The Doctor Shortage Is Here—and Getting Worse

In 2025, my wife and I took a summer road trip along France’s Brittany coast, a region renowned for its timeless villages with their spired churches, quiet squares, cafés, and boulangeries. Yet, one detail kept piercing the postcard charm: the same billboard on many village outskirts, pleading “Cherche médecin !” (“We need a doctor!”).  

We are both physicians, and the signs landed with a quiet force: not just a local plea, but a glimpse into the anxiety of small, doctorless communities. France is suffering from a physician shortage—the result of doctors retiring, an aging population with greater needs, and a stubborn maldistribution of providers away from small towns and villages. This is France today, but it may also be America’s tomorrow if we do not begin treating our physician workforce as a strategic national asset.  

According to the U.S. Health Resources and Services Administration, the U.S. is projected to have a shortfall of roughly 187,000 physicians by the mid-2030s, with nearly half of the deficit in primary care. As in France, rural, small towns as well as more racially/ethnically diverse communities will be the worst off. 

This is not alarmism. It is simple demographics. 

America is experiencing a once-in-a-generation convergence of demographic forces. Over the next decade, the population aged 65 and older, currently responsible for some 40 percent of health care spending, will grow by more than one-third, sharply increasing the need for chronic-care management, cancer treatment, cardiovascular care, and cognitive-decline services. Meanwhile, the current physician workforce is aging out. Nearly half of all practicing physicians are over 55 and approaching retirement. Many will reduce their hours or leave the workforce just as patient needs crest. Add the rising complexity of modern medicine (more subspecialization, more care coordination), and the gap between supply and demand becomes a chasm—meaning longer wait times, travel distance, and difficulty finding the right physician in the right place.  

Training a physician in the U.S. takes 11 to 15 years after high school. Even if medical schools expanded overnight, we would not feel the effects for more than a decade. In fact, medical schools have already done their part: admissions have risen 30 percent since 2002. 

Now, the greatest bottleneck appears to be at the residency training level. 

In 1997, Congress capped federal funding for residency positions through Medicare’s Graduate Medical Education (GME) program. Nearly 30 years later, America’s population has grown by 70 million people while the number of federally funded residency slots has barely moved. The most direct fix is to increase GME funding so hospitals can train more residents. The Resident Physician Shortage Reduction Act, introduced in 2023, would add 2,000 federally funded slots each year—a meaningful start—but it remains stuck in committee without a vote. 

Another option is hardly radical: allow more doctors who trained abroad to come here and practice. Already, an estimated 20 percent of current practicing physicians are both foreign-born and internationally trained. In some states, like Florida, New York, and New Jersey, that number rises to 30 percent.  

The U.S. currently issues about 3,700 H-1B visas to foreign-trained physicians each year and another 3,000 J-1 visas for residency training. Most remain in the U.S. permanently, often serving in underserved areas. 

Yet at the very moment U.S. states most need these physicians, federal policy is moving in the opposite direction, beginning with increasingly restrictive immigration procedures. A recent New York Times article highlighted over 100 physicians who have been caught up in the immigration dragnet and suspended from practicing. Add to that, lawmakers have proposed raising the H-1B visa fee to $100,000—a cost that would make training or relocating to the U.S. all but impossible for nearly every foreign medical graduate. There are roughly 7,000 highly trained physicians per year who may simply go elsewhere as other countries aggressively recruit them with relocation assistance and guaranteed placements. 

Workforce Multipliers We Can Deploy Now 

Even with better training pipelines and smoother immigration pathways, physician supply will lag. We need to rethink how care is delivered. 

A major part of the answer lies in expanding the numbers and scope of practice of nurse practitioners (NPs) and physician assistants (PAs). Trained in a fraction of the time and at lower cost, they can independently manage much of the routine and chronic care. In primary care, NPs and PAs are a major force multiplier, accounting for over 40 percent of all patient care visits. Most states are in the process of granting or have already granted full practice authority to NPs. PAs remain legally tied to physician supervision through practice agreements, but this, too, is changing as a number of states liberalize these oversight requirements. Physicians remain essential—particularly for complex conditions—but a team-based model allows each clinician to practice at the top of their training. 

Technology, too, can expand effective supply. And here, it is easy to slip into AI evangelism. Yet, the most transformative tools aren’t futuristic AI diagnosticians but more prosaic advances: AI medical scribes that reliably generate clinical notes, automated prior authorization, telehealth follow-ups, and structured care pathways for chronic diseases. Each reduces administrative load and frees physicians for direct patient care. In a shortage, productivity is supply. 

France’s Experiments—Bold and Controversial 

France is further down this road, and its response is instructive. 

Facing a rising wave of medical deserts, the French parliament has shown rare unity, passing measures that challenge long-standing norms of physician autonomy. The new “Solidarity Missions” program asks general practitioners in well-served areas to spend two days per month working in one of 151 designated underserved regions, with financial incentives and—if voluntary uptake proves insufficient—the possibility of mandatory participation. 

In April 2025, France empowered its Regional Health Agencies to regulate where physicians can set up practice. In some regions, a new doctor may open a practice only when another retires; in high-need areas, authorization is automatic. Those who relocate receive stipends, expedited credentialing, and assistance with setting up their practices. Meanwhile, the country has eased decades-old limits on medical school admissions and streamlined the path for foreign-trained doctors willing to serve in shortage areas. 

These measures have sparked fierce debate. Many French physicians see them as an intrusion on their long-held freedom to choose where and how to practice. But the government’s message is blunt: the ‘soft’ policy of volunteerism and incentives has failed, and the status quo is untenable. National emergencies require national responses. 

Lessons for the U.S. 

The parallels between today’s France and tomorrow’s America are striking: an aging population, an aging physician workforce, deep regional inequities in access to care. Yet the U.S. faces additional constraints: no unified payer system, no centralized workforce authority, and little appetite for mandatory service requirements. 

The lesson from France is not to copy its policies wholesale. Rather, it is to recognize the physician workforce as a strategic national asset—one that cannot be left to market drift, congressional neglect, or happenstance. 

A realistic roadmap here in California where I work would blend four elements and offer a model for other states:

(1) expanding residency positions through state and/or federal initiatives;
(2) streamlining immigration pathways for foreign-born and trained medical graduates;
(3) expanding numbers and granting full practice authority to NPs and PAs where appropriate; and
(4)  Deploying technology that meaningfully improves physician productivity by eliminating administrative friction—automating documentation, billing, and ordering—so physicians can devote more time and attention to their patients.  

None of this is simple, and, most notably, the politics of the moment doesn’t favor easier immigration. But demographic math does not bend. And this moment of stalemate on immigration and so many other issues will pass. For would be 2028 presidential candidates looking to make an impression in key early primary states like Iowa, New Hampshire, South Carolina, and Nevada, this could be a winning issue.  

France’s billboards are a warning of what happens when needs outpace supply and governments are forced into emergency measures. America still has time to act—to treat physician availability as a strategic imperative rather than an afterthought. Whether we heed the warning before our own “We need a doctor!” signs appear on our state highways is a choice we can still make.