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Premedical student Samah Khan discusses her article “The crisis of physician shortages globally.” Samah draws a powerful parallel between the medical exodus in Pakistan and the doctor deserts of California’s Central Valley, revealing how structural neglect drives providers away from the communities that need them most. She explores the root causes of this brain drain, from low wages to limited residency spots, and argues that health care systems must reshape their values to retain talent. The conversation highlights promising solutions like local recruitment tracks while emphasizing that without systemic change, patients will continue to suffer the cost of delayed care. Join us to understand why doctors leave and how we can anchor them back home.

This episode is presented by Scholar Advising, a fee-only financial advising firm specializing in providing advice for DIY investors. If you want clear, actionable strategies and confidence that your financial decisions are built on objective advice without AUM fees or commissions, Scholar is designed for you. Physicians often navigate complex compensation structures, including W-2 income, 1099 work, production bonuses, and practice ownership. Scholar’s highly credentialed advisors guide high-earners through decisions like optimizing investments for long-term tax efficiency and expert strategies for financial independence. Every recommendation is tailored to the financial realities physicians face.

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Transcript

Kevin Pho: Hi. Welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Samah Khan. She is a premedical student. Today’s KevinMD article is “The crisis of physician shortages globally.” Samah, welcome to the show.

Samah Khan: Thank you for having me.

Kevin Pho: All right. Tell us what led you to write this article and then talk about the article itself for those who didn’t get a chance to read it.

Samah Khan: Of course. This article came from a moment of really chilling clarity. I was sitting in Modesto, and my neighbor was talking about the fact that she had to drive two hours for a cardiologist. I sort of had this flashback of my father’s clinic in Pakistan where patients would literally walk for days from villages in Afghanistan just to see him.

The landscapes couldn’t be more different, right? One was arid and dry, and one was the agricultural heart of the global economy. But the symptoms were the same: the waiting and the profound physical distance between where sickness happens and where health care is allowed to exist. I realized that we diagnose this all wrong. We call it a physician shortage in the Valley, and we call it brain drain in Pakistan, but those are just different presenting complaints. If two patients with different histories show up with the same disease, you have to look for the common root cause. The root cause that I saw was a failure of value.

Both systems, one through neglect and the other through active pull, fail to value keeping a doctor in the community that needs them the most. In Pakistan, it is a system that trains brilliant clinicians and then gives them no viable future. In California, it is a system that trains them in the Valley but doesn’t counter the gravitational pull of the coasts.

Writing it felt less like an opinion article and more like a case study. Here are two patients, Patient A and Patient B. Here are their vital signs: the wait times, the doctor-per-capita ratios. The diagnosis was structural abandonment and neglect. The treatment is that you have to design systems that make the doctor’s life and the patient’s dignity the central value and the central focus. I didn’t want it just to be a comparison; I wanted it to be a warning. If it can happen in these two completely different places, it is not an anomaly. It is not a one-off phenomenon. It is a design feature of how we fail to build health care for the margins. If we don’t change that design, the deserts will only keep growing.

Kevin Pho: You contrast that physician shortage where someone had to drive two hours to see a cardiologist in Modesto, California, to your father’s practice in Pakistan. I am in New Hampshire. Tell me what Modesto, California, is like. What is the nearest big city? Just give us a picture of what that is like and how easy or difficult it is to see a clinician there.

Samah Khan: Modesto is the world’s largest producer of almonds, I believe. If you drive down any road, you will see almond trees lining every single square inch. It is almost equally distant between San Francisco and Los Angeles. I think it is a little bit closer to San Francisco, but the Central Valley is really like what it sounds like: right smack dab in the middle of California. I know Fresno is exactly three hours between LA and SF. While there are some really good hospitals in Modesto (you have Sutter Health and you have Kaiser Permanente), a lot of specialized procedures will require you to drive up to San Francisco to go to UCSF or to go to Stanford to get your treatment.

Kevin Pho: You mentioned in your father’s practice, a lot of physicians who were trained in Pakistan eventually leave, and I think you gave some data in your article: one in three Pakistani medical students plan to go overseas. What are some of the reasons why they don’t stay in practice in Pakistan?

Samah Khan: Pakistan will invest in medical schools; they will invest in education. But they are not investing in the salaries, in the job security, or in the health care infrastructure that could convince a graduate to stay. Obviously, every medical student wants the best salary. They want the best life to build a family. That is something they are going to find abroad. That is not something they are going to find in their own country.

