In my last blog I talked about the worsening doctor shortage in the U.S. (Doctor Shortage Worsening) The reasons for this shortage are many and include early retirement of current physicians, unqualified medical school applicants, insufficient training facilities, inadequate medical school capacities, a growing population, declining interest in the medical profession, and many others.

In the last blog, we talked about expanding the number of available spots in medical schools and in residency training programs. These solutions will take lots of money and time to build the facilities needed and support the increased faculty needed. Some have suggested a faster solution is increasing the number of foreign-trained physicians.

Jonathan Wolfson, writing in The Wall Street Journal, says some states are looking to solve the problem by lowering the requirements for foreign-trained physicians to become licensed in this country. Historically, foreign-trained physicians have been required to repeat their residency training in U.S. residency programs in order to be licensed to practice in this country.

This meant top foreign doctors who treat professional athletes around the world, for example, could treat American athletes only overseas. Or doctors who wanted to help underserved communities in the U.S. would have to take lower pay and repeat training they had already completed in another country.

When I was a general surgery intern, I developed an appendicitis while assisting a neurosurgeon doing a craniotomy for a brain aneurysm. When the procedure was finished, I excused myself, telling the neurosurgeon I needed to go have my appendix taken out! About two hours later I was lying on the same operating room table, having an appendectomy performed by a Vietnamese general surgeon who had practiced for many years in his country, but was required to do a repeat residency when he came to our country. He did a great job and I was back to work three days later.

 States are starting to see the value of letting internationally licensed physicians help fill their doctor shortages. Govs. Kim Reynolds and Glenn Youngkin signed bills recently allowing Iowa and Virginia to join Tennessee, Florida, Wisconsin and Idaho to create a pathway for doctors practicing abroad to become fully licensed without completing unnecessary post-medical-school “residency” training in the U.S.

States all face their own challenges because the distribution of physicians across the country isn’t uniform. Virginia ranks 33rd in the country for the supply of general surgeons, while Georgia ranks 41st in primary-care-physician supply. Michigan’s doctor-patient ratio for psychiatry is 26% worse than the national average.

These bills have earned bipartisan support because the doctor shortage affects everyone—whether Republican or Democrat, rural or urban. In Virginia, the bill’s lead sponsor was Kathy Tran, who leads the Democratic caucus in the House of Delegates. Wisconsin similarly saw a partnership between Democratic Gov. Tony Evers and Republican lawmakers. Near-unanimity in the Tennessee and Idaho legislatures and bipartisan sponsorship in Michigan show that despite partisan rancor, states can still solve important challenges together.

Pending bills in Minnesota, Maine, Arizona, Michigan and Massachusetts all deserve to become law. Those states know that a doctor shortage is looming. They want to increase the number of practitioners, rather than merely trying to increase medical-school enrollment or train more residents in the next 10 years. Colorado and Illinois have also taken steps to address this issue by mandating that their state medical boards create licensing pathways for international physicians. Those pathways remain under development.

Wolfson says, “On Jan. 1, Tennessee stood alone as the only state allowing internationally licensed doctors to become fully licensed. By year’s end, we may see more than 10 states with a legislative or administrative pathway on the books. As America searches for an answer to the looming catastrophe of patients losing access to care, foreign physicians should be called upon to help to fill those gaps. Every patient should have a doctor to see as soon as he needs one.”

This is just another piece of the puzzle needed to solve our physician shortage. Ideally, we should train a sufficient number of our own countrymen to fill the need for more doctors. But until we do, making it easier and faster for well-trained foreign physicians to practice makes sense.

The shortage of physicians is getting worse. For as long as I’ve been writing this blog, I’ve been commenting on the shortage of physicians. Sadly, the situation is getting worse.  But the solution to this dilemma is complex. There are many reasons for this shortage and solving the problem will require addressing each of these.

Not Enough Doctors or Medical School Seats

A.R. Cabral, writing for USNews.com, tells us of the comments of Dr. Jesse M. Ehrenfeld, president of the American Medical Association, who told the National Press Club in the fall of 2023, “Imagine walking into an emergency room in your moment of crisis – in desperate need of a physicians’ care – and finding no one there to take care of you,” he said. This situation is not far-fetched in some rural areas especially.

The demand for licensed physicians is at an all-time high and projected to be significantly higher by 2034, largely due to a growing and aging population. Many observers wonder if admitting more students into medical schools will address the scarcity. But that means more medical schools, larger faculties to teach those students, and more applicants of high quality to fill those seats.

In January 2024, there were just above 1.1 million professionally active doctors in the U.S., according to Statista, a worldwide data and business intelligence platform. And tens of thousands of those licensed physicians spend more time teaching, in research or in administrative roles than in patient care, according to the American Medical Association. Per the National Association of Community Health Centers, the physician shortage means 30% of Americans don’t have a regular primary care doctor.

That’s also a problem for medical schools: In short, you need doctors to make doctors. A shortage of them limits the number of mentors, teachers and attending physicians – for clinical hours – to engage with medical students. This is a consideration when increasing enrollment at medical schools, which number fewer than 200 in terms of accreditation to grant an M.D. or doctor of osteopathic medicine degree in the U.S.

A. Dexter Samuels, executive director of the Center for Health Policy at Meharry Medical School in Tennessee, echoes concerns. Admitting more students would disrupt the ratio of faculty to students, he says. For every med student, a slot should be available for training in a hospital setting. The doctor shortage can’t accommodate an increase in the number of students, Samuels says, and “hypercompetitiveness of recruiting and retaining faculty” is an ongoing challenge.

