the annual residency match. This is the only way to obtain a residency position in the U.S.
Graphic created by the authors from data in reference [mfn]http://www.nrmp.org/match-fees/[/mfn].
In 2019, the average number of applications sent per US medical graduate was 65. For International Medical Graduates (IMGs), it was 137. Even after all of this, candidates can still end up without a residency position.
Graphic, modified by authors, from NRMP Main Residency Match 2020 Results, page iv, reference [mfn]https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/06/MM_Results_and-Data_2020-1.pdf[/mfn].
Thousands of applicants go unmatched each year
While the number of residency positions has increased, it does not yet address the thousands of applicants that go unmatched each year. For example:
- The number of offered PGY1 positions in 2016 27,860 but the number of registered applicants was 34,266
- The number of positions in 2020 increased to 34,266 and the number of registered applicants increased to 44,959
- Including applicants who withdrew and those on the no rank list, the number of unmatched applicants in 2016 was 15,534. Even though the number of unmatched improved in 2020, there were still 12,560 medical school applicants who failed to get a residency slot.
The Supplemental Offers and Acceptance Program
After the main Match, candidates have one last shot at a Residency position. It is called the Supplemental Offers and Acceptance Program or SOAP. In the 2020 Match, there were 11,816 applicants scrambling for 1,897 spots available in SOAP[mfn]https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/06/MM_Results_and-Data_2020-1.pdf[/mfn].
So what happens to the ~10,000 applicants that don’t get a spot at the end of the cycle? From March – September, unmatched graduates have to do the following, at a minimum:
- strengthen their CV
- get more letters of recommendations
- save up to cover the cost to reapply for Residency
This leads to qualified doctors working minimum wage jobs and paying thousands of dollars to third party companies for clinical experience to fill the gaps. Many are also actively searching for open residency spots.
Searching for residency position…for a fee
Post Match and SOAP, there are few ways to search for open Residency positions. All of them require payment of a fee. In May 2020, a new Family Medicine Residency program opened up. Within 48hrs received 2,000 applications for 8 spots.
For the thousands of medical graduates who remain unmatched, there are simply no other opportunities to obtain a license to practice. That means the talents and skills of these doctors are not being used.
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So, what is the solution?
A number of things have been done to decrease the shortage of physicians. This includes establishing a goal of increasing medical school enrollment by 30%. This target was reached in 2018[mfn]https://www.aamc.org/news-insights/us-medical-school-enrollment-rises-30[/mfn].
This was the same year that the Association of American Medical College surveyed the 151 accredited medical schools in the United States. At that time, they found that 44% of deans voiced concerns about their students’ ability to find residencies.
While the number of medical school graduates have increased exponentially, there has only been an increase of 1% per year in residency spots. And, there has been little to no movement in removing the cause of the problem.
The Resident Physician Shortage Reduction Act of 2019 (S.348 / H.R.1763) was introduced in March of 2019 to remove the cap and increase residency spots. 186 members of Congress and 17 Senators have co-sponsored the bill. The problem is 218 are needed to pass it in Congress, and 51 in the Senate.[mfn]https://bit.ly/2CtvbkJ[/mfn].
Physician Assistants and Nurse Practitioners have also gained full authority to practice. However, medical graduates who have completed thousands of clinical hours and completed licensing exams are unable to practice[mfn]https://thriveap.com/blog/md-vs-np-vs-pa-heres-how-number-clinical-hours-compare[/mfn].
In Missouri, Utah, Arkansas, and Florida the Assistant Physician License has been adopted to allow these medical graduates to practice in underserved areas under the supervision of a licensed physician. Providing this license across all 50 states could help reduce the physician shortage and allow unmatched medical graduates a pathway to licensed practice outside of residency.
The bottom line
Every year, thousands of medical graduates fail to obtain a residency position. As a result, they are forced to work in jobs that don’t take advantage of their knowledge and skills. Furthermore, they must wait a year before applying again. This is unacceptable, particularly in this time of crisis, when physicians skills are so badly needed.
- Association of American Medical Colleges – New Findings Confirm Predictions on Physician Shortage https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage
- Association of American Medical Colleges – U. S. physician shortage growing (https://www.aamc.org/news-insights/us-physician-shortage-growing)
- Pathway to Medical Licensure in the US (https://www.fsmb.org/siteassets/usmle-step3/pdfs/pathway-to-licensure.pdf)
- Association of American Medical Colleges – The Role of GME Funding in Addressing the Physician Shortage (https://www.aamc.org/news-insights/gme)
- Match fees breakdown (https://www.nbme.org/taking-assessment/united-states-medical-licensing-e xamr-usmler https://www.ecfmg.org/fees/),(https://students-residents.aamc.org/financial-aid/article/cost-applying-medi cal-residency/), and (http://www.nrmp.org/match-fees/)
- NRMP 2020 Main Residency Match Results and Data page (https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/06/MM_Results_and-Data_2020-1.pdf
- NRMP 2020 Main Residency Match Results and Data pg 47-48 (https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/06/MM_Results_and-Data_2020-1.pdf)
- Association of American Medical Colleges – US medical school enrollment rises 30% (https://www.aamc.org/news-insights/us-medical-school-enrollment-rises-30)
- Resident Physician Shortage Reduction Act (https://bit.ly/2CtvbkJ)
- Education Comparison NP/PA/MD (https://thriveap.com/blog/md-vs-np-vs-pa-heres-how-number-clinical-hours-compare)