Medical schools and legislation aim to address a worsening doctor shortage that’s already hitting rural communities

• A doctor shortage is projected to hit 86,000 by 2036. Rural communities already feel the impact.
• Educational initiatives and congressional bills aim to combat issues like limited appointment slots.
• This article is part of “Trends in Healthcare,” a series about the innovations and industry leaders shaping patient care.

Every three to four months, Mellisa Case drives three and a half hours from her small town of Prineville, Oregon, to Portland to see her orthopedist for help with arthritis, a condition she believes she could have avoided at this stage in her life.

In 2021, Case had surgery for a meniscus tear at an orthopedic center in Bend, an hour away from her home. However, she couldn’t schedule appointments for follow-up care, which doctors consider necessary for proper recovery. For several months after her meniscus surgery, Case kept calling the center for an appointment with no success while her knee deteriorated.

Now Case takes time off from work and spends up to $125 round trip on gas while traveling to Portland for arthritis care. Case said that symptoms like stiffness, swelling, and discomfort — which resulted from a lack of postsurgical medical support — could interfere with her sleep, gait, and ability to enjoy her hobbies like hiking and gardening.

“Until you’ve experienced not being able to see a doctor, you don’t really realize how frustrating it is,” Case, who is 53, told Business Insider. Eventually, she will need surgery for a full knee replacement.

Case said that she remains concerned that the overall lack of medical care in her community, as she’s observed doctors retiring or leaving her area.

Some of her family members and friends also struggle to find physicians close to home, Case said, so they have to drive long distances or wait for appointments.

A March report from the Association of American Medical Colleges projected that the US would face a physician shortage of up to 86,000 specialists and primary-care doctors by 2036.

Michael Dill, the organization’s director of workforce studies, said this estimate was conservative.

“The country needs hundreds of thousands of doctors to provide an equal amount of care to everyone, including minorities, those without medical insurance, and people living in rural areas,” he told BI.

An aging population, physician retirement, and the administrative challenges of running a practice contribute to the shortage and disproportionally affect vulnerable populations such as older people, those lacking transportation options, and people with disabilities, public-health advocates told BI.

Two solutions could be increasing medical-training programs in rural communities and passing legislation to retain and bolster the physician workforce.

An aging population and provider burnout are contributing to a worsening doctor shortage

The effects of a doctor shortage are already here, Dr. Bruce Scott, the president of the American Medical Association, said.

Scott practices in Louisville, Kentucky, and said that in addition to patients in rural areas driving hours to appointments, they’re waiting months to see a doctor.

Various factors, including an aging population, play a part in the situation, Dill said.

In 2020, 55.8 million Americans, or 16.8% of the population, were 65 or older, and by 2030, all baby boomers will have reached age 65, according to a US Census report. As people age, they require more physician services, such as cardiologic or neurological care, and at the same time, doctors are aging and retiring, adding to the shortage, Dill said.

Physician burnout further exacerbates the problem, Scott said. In one survey that was part of AMA Organizational Biopsy report, of over 12,400 doctors, 48% of respondents said they were burned out. In another survey from the same report, one in three respondents said they planned to retire or reduce hours within two years.

One AMA survey found some doctors were leaving their practices because they were being paid less to handle more administrative burdens, such as spending 12 hours a week filling out prior-authorization requests. “Medicare is paying us nearly 30% less in 2024 than it did in 2001, when adjusted for inflation,” Scott said, citing further data compiled by the AMA.

Strategies to alleviate the shortage

To help alleviate the physician shortage in rural areas, medical students need to receive training there, said Molly Fox, the vice president of institutional advancement at Kansas Health Science University.

“We engage students with the rural community because we know that people tend to practice where they feel connected,” Fox said.

At KHSU’s Kansas College of Osteopathic Medicine, for example, third- and fourth-year students can complete clinical rotations at St. Catherine Hospital in Garden City, four hours from Wichita, where the university is.

Chase Hearn, a third-year student, said he’d seen doctors at the hospital who have worked 26-hour shifts to meet patient needs.

“I’ve also heard patients say they can’t take a day off work to travel 200 miles to see their OB-GYN,” Hearn said. He added that his training had strengthened his resolve to practice in a rural community but that he anticipated challenges, like burnout and working with patients who lack consistent access to care.

Rural residency programs are also needed to address the shortage, Dill said. Only 2% of residency training occurs in rural areas, the US Government Accountability Office says.

A residency program through Oregon Health & Sciences University aims to alleviate the doctor shortage in three central-Oregon counties, including Crook County, where Case lives. The program is training physicians in primary care, family birthing, emergency medicine, behavioral health, and hospital medicine.

According to the Rural Medical Training Collaborative, 133 rural residencies in family medicine and 69 rural-track programs are recruiting for 2025 enrollment, along with 30 internal-medicine residencies and 16 psychiatry residencies.

Several pieces of legislation have also been introduced to Congress to address the doctor shortage. Scott said bills to adjust Medicare payments for doctors — no matter where they practice — to the annual rate of inflation and rules to reduce the need for prior authorization could help ease administrative burdens.

Some legislation, if passed, would specifically influence rural areas.

For example, HR 7855, the Association of American Medical Colleges-endorsed Rural Residency Planning and Development Act of 2024, would codify the Rural Residency Planning and Development Program, which funds the startup costs of residency training in rural areas, Dill said. From 2019 to 2024, the program has enabled the launch of 46 accredited rural residency programs across 38 states and Puerto Rico.

Hollie Davis Frick, an immigration lawyer for Wintersteen Patel Law Group, said congressional action could easily incentivize doctors born abroad and who receive advanced medical training in the US to remain here and practice in rural areas.

“Many doctors who come here for residencies and fellowships return abroad because of our ineffective immigration policies,” Davis Frick said.

If passed, S 665, the Conrad State 30 and Physician Access Reauthorization Act, would allow state health departments to sponsor additional visa waivers for foreign-born doctors who agree to practice in underserved areas within those states.

While Case remains skeptical that doctor-training initiatives and legislation will directly affect her community anytime soon, she considers herself fortunate, she said.

“I have the ability to drive, afford travel expenses, and pay for out-of-network doctors,” Case said. “Not everybody does.”