It was recently match day in the medical school world. Students who have given their lives to their studies to become doctors learned where they’d spend the next three to seven years in their chosen specialty completing their residency. This is one of the highlights each year as newly minted dermatologists, surgeons, psychiatrists, and internal medicine doctors, among many others, begin their next chapters and disperse across the country. It’s also a moment to welcome an incoming cohort of residents to join our health system.
Amidst this celebration, it’s also difficult to not have a twinge of anxiety. The American medical system has put itself on a path in which the medical professionals currently being trained across the country won’t meet the needs of the country’s shifting demographics.
Fueled by the Baby Boomer generation, the population of the United States is older than it has ever been. In 2022 there were roughly 58 million Americans who were at least 65 years old. That figure is expected to increase to 82 million by 2050. Between 1980 and 2022, the country’s median age increased from 30 years old to nearly 40.
As physicians and educators, it’s essential to see around the corners. We need to design training pipelines that reflect not only the needs of the moment but also what’s to come. From 2000 to 2022, the number of board-certified geriatricians—doctors who specialize in care for those 65 years old and older—has fallen from 10,000 to 7,400. There is currently one geriatrician for every 10,000 older adults in the United States. In 2023, only 42 percent of geriatric medicine fellowships were filled. We have geriatric resident positions that are fully funded and have gone unfilled in recent years.
Currently, many primary care physicians treat older patients. While this is not atypical nor an issue on its own, it’s a solution that points to an even larger problem: The Association of American Medical Colleges projects a primary care physician shortage of between 20,000–40,000 doctors by 2036. This sobering statistic is made more urgent by the fact that as people age, they tend to have increased health challenges.
Shortages in physician supply extend to medical specialties like cardiology and nephrology, and to surgical specialties as well. Cancer incidence, for example, increases with age. According to the American Society of Clinical Oncology (ASCO), in 2023, there were just over 13,000 oncologists actively engaged in patient care in the U.S. Of those, more than 20 percent are nearing retirement age. This problem becomes even more acute in rural areas, where one in five Americans live, yet only eight percent of oncologists practice. When people live farther away from health care providers, they are less likely to visit the doctor—a phenomenon known as “distance decay.” Mobile clinics and smaller medical centers can help meet the need, but the truth of the matter is we need more physicians trained in specialties their communities will increasingly require.
Unfortunately, there is no simple solution to this problem. America needs more doctors, nurses, physician’s assistants, lab technicians, and nearly every other kind of health care provider. It takes a long time to train these health care workers, and there are limited methods to increase the number of students in medical school.
While medical school enrollment in general is at all-time highs—and students are increasingly representing the diversity of America—it’s not where it needs to be and is only part of the picture. We also need more residency positions for students to matriculate into. If medical schools increase their student bodies by 10 percent over the next five years, but residency positions don’t match that, we’ll have trained qualified doctors who are unable to begin their careers. Given the current and pending physician shortage, neither are keeping pace with our needs.
The country’s medical training system is more like a jigsaw puzzle than a holistic and comprehensive approach. The pieces tend to fit together, but it seems a few have been lost to time. More than 80 percent of counties in America are considered health deserts. These health deserts can be found in both urban and rural areas.
Innovations like AI are using to support breast cancer screenings and accelerate vaccine development, can add capacity to our medical infrastructure, but they can’t replace doctors, nurses, and an entire care team. Telehealth can also be a tool to expand access and overcome distance to a doctor, but not all aspects of care can be managed in that setting. The good news is that we know what works: Understanding society’s needs and then evolving our approach to health care training to reflect it. We can’t let a shortage today turn into a catastrophe tomorrow. At each medical school and hospital system, we must not only expand our training capacity; we have to roll up our sleeves to examine how we are training physicians and more effectively weigh the needs of society—of patients in every state—to design our programs for today and for decades into the future.
William Wertheim is an academic physician executive.
