What You’re Not Told About The U.S. Doctor Shortage
Underlying Causes and Misinformation
The United States is currently facing a serious and worsening doctor shortage, which has significant implications for access to healthcare, particularly in underserved areas. However, the mainstream narratives often fail to address the underlying causes of this crisis. In this article, I aim to provide a comprehensive understanding of the truth behind the US doctor shortage and expose misleading ideas that have misled working American people.
The State Of Healthcare In The United States
The healthcare landscape in the United States has been under severe strain, and one of the pressing issues exacerbating this situation is the shortage of doctors. This shortage is not distributed evenly across the country; certain communities — rural areas, inner cities, and Native American reservations — are disproportionately affected. This report provides an in-depth analysis of the doctor shortage in these areas, exploring the root causes and potential solutions, as well as comparing the U.S. healthcare system to alternative strategies and outcomes. The role of socio-political influences in shaping healthcare policy and the disparities resulting from these decisions will also be examined. Finally, the future implications of this crisis and potential pathways toward a more equitable healthcare system will be explored. By understanding and acknowledging the political-economic drivers of these challenges, we can simultaneously discover the only plausible remedies— the socialization of medicine and universally accessible entry into medical school.
Health Disparities in Rural Areas
One of the areas most affected by the doctor shortage is rural regions, small towns, and economically deprived urban communities. The lack of profitability in providing healthcare services to these populations often leads to neglect from healthcare providers, resulting in the closure of many rural hospitals. As a consequence, residents are left without access to essential medical care.
This has always been an issue in rural America. Roughly ten years ago, according to an article in The Atlantic, there were about 6,000 federally designated areas with a shortage of primary care doctors in the U.S. and 4,000 with a shortage of dentists. Rural areas have about 68 primary care doctors per 100,000 people, compared with 84 in urban centers (The Atlantic, 2014). Today, across the country, physician shortages have left a growing number of communities like Wheeler County (Oregon) desperate for care. Of the more than 7,200 federally designated health professional shortage areas, 3 out of 5 are in rural regions. And while 20% of the U.S. population lives in rural communities, only 11% of physicians practice in such areas (AAMC, 2020).
Access to doctors has become increasingly challenging in rural America, turning many areas into medical deserts. Nearly 80 percent of rural areas in the United States are designated as “medically underserved” by the federal government.
Accoring to alternative data to the AAMC, despite being home to 20 percent of the population, less than 10 percent of doctors serve these communities, and this disparity is expected to worsen with an aging rural doctor population (The Washington Post, 2019).
Health disparities in rural areas simply deserve more attention. According to CDC data, rural residents in the United States face higher mortality rates compared to their urban counterparts in various health conditions, including heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke. Unintentional injury deaths occur at approximately 50 percent higher rates in rural areas. Moreover, residents of rural areas tend to be older and experience poorer health compared to those living in urban areas (CDC, 2023).
Health Disparities for Native Communities
Addressing the doctor shortage and health disparities faced by Native communities requires addressing the socio-economic factors that discourage Native students from pursuing medical careers and developing initiatives that make medical education more accessible to this demographic.
According to the Association of American Medical Colleges (AAMC), Native Americans make up less than 1 percent of the medical student body. To be precise, they make up only .o2%. This severe underrepresentation reflects the systemic barriers that many Native students face when pursuing a career in medicine, including high levels of poverty, low high school graduation rates, and a lack of role models within the medical field.
The crisis extends beyond the lack of Native physicians. Even where healthcare facilities exist within or near Native communities, they are often underfunded and understaffed, leading to long waiting times, inadequate treatment, and unmet healthcare needs. Additionally, the Indian Health Service (IHS), the primary healthcare provider for many Native Americans, has been chronically underfunded, compromising its ability to deliver quality healthcare.
Addressing these issues requires an approach that addresses systemic bias, provides educational support and opportunities for Native students, and improves funding and resources for the IHS and other healthcare providers serving Native communities.
Inner City Health Disparities
Like rural and Native populations, inner-city communities also face significant health disparities. These areas, characterized by high poverty rates, racial segregation, and physical decay, suffer from a severe lack of quality healthcare facilities and professionals.
In inner-city communities, the physician-to-population ratio is alarmingly low. Many physicians avoid practicing in these areas due to lower reimbursement rates, higher patient loads, and increased instances of chronic illnesses such as diabetes and hypertension.
In addition to the doctor shortage, these communities also face numerous systemic issues that exacerbate health disparities. These include a lack of access to fresh food, leading to higher rates of obesity and diabetes, inadequate housing contributing to higher rates of asthma, and higher crime rates causing psychological stress and trauma.
Moreover, residents of these communities often lack health insurance or have inadequate coverage, making them less likely to seek preventive care and more likely to delay treatment. A report by the Colorado Health Institute states that approximately 60 percent of Inner City Health Center patients are uninsured (Inner City Health Center).
