The answer is simple. There is a bottleneck in the physician training pipeline leading to a manufactured physician shortage–as in, the physician shortage has been created by policies and a lack of funding. 

To put it in visual terms, above is a bottle full of physicians. All of the physicians inside the bottle have graduated medical school, but they cannot practice medicine AT ALL–even after 4 years and thousands of clinical training hours. They must get at least an internship to get a license in most states, which can only be achieved through applying to residency.

The problem is there are not enough residency positions to go around. In 2024, according to data from the National Resident Matching Program, there were 10,000 more applicants than were available residency positions. That means at least 10,000 physicians last year alone were kept from offering their highly specialized skills to patients and communities that mean so much to them. And that number compounds year after year.

It all started back in 1980 when The Graduate Medical Education National Advisory Committee (GMENAC) report came out. It predicted that by 1990, there would be an oversupply of physicians (by 70,000). One of the recommendations to come out of the report was to open no more medical schools. Another was “sharp restrictions of the entry into the United States of students from foreign medical schools” because international medical graduates would make up a large proportion of that oversupply. Yet another was “prompt adjustments in the number of residency training positions in individual specialties to bring supply into balance with requirements in the 1990s.”

A vast majority of residencies are federally-funded through Medicare. In 1997, President Clinton signed The Balanced Budget Act that capped funding for residency programs. It stayed that way until 2010, when the Affordable Care Act (ACA) began expanding funding through its Teaching Health Center Graduate Medical Education (THCGME) program. (As an aside, the ACA expanded funding for physician assistant and nurse practitioner education programs significantly more.) Still, despite the increase in funding for residency positions, funding for these residency positions was not keeping up.

Slowly, Congress is releasing more funding via the Centers for Medicare and Medicaid Services (CMS). Furthermore, The Resident Physician Shortage Reduction Act is being continually introduced year after year, but has not, as far as I can determine, yet been cemented into law.

All of that being said, it is obvious that the so-called “physician shortage” could be alleviated by offering more funding for residencies. Alternatively, allowing a limited license to practice for graduates of medical school would bring thousands of highly trained physicians into the field. Limited licenses for med grads are legislated at the state level, and several states have enacted Associate Physician legislation. Finally, an alternative pathway to full licensure can also be developed.

Some of the controversies surrounding this include the fact that physician assistants and nurse practitioners are allowed patient contact with less than half the clinical training hours as a medical school graduate. PAs and NPs have organizations that lobby for them.

Another controversy is that of international medical graduates being able to practice. IMGs are in direct competition with American medical graduates for residency positions. IMGs also have an organization that lobbies for them.

Unfortunately for physician graduates of American medical schools, they have no organization to fight for them. No, the American Medical Association doesn’t care at all. If physician graduates of American medical schools don’t match into a residency, they are left in the cold–no prospect for a job in patient care and, like I said, no organization to turn to for support. Unmatched American medical grads are left with only shame, stigma, and mountains of debt.

The only way things will change is if unmatched medical grads speak up. Write to your legislators, write letters to the editor of your local paper, form a community–so you can do what you were trained to do: care for patients.