The US healthcare system is going to need a lot more doctors very soon. This growing physician shortage is being framed by some as a problem that is best solved through expanded reliance on foreign-trained physicians. This is the wrong approach.
For a nation that leads the world in artificial intelligence, biomedical research, and advanced innovation, it is striking that some are proposing that the solution to a growing physician shortage is to import more doctors trained elsewhere. The United States invests billions in cutting-edge health technology, yet it struggles to align its own medical education system with projected workforce needs.
Current projections estimate that the country could be short up to 86,000 physicians by 2036.
The demand for healthcare is rising because the number of Americans aged 65 and older is expected to grow by more than 40% between 2019 and 2034, which will significantly increase the need for medical services. At the same time, the physician workforce is aging, with more than 40% of physicians expected to reach retirement age by 2031.
Training capacity has not expanded enough thought to keep up because the number of federally supported residency positions remains limited. To make matters worse, the shortage is also worsened by high levels of physician burnout, administrative burdens such as electronic health record documentation and prior authorization requirements, lower compensation in primary care compared to specialty medicine, and the uneven geographic distribution of doctors.
For example, rural areas have roughly 30 physicians per 100,000 people compared to about 263 per 100,000 in urban areas. Together, these factors are creating a structural gap between the number of physicians needed and the number the system is able to train and retain.
H-1B for MD’s is not the answer
International medical graduates make up a significant portion of the U.S. physician workforce. Roughly one in four practicing physicians in the United States—about 25%—earned their medical degree outside the country, with many coming from nations such as India, the Philippines, and the Caribbean. This contribution is especially pronounced in underserved areas, where foreign-trained doctors often provide care in communities with limited access to U.S.-trained physicians.
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Recently, attorney Harmeet Dhillon supported broader use of H-1B visas for international medical graduates to fill domestic gaps. International physicians unquestionably contribute meaningfully to American healthcare. Yet treating the projected shortage primarily as an immigration issue risks misdiagnosing the underlying problem.
The answer should first be focused on what can be done to address the shortcomings of US medical training that can meet the projected shortfall.
Relying on foreign-trained physicians to address the anticipated shortfall would be analogous to recommending a heart transplant for a patient experiencing chest pain for the first time. The symptom is real but intervention bypasses the more obvious necessary steps .
Before replacing the organ, one must determine whether the pain reflects reversible ischemia, poorly controlled hypertension, or modifiable risk factors and importantly all medical and surgical options have been exhausted. Likewise, before importing labor to compensate for shortages, policymakers must examine whether structural constraints within the U.S. training and reimbursement system are artificially suppressing domestic physician supply.
Medical education capacity and the structural gap
The United States has nearly 200 medical schools, robust applicant interest, and world-leading academic medical centers. The central issue is not a lack of talent or educational capability. It is a misalignment between medical school expansion, residency financing, tuition inflation, and reimbursement incentives that collectively restrict how many physicians are produced and where they ultimately practice.
The U.S. currently supports approximately 158 accredited MD-granting medical schools and 38 DO schools, creating nearly 200 colleges of medicine that enroll highly qualified students. In 2025–26, total enrollment exceeded 100,000 students for the first time, with more than 23,000 first-year matriculants entering medical programs. These figures reflect sustained expansion and strong demand.
Yet the most significant bottleneck in the physician pipeline occurs after graduation from medical school because graduate medical education (GME) remains constrained by federal policy.
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Since the 1997 Balanced Budget Act, Medicare—the principal funder of residency training—has effectively capped support for residency positions. Although incremental increases have been authorized, expansion has not kept pace with population growth or demographic change.
For example ,in the 2025 National Resident Matching Program (NRMP), approximately 43,000 residency positions were offered while more than 52,000 applicants competed for them. Without proportional expansion in GME capacity, medical school growth cannot translate into sufficient numbers of practicing physicians.
Projected workforce need
Federal workforce projections from HRSA suggest that physician shortages could reach up to 180,000 doctors by 2037 across different specialties and practice settings. The shortages are especially severe in primary care. Fields such as family medicine, general internal medicine, and psychiatry consistently fall short of projected need. Some surgical specialties and subspecialties are also expected to face gaps. The problem is made worse by geography: rural communities and underserved urban areas have far fewer physicians than wealthier metropolitan regions.
Interest in becoming a physician still remains high. Each year, about 55,000 applicants compete for roughly 23,000 first-year MD seats, making medical school admissions highly competitive. There is no sign that a lack of interest is causing the projected shortage. The main limitation occurs after medical school—there are not enough residency training positions to match the number of qualified graduates.
Tuition inflation and debt burden
Over the past decade, the cost of medical school has continued to rise faster than inflation. Today, the median four-year cost of attendance is close to $290,000 at public medical schools and nearly $400,000 at private schools. As a result, the average medical student graduates with more than $215,000 in debt, and many owe significantly more when undergraduate loans are included.
