Fixing the rural physician shortage can begin with adding more federal and state funded residency slots

When residency slots increase, the number of
rural physicians can increase. (UICOMP photo)

By any measure, rural America is hurting for physicians, but more broadly, the nation doesn't have enough doctors. While U.S. medical schools have increased their enrollments, hospitals have yet to increase their number of residency slots, reports Brenna Miller of the Lown Institute, a nonpartisan health think tank.

"Medical school enrollment has been consistently growing, but funding for residency slots hasn't caught up. For every medical school graduate looking for a resident position, there have been between 0.8 and 0.85 slots available in recent years. This a problem as states require at least one year of hospital residency as a licensing requirement."

Without intervention, rural physicians will become increasingly scarce. "Rural areas face the brunt of this shortage as urban areas have higher densities of primary care physicians and specialists," Miller writes. "Patients in rural areas tend to be older, poorer, and sicker, especially with chronic conditions. With fewer doctors around, they have to travel further for both preventative and emergency care, putting them at greater risk for poor health outcomes and mortality."

If rural areas want more doctors in the future, there must be fundamental changes to residency funding and slot offerings. Miller explains, "The mismatch between medical school enrollment, residency slots, and the need for physicians in the workforce has resulted in a lose-lose situation where perfectly competent physicians face barriers to working while simultaneously, entire regions of the country are without sufficient access to physicians."

Some changes need to begin at the federal level. Residency slots are primarily funded by the Centers for Medicare & Medicaid Services, meaning that "they need action by the federal government for expansion. This also means that no significant action had been taken for over 20 years (Congress had actually capped the number of residents) until the Covid-19 relief bill was passed," Miller reports. "The  bill opened the door for 1,000 new residency slots, 10% of which must be in rural areas. Another similar bill has been introduced in Congress that would allocate funding for an additional 2,000 residency slots every year for seven years starting in 2025."

State funding is an additional option. Miller reports, "The majority of doctors stay in the states where they completed their residency. Both California and Texas – where the shortage is predicted to be the worst – approved multimillion-dollar expansions in funding, resulting in increased retention of physicians in underserved, local areas."