Despite the increased demand for healthcare, the American educational system isn’t responding by producing many more doctors. The American Association of Medical Colleges expects that in 2025, we’ll be about 46,000 to 90,000 doctors short of where we need to be. That means we’ll have to look into how to make more doctors to fill the physician shortage, or, alternatively, how to need fewer doctors in the first place.
Americans are going to the doctor more often. The Boomer generation is settling into more serious age-related health complexities and a greater need for medical care. Meanwhile, the Affordable Care Act’s individual mandate meant that millions of us had insurance, perhaps for the first time, and were finally able to see a doctor.
However, despite the increased demand for healthcare, the American educational system isn’t responding by producing many more doctors. The American Association of Medical Colleges expects that in 2025, we’ll be about 46,000 to 90,000 doctors short of where we need to be. That means we’ll have to look into how to supply more doctors to fill the physician shortage, or, alternatively, how to need fewer doctors in the first place.
One way to reduce the demand for medical care is to look at how we distribute it.
There are two major ways that societies have traditionally rationed access to health care when there’s more demand than supply. The first is to ration based upon cost. In a cost-rationing system, prices are allowed to rise until those who have the fewest resources drop out of the market, allowing those with more money to purchase the care they need. This is the rationing system endorsed by House Republicans who passed the American Health Care Act (AHCA) that would reduce the number of people with sufficient insurance and provide inadequate resources to those in high-risk pools who need more care.
The other way is to provide need-based access to care, where everyone pays into a system that prioritizes those with the most critical situations. This means that people with lesser health concerns have to wait in line a long time, or find alternate means of treatment. Long waits are a criticism leveled at countries with socialized medicine, such as Canada and the UK.
Neither of these schemes fixes the underlying physician shortage. However, there are ways to treat this problem on the supply side as well.
Americans have already turned to medical tourism, traveling to countries where care is cheaper (or even socialized) in order to externalize their costs by taking advantage of price arbitrage, the taxes paid by citizens of other countries to support their systems, or by pricing people in other countries out of their native supply of physicians. While this doesn’t bring more doctors to American communities, it effectively adds to the pool of health professionals that can be accessed by Americans with the means to visit other countries, but not to pay American medical bills.
We can also encourage more doctors from other countries to practice in the United States. Many doctors trained overseas (or foreign students who pursue medical education here) might relieve the physician shortage if given the right incentives. However, we seem to be opting against doing so. Over 25% of our physicians come from other countries, including places like Syria and Iran. These doctors are likely to be subject to greater difficulties and more personal chaos when attempting to enter the United States and may be banned outright if Trump has his way. Similarly, medical students from around the world are more reluctant to study in the United States, where the racially charged political climate and threat of violence makes them feel unsafe. Why come here when they can go somewhere like Canada or Australia instead? As we yield our world leadership role to countries like Germany and China, we become a less popular destination altogether.
Finally, maybe the best way to really Make America Great Again lies in filling the physician shortage from within our own ranks. Currently, doctors graduate from medical school with a mountain of debt: about $180,000 in the hole, as of 2015. Indirectly paying their student loans is one reason care is so expensive. (Another is waste.) We’re told that doctors must be free to get as rich as the market will stand, or they won’t want to be doctors, but what if the education of our future physicians and medical professionals were as much of a priority here as it is in Cuba, of all places? (Surely we need more doctors and nurses than we need rentiers in finance.)
Cuba Trains 80,000 International Doctors For Free, posted by teleSUR English
Cuba may not have the newest and greatest medical facilities, but they have a life expectancy on par with the United States, a better infant mortality rate, while making breakthroughs like the lung cancer vaccine and ending the transmission of AIDS and syphilis from mother to child, and they do this by prioritizing education. While we’re making student loans even more predatory, Cuba offers to educate American doctors for free, hoping that they’ll return home and provide medical care in underserved neighborhoods, such as rural New Mexico. (Learning medicine in a poor country may even better prepare these medics for a career in the United States.)
A physician shortage is not just a physician shortage. Everything is related: the way we disparage education and how that affects our educational system. The way we underfund students in fear that they will be “lazy,” and how this exacerbates inequality by creating a hereditary aristocracy of those who can afford education. Our xenophobic politics. The way we use debt to chain students to lucrative city and specialty practices instead of going where they’re needed most. Even our economic system. Our out-of-whack priorities have created the physician shortage. This is our choice.