Already, fewer than half of all applicants to U.S. med schools are accepted each year, with the average hopeful applying to multiple schools. Solving the doctor shortage in the U.S. will take more than just increasing the number of spots available in medical school, says Dr. Amy Waer, dean of Texas A&M University’s School of Medicine. That’s because there’s a bottleneck between medical school and graduate medical education – that is, residencies and fellowships – also known as GME.

“While many medical schools would like to increase their admission numbers, finding appropriate clinical training sites and physician faculty are limiting factors, particularly for community-based medical schools like Texas A&M,” Waer wrote in an email.

Per the Association of American Medical Colleges, residency slots and clinical training sites haven’t kept pace with growing medical school enrollments – and without residency training, graduating doctors can’t be licensed to treat patients. Experts say the shortfall is largely due to a congressionally imposed cap on federal support for GME through the Medicare program, in place since 1997.

Medical School Enrollment

Enrollment in M.D.-granting medical schools has grown steadily from 92,626 during the 2019-2020 school year to 97,903 in 2023-2024, according to AAMC data. That’s up significantly from 69,718 med school students in 2002, per the AAMC.

However, the increases are unlikely to fully address the scarcity of doctors predicted through 2034. The class sizes, enrollment and number of medical schools are “not growing fast enough to meet the demand for physicians’ services and health care across the nation,” Ehrenfeld says.

New medical schools are opening, aiming to produce more doctors. They will also benefit their surrounding communities, Ehrenfeld says. “Schools have different missions and different goals they are trying to achieve,” he says. “As there continue to be innovative solutions around medical education and meeting those demands, we will see more campuses and more schools trying to align the needs of the community with the mission of the program.”

Unfortunately, some medical schools are resorting to “wokeness” to find more medical school applicants, lowering the bar for qualification. For more on this read my post called Rejecting Wokeness in Medical Schools. The solution to the shortage of physicians is not accepting less qualified applicants of any race or socioeconomic background. It is incentivizing the best of our youth to pursue a medical career so we have an abundance of highly qualified physicians. I favor government subsidized medical education. If we want the best doctors, we have to be willing to make it easy for anyone who is qualified to go to medical school. We also must make larger investments in medical school facilities to meet the challenge of physician shortages.

Eighty years ago today about midnight my father jumped out of a plane over Normandy, France. He was the first man out of the second plane that began the invasion that would liberate France and the civilized world. As a Captain in the 101^StAirborne Division, he was one of about 20,000 paratroopers to make that jump on that historic night.

According to Barrett Tillman’s D-Day Encyclopedia, The Normandy Invasion consisted of 5,333 Allied ships and landing craft embarking nearly 175,000 men. The British and Canadians put 75,215 troops ashore, and the Americans 57,500, for a total of 132,715, of whom about 3,400 were killed or missing, in contrast to some estimates of ten thousand. The foregoing figures exclude approximately 20,000 Allied airborne troopers.

The Allied forces for Operation Overlord comprised twenty-three infantry divisions (thirteen U.S., eight British, two Canadian); twelve armored (five U.S., four British, one each Canadian, French, and Polish); and four airborne (two each U.S. and British)—for a total of twenty American divisions, fourteen British, three Canadian, and one each French and Polish. However, the assault forces on 6 June involved two U.S., two British, and one Canadian division.

Air assets included 3,958 heavy bombers (3,455 operational), 1,234 medium and light bombers (989 operational), and 4,709 fighters (3,824 operational), for 9,901 total and 8,268 operational. Allowing for aircrews, 7,774 U.S. and British Commonwealth planes were available for operations on 6 June, but these figures do not include transports and gliders.

Of the 850,000 German troops awaiting the invasion, many were Eastern European conscripts; there were even some Koreans. There were sixty infantry divisions in France and ten panzer divisions, possessing 1,552 tanks, but not all were combat ready. In Normandy itself the Germans had deployed eighty thousand troops, but only one panzer division.

I had the privilege of accompanying my father when he revisited Normandy on the 50^th anniversary of D-Day. It was a solemn event as we walked together the grounds of the Normandy American Cemetery at Omaha Beach and viewed the thousands of white gravestones of the men who died there on that day.

But it was a joyful day as well as my father recounted the events of the first twenty-four hours when he landed in a tree and lost his “clicker.” In the pitch-darkness of that night, he managed to pull on the shrouds of his parachute until he was able to feel the tops of bushes with his feet and then jump to the ground. He soon connected with his fellow paratroopers and together they achieved their first objective: taking out a pill-box (large German artillery gun) that threatened the beaches.

We were able to find that concrete pill-box on our return visit, still sticking up like a swollen thumb in the field of a cow pasture. Then we found the nearby farm house where my father set up a base of operations with the cooperation of the farmer and his family. We even discovered the farmer’s daughter, a girl of fifteen during the war, was still living there! The reunion with my father transcended their mutual lack of a common language.

As I reflect on that day 30 years ago, and the events of 80 years ago, I have a profound sense of appreciation in my heart for my father – and for the thousands of men and women who gave their lives that day that we might be free. America is the greatest country in the world and has done more to promote the freedom of other countries in the world than any other country in history. It’s too bad that so many young Americans don’t know this.

Today, June 6^th, is a day that all Americans should be proud to say, “I am an American.”