Kevin Pho: And are you seeing some similarities between that picture with what’s going on in Modesto, California?

Samah Khan: Absolutely. My school, UC Merced, just started a pipeline program to get students from the Central Valley into an eight-year combined bachelor’s and medical degree program with UCSF. So you are having these high school students getting a seat automatically in one of the top five medical schools in the country just to sort of convince them to stay in the Valley and work for the Valley, just like these homegrown physicians. There are steps to rectify these doctor deserts that I talked about, but the problem is still there. One program which admits 12 students a year isn’t going to drastically change the landscape of these doctor deserts. While it is a good first step and it is successful, this should be a model for future programs.

Kevin Pho: Have you talked to some of the medical students or clinicians in Modesto, California, in the Valley and got some reasons about why they’re leaving? Is it similar to what you said earlier, that they just want to leave for the coast and big cities? What are some of the specific reasons? Because it doesn’t sound like Modesto, California, is that much of a rural area to me.

Samah Khan: Certainly. Obviously, there is better weather, better pay, and more quality of life in the coastal areas. You have almost better prestige. Honestly, if you say you are a doctor in LA or SF, that is going to carry a little more gravitas than saying you are a doctor in Modesto or Fresno or Stockton. Also, these are sort of urban underserved areas (I wouldn’t say rural, but more urban underserved) where they need a lot more primary care physicians. They need a lot more nurse practitioners as first-point-of-care clinicians than super-specialized ones.

Kevin Pho: In fact, in your article, you talk about 42 percent of family medicine graduates staying in the Valley in 2024. So that really speaks to that lack of primary care, and I think that is endemic to the rest of the country as well in terms of finding that primary care clinician.

Samah Khan: That is exactly right.

Kevin Pho: So there’s a certain irony, right? You wrote about these medical schools using public money to train these physicians and then they leave that area. Talk more about those programs. You mentioned a program in the past that hopefully would keep some of these physicians to stay in the Valley after they finish training.

Samah Khan: Precisely. We can’t just train more doctors. We have tried that. Pakistan trains them and they leave. California trains them and they just cluster. We have to be very specific: What are the precise and tangible conditions that make a doctor stay? For the Valley’s PRIME programs, it was selecting students from the Valley, investing in them, and tying their training to the community, to Fresno, to Modesto. It is showing them that this is your home. We will make it possible for you to thrive here. That is a design intervention, and that is working.

For Pakistan, it is a little harder. It is about rebuilding a system that is worth staying for, and that is a lot of brutal and long-term work. But the first step is just admitting that diagnosis: We don’t have a doctor shortage; we have a retention crisis. You don’t solve a retention crisis just by recruiting more people. You solve it by fixing the place that people are leaving.

Kevin Pho: So you mentioned the PRIME track, and you said that it is working. Do we have any data? Give us some stories or examples that show that it is really moving the needle.

Samah Khan: Definitely. That first cohort was actually admitted with me back in 2023. They are still completing their premedical studies as undergraduates. But everyone that I had met was so passionate about medicine, about the Valley, about staying where they had grown up, and building a practice, even not just joining a hospital. That speaks to the passion and the level of dedication that these students have to the Valley. Of course, they are small, it is like 12, 15 people every year. But having that sort of close-knit community is also very good.

Kevin Pho: It’s really interesting because whenever I hear about the doctor shortage, it’s primarily in rural areas, and you don’t think of Modesto, California. But now you’re seeing these doctor deserts, as you said, in these urban, I guess urban-light, areas as well. Right?

Samah Khan: That is absolutely true. It is about the choice to reimburse a procedure in San Francisco at a rate that you have never offered in Stockton.

Kevin Pho: Talking again about your father’s practice in Pakistan. So what’s it like there? Are medical students still leaving? You talk about some structural changes. So is there any progress in Pakistan in terms of relieving some of these doctor deserts?

Samah Khan: You know what? I wouldn’t say that I have family back in Pakistan. I have friends who are training as medical students and they are all just so excited to take the USMLEs; they are so excited to get out of the country. Like my dad saw it firsthand as well. He was Cleveland Clinic trained. He could have had a lucrative career here, but he chose Pakistan. For years he was that anchor in the community. But for every one of him, how many other brilliant physicians are looking at the crumbling system and the threats and the exhaustion and just getting on a plane?

