How States Are Tackling America’s Physician Shortage

The United States is in the middle of a healthcare paradox. Sure, we've got some of the most sophisticated hospitals, state-of-the-art tech, and patients spending trillions (Americans spent $4.9 trillion on healthcare in 2023) of dollars in a single year.

Source: AMA

We are a nation that has consistently led in terms of research and innovation, and the current state of healthcare undoubtedly reflects America's commitment to staying at the forefront.

Yet none of this is possible without the human infrastructure, of which physicians are an irreplaceable component.

The Physician Shortage in America: A Growing Crisis

“We know that people struggle to find new physicians — both primary care and specialists — so the real-world impact of the physician shortages in our research findings is felt every day by people all over the country,” said AAMC Chief Health Care Officer Jonathan Jaffery, MD, MS, MMM.

“While we're grateful that our advocacy with Congress and CMS to create additional residency positions has been able to expand access — especially in rural communities and for mental health services — we also know that many of our friends, families, and neighbors still cannot always get the medical care they need. The ongoing physician shortage is a major part of the problem.”

It's clear then that this is not an issue best left to the future. In physician shortage states and cities, like rural Kansas, inner-city Detroit, and stretches of the Mississippi Delta, the physician shortage has already hardened into reality. A woman may have to wait 40 minutes before an ambulance arrives — only to be pronounced dead.

A child with developmental needs might live in a county with no pediatrician at all. A patient with chest pain might have to wait weeks to see a cardiologist.

What makes the physician shortage so difficult to address is that no single cause explains it.

It's a confluence of aging physicians retiring in waves, younger doctors pushing back against punishing workloads, medical education bottlenecks, immigration barriers for foreign-trained doctors, and the increasing complexity of patient needs as America grows older and sicker.

Each factor compounds the others, creating a perfect storm and pushing states to experiment with bold fixes to patch the gap. This hodgepodge, patchwork quilt should be enough to tell us where American medicine is headed, and whether we can afford to sustain the system as it's currently built.

Source: RHIhub

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Why the Physician Pipeline is Bottlenecked

Every solution has to start with the pipeline. U.S. medical schools had expanded enrollment by roughly 52% since 2002, in response to warnings of a looming doctor drought. But limited residency slots, the actual bottleneck between med school and practice, are still capped by  Medicare's (antiquated) 1997 funding freeze.

That cap has only budged slightly in the past two decades, with Congress adding a mere thousand slots, mostly in light of the recent pandemic. Which are, might I add, nowhere near enough.

“It is vital that more Medicare residency positions are added so that every physician can obtain a residency slot so that patients can have access to the health care they really need,” said Alexis Pierce, senior attorney in the AMA Division of Legislative Counsel.

Some states aren't waiting for Washington, however.

Texas, anticipating population growth, has poured state dollars into expanding graduate medical education. The Texas Hospital Association reports (PDF) a steady increase in residency slots, though still not enough to match medical school graduates.

Source: Texas Hospital Association

California has invested hundreds of millions in expanding family medicine and psychiatry residencies, targeting communities with the worst shortages. And although the gap is far from bridged, more reforms on the horizon mean that the glimmer of hope is shining brighter than it has in the past.

For instance, the Health Plan of San Mateo offers grants to help medical practices retain and add to primary care staff. California has recently joined states like Connecticut, Oklahoma, and Rhode Island in setting a target to increase primary care spending.

“This is the most hopeful I have felt in decades,” said Sumana Reddy, a primary care physician in Salinas, LA.

Still, there are other states, like Idaho, that are falling behind. Though not for lack of trying. Idaho has the poorest physicians-to-population ratio, with just 196.1 per 100,000 people.

Most states are pushing for reforms that focus on robust local training pipelines, which may very well be the answer. If, these pipedreams become reality.

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Immigration and the J-1 Visa Waivers: A Lifeline for States

Immigration, while a touchy subject even at the best of times, is an undeniable pressure valve of physician shortage in the U.S.

