America will face a shortfall of up to 124,000 doctors by 2034, according to alarming new data from the Association of American Medical Colleges. This physician shortage will disproportionately hurt historically marginalized communities, where many people already struggle to find care.  

The problem stems in large part from an insufficient number of residency spots — the mandatory, hands-on training that medical school graduates must undergo before they're able to practice on their own.

Funding more residencies — so that more newly minted MDs can actually join the physician workforce — is the most straightforward solution to the doctor shortage.

The number of residency positions has been growing in recent years. The National Resident Matching Program, which matches medical school graduates to U.S. residency programs, offered 38,106 positions in 2021, the most ever. That's compared to just 25,500 positions in 2010.

But given the scale of the doctor shortage, we need even more — especially in historically underserved areas and high-demand specialties. Where a doctor completes a residency plays a huge factor in where she ultimately practices. Yet the majority of current residency positions are located in wealthier, urban areas.

Congress recently recognized the challenge. In December, lawmakers increased funding for graduate medical education and residencies, adding 1,000 more positions targeted at rural and urban underserved areas.

Another bill under consideration in the House seeks to address the shortage of primary care doctors by expanding medical education and training. If passed, the bill would increase the number of residencies at the country's "Teaching Health Centers" — medical training programs located in particularly needy areas — from 769 to more than 3,000.

That's meaningful, given that more than 81.5 million Americans currently live in places with limited access to primary care.

Expanding the number of residency programs is a critical step toward addressing the doctor shortage. But we also need more medical school graduates.

Medical schools in the United States aren't graduating enough students to meet demand. In 2020, about 27,000 U.S. students earned their medical degrees at allopathic and osteopathic schools — hardly enough to fill the more than 37,000 residencies offered that year.

International medical school graduates are filling that gap.

These graduates — many of whom are U.S. citizens who simply studied abroad for medical school — already make up one-quarter of the U.S. physician workforce. At the school I lead, St. George's University (SGU) in Grenada, a majority of our students go on to complete their residencies in the United States.

They are, of course, required to pass the same licensing exams as students graduating from American medical schools. SGU grads pass the first step of the U.S. Medical Licensing Exam at a 94 percent clip — about the same as the average pass rate for all American medical schools.

International medical graduates (IMGs) are often best suited to serve the neediest populations. A study in BMC Family Practice found that IMGs are more likely to care for underserved communities, practice in lower-income areas, and live and work in rural regions. 

The recent congressional actions to address the doctor shortage focus specifically on expanding care in such locations.

Many international medical graduates want to return home and serve their neighbors. Nearly two-thirds of students from Caribbean medical schools are U.S. citizens. At St. George's, the share is even higher — three-quarters of our graduates are U.S. citizens.

America's looming doctor shortage is growing. To address the problem, we must expand the number of residencies available to medical school graduates in the places they're needed most.

Dr. G. Richard Olds is president of St George's University (www.sgu.edu).

Published on Aug 19, 2021