Kevin Pho: So I understand that you are studying for a master’s in public health. From a public policy standpoint, what are some of the policy solutions that can help with these doctor deserts? And like you said, it’s not necessarily a doctor shortage, but it’s more of a retention problem. Is there a policy solution that can help address this?

Samah Khan: Without a doubt. Pakistan as a country spends less than 1 percent of its GDP on health care. You can see that manifest physically. If we put a little more spending into something that is a basic human birthright, we will see results. It will make more doctors stay; it will increase quality of life for patients.

I think the same goes for California. Obviously, it has the world’s fourth largest economy; it could be a country on its own. Just spending a little more money in the right places, redistributing funds, not even pulling from anything else.

In my MPH classes, we are talking about countries making ethical agreements, like India making ethical agreements with countries abroad to give their physicians there because they have a surplus of really brilliant clinicians and these abroad countries want them. But as my professor said, it is kind of like having dogs that you are not feeding, and your neighbor comes and sees the dogs and says: “Oh, you have a surplus of dogs; we will take them.” It is not that you have a surplus of dogs. The problem is not the surplus; it is neglect. The fact that you make a polite agreement with your neighbor to give them the dogs doesn’t change the fact that you are not feeding them at home. So I think the real solution here is to start feeding your dogs at home.

Kevin Pho: So you mentioned more funding, more money. Of course in health care, that’s going to be a tough ask. So again, let’s say if you were in charge of public policy, what are some specific ways that we can reallocate those funds to help with that doctor desert in the Valley of California?

Samah Khan: For sure. I would definitely put funding into these pipeline programs. Obviously, a homegrown physician is the ideal solution to this. I would invest in rural health clinics and community health workers, these anchors of the community that unfortunately don’t get enough recognition.

There are a lot of other problems in the Central Valley. There is water insecurity. There is a large farmworker population. They have their own slew of health issues and corresponding health barriers. I conducted a secret shopper audit of pharmacies in Fresno, and I found that 11 out of 95 listed pharmacies were closed, not open to the public, not public-facing pharmacies. A large majority were not accepting new patients for controlled medications. Only one in three really said: “Yes, we are accepting new patients.”

That showed me that it is not just a doctor desert; it is a pharmacy desert. It is really just a health care desert. The next step after a patient sees a doctor is to go to the pharmacy and get their medication. If they can’t do that, then you label that as patients in Central Valley having low medication adherence or low compliance. But the fact is that they are just being turned away at every point in their journey.

Kevin Pho: So you studied in the Valley in California. Maybe give us a little pitch. What are some of the reasons why you think physicians should stay in the Valley? What are some of the perks and draws of practicing in the Valley?

Samah Khan: Totally. It is sort of like that supply and demand where there is a lot of demand and very low supply. Obviously, there is the prestige, the recognition from the community, the gratitude, and the instant validation that you get from treating these patients who are starved of this resource. There are a lot of hospitals offering insanely high packages, insanely high salaries, to doctors who are willing to come just to sort of attract them and keep them there.

I think honestly if you look in the right places, you can find higher salaries in the Valley than you can on the coast, just depending on which hospital you work at. The coastal areas are suffering from overpopulation and overcrowding. They are going to eventually migrate towards the middle. The real estate markets in Modesto and Fresno are booming because people are commuting a lot more to their jobs in the San Francisco area and Los Angeles. So there is a lot of long-term potential for your job security, and they need you.

Kevin Pho: Yeah, and sometimes it’s just more than money because as you said, these hospitals in Modesto are offering insanely high salaries, but people still aren’t coming. So it has to be more than money that draws physicians to practice in the Valley.

Samah Khan: You are absolutely right. It is just that really stark hunger for physicians.

Kevin Pho: We are talking to Samah Khan. She is a premedical student. Today’s KevinMD article is “The crisis of physician shortages globally.” Samah, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Samah Khan: Yes. I actually want to leave this message just to look upstream. The patient in your office is often the endpoint of a broken system. You should advocate for them by also advocating for audits, like of the algorithms, of the policies, of the insurance directories that failed them long before they reached you. That upstream ounce of prevention truly outweighs any downstream pound of cure.

Kevin Pho: Thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Samah Khan: Thank you so much.