Tuition has increased for several reasons. Medical schools face high operating costs, including faculty salaries, simulation technology, clinical training infrastructure, and compliance with accreditation and regulatory requirements. At the same time, reductions in state funding for public universities have shifted more of the financial burden onto students. Unlike many graduate programs, medical education is resource-intensive and closely tied to hospital systems, which adds to overall cost.
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This level of debt has real workforce consequences. Graduates carrying hundreds of thousands of dollars in loans are more likely to choose higher-paying specialties in order to manage repayment. Primary care fields—such as family medicine, general internal medicine, and pediatrics—typically offer lower compensation compared to procedural specialties. As tuition rises, financial pressure increasingly shapes career decisions, reinforcing shortages in the very fields where the country faces the greatest need.
Some medical schools have begun using endowment funds to reduce or even cover full tuition for students as a way to lessen financial barriers and reshape workforce incentives. For example, institutions such as New York University School of Medicine and Kaiser Permanente School of Medicine offer tuition-free programs funded through philanthropic gifts and endowments, which help graduates avoid large debt burdens and expand the pool of students willing to enter lower-paid primary care and critical shortage specialties. These programs represent emerging models that address tuition inflation and debt pressure, but they remain exceptions rather than the norm across U.S. medical education.
The way doctors are paid also affects career choices, especially when students graduate with large debt loads. Recent surveys show that in 2025 the average primary care physician earns about $287,000, while specialists earn around $404,000 on average, meaning specialists make roughly $117,000 more per year than primary care doctors.
At the same time, Medicare and many insurers have allowed physician payment rates to lag behind inflation. Research shows that, when adjusted for inflation, physician reimbursement per Medicare patient actually fell by more than 2% between 2005 and 2021, even though the amount of care provided increased.
According to other analyses, Medicare physician payment has lost a large portion of its real value over the last two decades as the cost of running a medical practice (staff, technology, rent, malpractice, etc.) has risen much faster than payment rates.
For a new physician graduating with more than $200,000 in debt, this matters. Lower or stagnant payment for primary care relative to specialists means a smaller income stream at a time when loan repayments are due. When primary care reimbursement does not keep pace with inflation or practice costs, students may rationally choose higher-paying specialties to manage debt and financial stability.
This combination of rising educational debt and slower growth in reimbursement contributes to fewer graduates entering essential fields like family medicine and general internal medicine—precisely where the country has the greatest need.
The cure for the broken medical education system
A workable solution requires coordinated policy changes that are easier to understand and implement. The United States should expand the number of federally funded residency training positions, especially in medical specialties and geographic areas where patients have the hardest time finding care, such as primary care, psychiatry, and rural communities.
At the same time, programs that reduce or forgive medical school debt for physicians who agree to work in shortage areas could help make these career paths more financially feasible for graduates.
Updating Medicare’s graduate medical education funding formulas is also necessary so that residency training support reflects current population growth, aging demographics, and real workforce needs rather than outdated historical allocations.
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In addition, payment systems should be adjusted so that primary care and other patient-centered services are compensated more fairly compared to procedure-based specialties, since current reimbursement patterns influence career choices.
Finally, states and academic health systems should invest more in rural and community-based training programs to help ensure physicians are more likely to practice in areas where access to care is limited. These steps focus on strengthening the United States’ own physician training capacity rather than relying primarily on foreign-trained physicians to fill workforce gaps.
International medical graduates: Valuable but not a substitute
International medical graduates make up about one-quarter of the practicing physician workforce in the United States and play an especially important role in serving underserved communities. Their contributions to American healthcare are significant, and this discussion does not question the quality of medical training in countries such as India, the United Kingdom, or Canada.
At the same time, relying too heavily on foreign-trained physicians to compensate for domestic workforce limitations is not a long-term solution. Each country must build and maintain its own training system to meet future healthcare needs. Immigration can help support workforce needs, but it should not be the primary strategy for solving structural shortages in physician supply.
The physician shortage in the United States is not primarily an immigration problem; it is a policy problem driven by limits on residency funding, rising medical school costs, payment system incentives, and the uneven distribution of physicians across specialties and regions.
Expanding H-1B visas may help address short-term staffing needs, but it does not fix the deeper structural barriers within the American medical education and healthcare financing system.
The United States already has strong medical schools, many qualified applicants, and the economic resources needed to train more physicians.
The main challenge in addressing physician shortage is political and policy alignment to ensure funding, training capacity, and workforce incentives match the country’s future healthcare needs. Until these structural issues are addressed, the physician shortage will continue—not because there is a lack of capable people, but because the system limits how many physicians are trained and where they practice.