Nearly 1 in 5 U.S. physicians is foreign-born and foreign-trained, yet the immigration system often functions as an obstacle course. At a time when 20% of the U.S population is living in rural areas, with access to only 11% of physicians, we need every trick in the book to boost physician supply. One of the many physician shortage solutions would be bringing in J-1 visa waiver doctors.

At the University of North Dakota's School of Medicine & Health Sciences, about half of all internal medicine residents are international medical graduates, according to Dr. Dinesh Bande, the department's chair.

“We only have one medical school in the state, and it can be hard to recruit candidates from other states. So we are happy to have non-U.S. IMGs for many reasons, including that they are very hard-working,” he said.

The J-1 visa waiver program allows international medical graduates to stay in the U.S. if they agree to practice in underserved areas. Many states have taken advantage of this visa waiver, and it has proven to be a lifeline for many communities.

Kentucky, Michigan, and New York filled all the allowed Conrad slots, but those like Idaho and New Jersey barely scratched the surface.

Still, the slots are limited and severely underserved areas, or those regions that need to meet high demands could use an expansion in slots for J-1 visa waiver doctors.

States are lobbying Congress to expand the Conrad 30 waiver program, which caps waivers at 30 per state per year (with an additional 10 flex spots), regardless of need. Now, 30 slots a year might cover Philadelphia (PA) or Fairview (SD), but they don't even make a dent in a sprawling rural landscape.

Telehealth As A Stopgap for Rural Care

Some policymakers point to technology as a pressure release.

In states with vast rural populations such as Montana and North Dakota, pediatric care has improved through targeted investments and stronger telehealth networks, making routine checkups more accessible.

The pandemic accelerated this shift, with emergency policies fast-tracking telehealth adoption and extending care to millions of families.

In places like New Mexico and Alaska, those same protocols have been crucial in reaching minority and Indigenous communities, giving pediatric patients in underserved areas a clearer path to quality care.

As of 2022, 86.9% of hospitals nationwide have added telehealth services. This number is only expected to rise since experts forecast that by 2026, 25-30% of all medical visits will be via telemedicine. Source: AHA

But even telehealth has ceilings. Broadband deserts remain a stubborn barrier, and for specialties requiring physical exams or procedures, there's no substitute. Then there are concerns about privacy and fraud. Meanwhile, policy reforms like codifying virtual supervision flexibilities, removing barriers to cross-state licensure, and eliminating dangerous reporting requirements (like provider home addresses) are necessary to make this model more effective in curbing physician shortages.

Even more so, telemedicine, no matter how expansive, will not address the underlying issue. Sure, it can help extend the reach, but it doesn't create more physicians out of thin air. And we can only stretch the current workforce so far.

Expanding NP and PA Scope: Help or Harm?

Nurse Practitioners (NPs) have been a bit of a hot topic recently, and even Physician Assistants/Associates (PAs) are gaining more traction as physicians get sidelined in the name of cutting costs and expanding access to care.

Also read: Ways Burnout Affects Physicians and Patients

State policies diverge most dramatically in this instance. Some legislatures see NPs and PAs as a solution-in-waiting. Others see scope expansion as a dangerous shortcut.

29 states (including Washington D.C.) now allow NPs to practice independently without physician oversight

Source: Medicus

Proponents argue that this brings immediate relief, especially in rural areas. They also emphasize that NPs are just as capable of providing high-quality care in primary care settings.

While others say that the meteoric rise of NPs may cause more harm than good. Physician groups are pushing back, with many warning that a lack of oversight could result in patient confusion and undesirable outcomes.

The AMA is diligently fighting scope creep, but there seems to be no end in sight for this legislative tug-of-war. Across the country, states are weighing bills that expand NP and PA scope of practice. Which means that the physician shortage might result in physicians getting replaced altogether.

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The Retention Crisis Among U.S. Physicians

Even if states succeed in training more physicians, the leaky bucket problem remains: doctors are leaving practice earlier than expected.

In the U.S., physician burnout rates have dropped slightly, but they still remain stubbornly high when compared to other sectors.

