Healthcare has a daunting and growing supply and demand problem.
We have a growing population in the United States and not enough physicians, nurses, allied healthcare providers and technicians. It is a very clear and simple math problem. We have approximately 340 million people in the United States and only about 840,000 direct patient care physicians and about 5.3 million nurses. Similarly, we face shortages across the board in other provider types and critical staff roles.
This imbalance between supply and demand is getting exponentially worse. Projections and estimates vary, but in the U.S. we produce roughly 29,000 physicians a year and nearly 175,000 to 200,000 nurses a year. The number of physicians added may, at best, match the number going part time or retiring each year while the demand continues to grow. On the nursing side, the situation is very similar — the number added barely matches the number leaving the workforce.
These issues of supply-demand imbalance are exacerbated in numerous ways.
1. There is uneven distribution on top of shortages. Physicians and nurses self-select to practice in certain geographic areas and settings. Higher-income, suburban or urban markets continue to draw physician and nurse talent, leaving entire rural and lower-income regions critically underserved. Nursing shortages mirror this, and nurses increasingly prefer to work part-time and not in the hospital inpatient setting.
2. Expanding care roles can work in many cases, but not all. We are short on both primary care physicians and specialists. While we all prefer to have a primary care physician, it may be easier to substitute a PCP with a PA or NP — that is, to substitute a person practicing at the height of their license for some types of physicians. Substituting specialists is far more difficult, however, particularly in high-complexity care. For example, using CRNAs for routine anesthesia — substitution can work. But there’s no equivalent when it comes to brain surgery. Even in areas where we’re training more specialists, supply isn’t keeping pace. Take surgery: Despite efforts to expand medical education, the number of surgeons is projected to remain relatively flat over the next 15 years, even as demand continues to rise.
3. You increasingly need to know someone to get care from the right provider. The healthcare system too often functions on an insider principle: timely, appropriate care goes to those with connections. This dynamic isn’t easily captured by a KPI or dashboard metric, but it’s real, increasingly relied upon and is symptomatic of a larger problem. A system that privileges relationships over need is fundamentally broken and a debacle for health equity.
4. Alternative business models are growing due to the limited supply of physicians. Concierge medicine is one such model, in which patients pay a membership or retainer fee — typically out-of-pocket — in exchange for reliable access to a physician or practice. Don’t get me wrong, I completely believe every physician should be free to practice how they desire. But concierge medicine is not a solution to the supply-demand imbalance; it’s a symptom of it. In a similar vein, many specialties are increasingly structured around self-pay models — prioritizing patients who can pay out of pocket and leaving others behind.
5. It’s not just headcount — it’s hours. Just as projections for the overall physician shortage in the U.S. differ, so too do estimates specific to primary care. Of the approximately 29,000 physicians who graduate annually in the U.S., we estimate no more than 10,000 enter primary care. Based on various models and assumptions, the projected shortfall in full-time primary care physicians over the next decade or so ranges widely — from 90,000 to nearly 200,000. Adding to this projected deficit, more and more physicians of all types tend to go part-time in their 50s and 60s, reducing their hours as they near retirement. This leads to a larger shortage of actual physician hours to the population. The huge and almost impossible delta between supply and demand in primary care means we have little choice but to identify and empower effective substitutes as much as possible for primary care. We must leverage them much better.
6. U.S. medical schools and residencies produce great physicians, but in an extremely slow and very expensive way. The average total cost of medical school in 2024 was $238,420. The majority of students graduate with debt, with a burden often exceeding $200,000. Much of current-day medical education was developed before the internet was invented. Moreover, many other countries produce physicians who are considered top-tier by U.S. standards and can begin practicing here by age 26 to 28, earlier than the typical U.S. physician, who often starts post-residency at 30 or older. It’s a great education in the U.S., but it takes too long.
7. Politicians look the other way. Our politicians fixate on health insurance coverage, particularly during election cycles and in the media. However, coverage is very different from access. Lawmakers have a number of levers at their disposal to significantly alter the restrictions that contribute to the physician shortage, such as expanding the number of Medicare-funded graduate medical education residency slots or adjusting the Medicare physician payment system. Politicians so rarely focus their attention on meaningful solutions to the core problem, instead focusing on its symptoms or the coverage issue instead. Insurance only does so much for one’s health if you cannot access a physician in a timely manner.
8. As physicians retire, it becomes harder and harder for older patients to find replacements. As of 2021, nearly half of practicing physicians were over the age of 55, meaning more than two in five active physicians will hit retirement age within the next decade. These retirements pose serious challenges, especially since physicians often give less notice than health system employers need to prepare. When retirement planning is insufficient and replacements aren’t readily available, continuity of care suffers — particularly for older patients who need frequent, relationship-driven and specialized care. The impact is even more severe in communities already facing provider shortages, where finding a new physician can take months or more.
9. Scarcity always worsens inequity. When we have shortages in our economy, wealthier people can buy and find access much easier than poorer people. The same holds in healthcare. When access is limited, wealthier and well-connected patients can navigate the system more easily, pay out of pocket or travel to where care is both high-quality and quickly available. Meanwhile, those with fewer resources face longer waits, fewer options, more trade-offs and greater odds of inferior health outcomes. This is one way health equity tends to get crushed.
10. It’s both-and, not either-or, with technology. We need to create more providers while using technology to help fill gaps — but we need to do both. We need more providers and better technology, including tools like ambient AI documentation, smarter scheduling and virtual or remote care options that match, not fall short of, the quality of in-person visits. Currently, technology is often a leveraging solution versus a replacing solution. Better technology without more physicians will not solve the problem of supply and demand.
11. Other nations with horrendous shortages of providers get crushed in times of serious need. This really elevates the issue of provider supply closer to one of national security. Whether it’s a pandemic, natural disaster, public health crisis or aging population, our ability to respond hinges on the availability of trained clinicians. And it doesn’t take a crisis to feel the strain — the U.S. already underperforms on key health system metrics, despite spending more than any peer nation.
A 2024 Commonwealth Fund analysis comparing 10 high-income countries ranked the U.S. last for access. It put it plainly: “The U.S. continues to be in a class by itself in the underperformance of its healthcare sector,” noting that while the other nine countries differed in system design, all had found a way to meet their residents’ most basic healthcare needs.
