Monday, July 3, 2017


When policymakers discuss health care, a central question is how to improve access to care while making insurance more affordable and available.

While reforming health insurance is essential, the fact is that health insurance is essentially useless if there aren’t enough medical providers available to provide treatment.

Unfortunately, our country is facing a serious shortage of doctors. The Association of American Medical Colleges forecasts that the U.S. will have a shortfall of up to 104,900 physicians by the end of the 2030s.

That distressing number reflects two demographic trends: The U.S. population is aging and will therefore demand more care. And then there’s the physician population, which is aging too. Many doctors will be retiring in the coming years and, under current trends, will not be replaced at a sufficient rate.

Paradoxically, even in the face of a looming physician shortage, America has a surplus of talented medical graduates without access to the necessary training, licensure and certification to treat patients.

Medical school graduates in the U.S. are required to complete a residency training program in order to become certified in their chosen specialty. Just to become licensed, they must complete from one to three years of residency training, depending on the state. However, these residency positions, heavily subsidized by taxpayer funding, are exceptionally limited in number. As a result, nearly 5,000 medical school graduates in the U.S. fail to find a residency position each year.

This surplus of talent could be instrumental in helping ameliorate the impeding shortage of care. In our research at The Heritage Foundation, we have recommended that states consider offering provisional medical licenses that would let medical graduates work under the supervision of a collaborating physician and help treat patients in areas of need.

Four states — Missouri, Kansas, Arkansas and Utah — have already begun to pursue these policies. As a result, medical graduates in these states who have not yet placed into residency programs can now participate in patient care under the supervision of an experienced physician.

Some organizations — including the American Medical Association and the American Osteopathic Association — have criticized these initiatives, claiming that allowing medical graduates to enter their market will jeopardize patient safety and create an underclass of physicians. However, medical graduates have acquired a vast amount of knowledge and training in their studies, and under properly structured supervision, can put this knowledge to use in areas of need.

It is not uncommon for longstanding industries to oppose fundamental changes to its laws and regulations. The emergence of Uber and Lyft as challengers to the old-fashioned taxi industry is a classic example. Taxi drivers and their managers have bitterly opposed the ride-hailing upstarts, voicing concerns about passenger safety. Regardless, Uber and Lyft’s service has won over much of the clientele.

Training doctors to treat patients is obviously not the same as driving passengers. However, given the existing and predicted shortage of physicians, the current system of graduate medical education is not meeting the nation’s health care needs. Therefore, fundamental changes to physician training may be needed, including alternatives that challenge the status quo.

Simple reforms regarding medical licensure could help moderate the doctor shortage and enable our country to make great strides in improving access to care for all Americans. Policymakers across the country would do well to give serious consideration to these recent state-level reforms.

Kevin Dayaratna is senior statistician and research programmer in The Heritage Foundation’s Center for Data Analysis. Dr. John O’Shea is senior fellow in Heritage’s Center for Health Policy Studies.

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