“It's concerning because we know from studies published by our research team at Stanford and elsewhere that objective turnover increases and that physicians are more likely to reduce their clinical work hours when burnout is higher,” said Tait Shanafelt, MD, chief wellness officer at Stanford Medicine.

“And it comes at a time when we're already projected to be facing large workforce shortages in medicine, including problems with access to care.”

A MedCentral survey found that more than a third of physicians (35%) have thought about leaving practice since the start of 2025, with burnout emerging as the leading driver, as 31% of those eyeing the exit cited it as their primary reason. That statistic dwarfs any pipeline fix.

“Many physicians still love what they do, but they just can't keep doing it at this pace in the current practice environment, with its administrative burdens and regulatory burdens, and the proliferation of asynchronous messaging with patients through the electronic health record,” Shanafelt added. “So physicians are, in essence, just saying, ‘I can't keep working this way.'”

Back in 2022, California experimented with retention bonuses for front-line healthcare workers. But such incentives disappeared as pandemic-fueled desperation eased.

This year (2025), New Mexico passed the Physician Loan Repayment Act (PDF), which aims to attract physicians by repaying loans in exchange for practice in an underserved area or designated health professional shortage area.

However well-intentioned, these reforms miss the mark. The deeper issue, we all know, is one that never gets addressed. It's cultural. The endless charting, administrative burdens, and corporate consolidation are what erode our sense of calling.

Policymakers can throw all the money they want at it, but it won't matter because it isn't about the money. It never was.

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Patchwork State Responses To Physician Shortages

What we see today is a patchwork map of interventions. 17 states, including Wisconsin, Texas, and North Carolina, have passed legislation that allows international doctors to practice in the United States without U.S. residency training.

Florida has greenlit new residency programs to address the physician shortage. 31 state Medicaid programs, including California, Massachusetts, New York, Ohio, Texas, and Vermont, reimburse for all four modalities (live video, store-and-forward, remote patient monitoring, and audio-only), although certain limitations may apply.

Each of these physician shortage solutions and policies reflects local pressures, but together they point to a larger truth: America has no coordinated playbook for physician supply. Healthcare in the U.S. is fragmented by design, and the physician workforce mirrors that fragmentation.

Which raises the bigger question: is this really a supply issue, or a structural one? Does the solution lie in producing tens of thousands more physicians or in rethinking the way medicine itself is practiced?

Whatever the answer, physicians remain the linchpin. They are the interpreters of science, the human faces patients turn to in moments of fear. Which is why a physician shortage lands differently than any other labor gap.

The truth is uncomfortable. There is no quick fix.

Expanding residencies takes years. Immigration reform is politically fraught. Scope-of-practice battles pit professionals against each other. Burnout will not evaporate with a signing bonus.

What states are doing right now is improvisation. Some experiments will work, some will fail. But underneath the hodgepodge lies the truth that America has treated its physicians as an endlessly renewable resource. Which they aren't.

So, are states simply buying time with these fixes? Do we need a deeper overhaul of how medicine is practiced in America? Leave a comment with your experience and thoughts. It would be interesting to hear how this shortage is showing up in your neck of the woods.

Frequently Asked Questions

1. What states are most affected by the physician shortage?

Ten states with the fewest physicians per resident are Mississippi, Arkansas, Utah, Idaho, Texas, Alabama, Nevada, Oklahoma, Wyoming, and Georgia.

2. Which states pay doctors the most in the US?

Some of the highest-paying states are New Jersey, South Carolina, California, North Dakota, Missouri, Illinois, Georgia, and Montana.

3. What impact does physician burnout have on the shortage?

Burnout accelerates turnover and reduces clinical hours. Even with new physicians entering the workforce, many leave early due to workload, administrative burdens, and loss of autonomy, worsening the shortage.

4. Which states are leading with innovative physician shortage solutions?

Texas and California have invested heavily in expanding residency programs. States like New Mexico have passed loan repayment acts, while Wisconsin, Texas, and North Carolina allow some international doctors to practice without U.S. residencies.