The Association of American Medical Colleges (AAMC) predicts that at least 139,000 doctors will be needed by 2033, particularly in rural and low-income areas. In an attempt to address this need, states have been replacing physicians with non-physician health care providers and reducing physician oversight.

I’ve seen it firsthand.

One day in the ER, a patient came in fatigued and dehydrated. He had been to his primary care physician (PCP) thrice but still ended up in the ER. I diagnosed him with diabetic ketoacidosis, a serious and life-threatening complication of diabetes, and learned that his PCP had performed no lab tests. He had been examined by the nurse practitioner (NP), who had tested him for COVID instead.

While NPs are extremely valuable, essential health care practitioners, they are not trained to evaluate and treat advanced illnesses like diabetes. Unfortunately, due to a lack of residency funding, the rate of producing physicians has not kept up with the population growth. Instead, lobby groups have pushed to address this by increasing the scope of NPs to include responsibilities they are untrained for.

There are thousands of stories shared by physicians on groups like Physicians for Patient Protection, warning about the dangers of replacing physicians with non-physician health care providers. Due to a lack of training, they tend to order more tests, refer to more specialists and prescribe more antibiotics and opioids.

We cannot sacrifice patient safety to meet the desperate demands for access to care. Instead, we must train more physicians, capitalize on the existing pool of non-practicing physicians and address burnout so that doctors will continue practicing for their expected careers.

Unclogging the pipeline: the medical school bottleneck

To become a practicing physician, students must complete medical school, pass the U.S Medical Licensing Exam and complete an arduous residency. While the number of medical schools and seats has increased over the years, there hasn’t been a parallel increase in residencies since Congress established a funding cap in 1997.

Every year, 10 percent of medical school graduates remain unmatched — in 2021, this number was 9,000 graduates.

In 2021, Congress attempted to rectify this issue by expanding the residency program to include 200 new residency positions for 5 years and while this is a step in the right direction, it is woefully insufficient to relieve the backlog of unmatched students. Much more funding must be allotted to ensure enough physicians are trained.

Capitalize on non-practicing workforce

There are about 65,000 non-practicing medical graduates (IMG) in the U.S. These physicians are American citizens or permanent residents who were trained as residents outside the U.S. Current regulations require that they redo their residency in the U.S. before being licensed — a difficult task given the scarcity of residency funding. Increased funding would allow IMGs to complete their residency and enter the workforce, thereby capitalizing on an existing resource.

Similarly, foreign medical graduates (FMGs) are students who graduated from foreign medical schools but did their residencies in the U.S.

Under current provisions, they must return to their home country for two years before applying to immigrate to the U.S. However, the hugely successful Conrad 30 Waiver program allows FMGs to begin practicing in the U.S. immediately if they commit to working for three years in a rural or underserved area with physician shortages. Only 30 waivers are available each year per state, so this could be expanded to capitalize on FMGs.

Ameliorate working conditions: Reduce administrative burdens to retain physicians

As the pandemic continues on, a growing number of physicians are switching to a primary telemedicine practice. Though not a replacement for in-person care, telemedicine is a good tool to bridge inequalities in health care access faced by rural and impoverished demographics. Under existing laws, physicians must be licensed in each state they want to practice in. A burden typically borne by physicians practicing at inter-state junctions, these laws also prevent physicians from catering to patients in different states through telemedicine.

The process of attaining and maintaining a license is cumbersome and expensive. For telemedicine to be considered a viable tool to help bridge health care gaps, medical licensing laws must be readdressed.

Another administrative burden is the excessive documentation requirements needed to keep up with patient electronic health records (EHRs). The 2009 HITECH Act was passed to promote the adoption of EHRs, which were sold as a cost-effective, time-efficient, paperless system to track patient records and submit the required information for insurance reimbursement for prescriptions and procedures.

Unfortunately, in the past decade, ever-increasing documentation requirements have become untenable. A 2017 study revealed that the burdens of EHRs significantly impact physician mental health by encroaching on their work-life balance.

EHRs must be optimized to reduce physician burdens, prevent burnout and protect physician mental health. This may go a long way towards improving working conditions, thereby retaining the workforce.

What to do

The national physician shortage is an urgent issue that requires immediate attention. Otherwise, the next time you seek medical care, you might be treated by a non-physician for a condition that requires physician attention. This could be expensive and detrimental unless we solve the issue of training and retaining physicians.

Physicians are uniquely positioned to advocate for solutions in three roles: trusted messenger, physician-administrator, and political officeholders.

Surveys consistently show that health care is in the top three motivators for voters, yet patients are likely unaware that the physician shortage is a grave threat to their health and wellness. As trusted messengers, physicians can educate and inform the public about this particular peril in our broadly broken health care system. Voters can only effectively advocate for themselves and their communities and compel their elected officials to legislate change if they understand the roots of these issues.

Physicians must also consider getting involved as physician-administrators to advocate to reduce administrative burdens and improve working conditions. They should also consider running for office at the local, state, and national levels to advocate for policy change. Doctors in Politics encourages and supports doctors to run for office.

A healthy populace is essential for a stable, functioning, flourishing economy. Veteran physicians are needed to construct and advise national health care policies.

Sujan Gogu is a family physician. Aishwarya Sivaramakrishnan researches the intersection of science, health care, politics, and society.

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