'Locked out of the profession': Residency policies creating physician shortages, new report finds

Bottlenecks in the physician training and education pipeline are limiting entry for residency and playing a vital role in U.S. physician shortages and care access issues, according to a Sept. 20 report from nonpartisan think tank Niskanen Center.   

The U.S. has significantly fewer physicians per capita than other high-income countries, with 3.1 primary care physicians per 10,000 people, compared with 7.6 PCPs per 10,000 people in the U.K. and 13 in Canada, according to the analysis. 

U.S. physician shortages persist not because of lower interest or less capable citizens, according to the report, but instead "because of the remarkable degree to which its physician pipeline filters out entrants into the profession." The shortages then foster a reliance on "high-intensity, low-access care," the analysis found.

Though the number of U.S. medical school graduates has grown over the last few decades, physician supply remains limited. At least a year of residency is required before licensure, with a lack of available slots creating a bottleneck, the report found.

The number of potential physicians capable of entering and completing a residency is "ultimately determined by the financial costs and benefits of such programs," reads the report.  

Without this final step, newly graduated medical students "are effectively locked out of the profession they have spent years preparing for," the report notes. In 2020, more than 2,900 medical school graduates went unmatched for residency, compared to about 1,000 in 1980.

"The residency bottleneck ... results in an enormous waste of persons and talent," according to the analysis. 

The report recommends boosting reimbursement rates to offset the costs of starting a residency program. Since Medicare and Medicaid primarily fund residencies, the report concludes that, "the problem is eminently within the powers of the federal government to fix."

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