To combat these challenges, programs such as the National Health Service Corps (NHSC) and the Teaching Health Center Graduate Medical Education (THCGME) program aim to incentivize doctors to work in underserved areas by offering student loan repayment and residency training programs, respectively. However, the impact of these initiatives is ineffective due to their small scale and insufficient funding.
Insights From The Past
To address health disparities and the doctor shortage in disenfranchised areas, we can turn to revolutionary leader Mao Zedong (1893–1976) for a sentiment that remains relevant, even in the United States of America in 2023.
“In medical education, there is no need to accept only higher middle school graduates or lower middle school graduates. It will be enough to give three years to graduates from higher primary schools. They would then study and raise their standards mainly through practice. If this kind of doctor is sent down to the countryside, even if they haven’t much talent, they would be better than quacks and witch doctors, and the villages would be better able to afford to keep them (Zedong, 1965).”
Looking at Chairman Mao’s sentiments regarding medical education, we see a concept that, while not directly transferable, still holds potent relevancy for the United States in 2023. Mao emphasized reducing institutional gatekeeping and improving the provision of medical services in society as a means to address doctor shortages faced in his own time. His practical, effective vision of lower entry barriers for medical education could pave the way to addressing healthcare disparities in the present-day United States.
Chairman Mao’s emphasis on improving medical services finds resonance in China’s healthcare reforms since 2006. One notable initiative is the New Rural Co-operative Medical Care System (NRCMCS), implemented in 2005. This reform aimed to address healthcare affordability issues specifically faced by the rural poor. By launching the NRCMCS, the Chinese government recognized the need to make healthcare more accessible and affordable for underserved rural communities. This policy overhaul demonstrates a commitment to reducing financial barriers and improving healthcare provision, aligning with Mao’s vision of addressing disparities in medical services. The successful implementation and ongoing development of the NRCMCS showcase the effectiveness of strategies that prioritize the needs of disenfranchised populations, providing valuable insights for addressing healthcare disparities in the United States.
In the United States, a modern interpretation of Mao’s approach could entail a reevaluation of medical school admissions with an emphasis on hands-on training for graduates from higher primary schools. Broadening these criteria would increase the number of healthcare professionals in underserved regions. Deploying these medically trained individuals in rural areas could mitigate the existing healthcare access disparity.
The idea of reevaluating medical school admissions with an emphasis on hands-on training for graduates from higher primary schools is not a new or novel idea. In fact, there are several programs that have been launched to address this issue. For example, the HRSA Teaching Health Center Graduate Medical Education (THCGME) Program has had significant success embedding residency training in community-based, rural, and primary care settings. The Rural Training Track Technical Assistance (RTT-TA) consortium supported communities, educational institutions, and others interested in developing rural training tracks — a 2016 review of the RTT-TA consortium found that more than 35% of graduates were practicing in rural areas through seven years post-graduation. Building on the RTT-TA strategy, in 2019, HRSA awarded $20 million in Rural Residency Planning and Development (RRPD) grants to 27 organizations to increase the rural workforce through the creation of new rural residency programs (COGME, 2020).
However, these programs have ultimately failed due to challenges such as inadequate funding, lack of comprehensive support systems, high medical malpractice insurance costs, and other factors (Coughlin et al. 90; Levine). Overcoming these obstacles requires substantial investment, resource allocation, and high state involvement. For example, rural healthcare providers often face low reimbursement rates from public and private payers, which affects their financial viability and ability to invest in new technologies and equipment (Levine; Health Affairs). Rural communities also have higher rates of poverty, uninsured or underinsured individuals, chronic diseases, and mortality than urban areas, which increase the demand and complexity of healthcare services (Coughlin et al. 90; NIH News in Health). Moreover, rural healthcare providers may encounter cultural and linguistic barriers when serving diverse populations, such as immigrants, refugees, Native Americans, or other minority groups (Levine; Health Affairs). These factors may affect the quality of care and patient satisfaction. Therefore, expanding medical education in rural areas is not enough to address the healthcare disparities. There is also a need for state policy changes, such as dramatically increasing funding for health programs, improving payment models to address disproportionate incentives, expanding telehealth services, and promoting community engagement and collaboration (Coughlin et al. 91; Levine; Health Affairs).
Outside of disproportionately affected communities, applying policies influenced by Marxist principles also has potential implications on a national scale. For example, expanding medical education by offering a universally free college education, as seen in Cuba, will reduce the stressful financial barriers that hinder aspiring medical students nationwide. Only by prioritizing accessibility and workforce requirements over profit can we bring about a substantial change in the medical landscape of the country.
Cuba’s Contrasting Success Story
All health care is free in Cuba.
Contrary to the propaganda perpetuated by corporate media narratives, countries like Cuba demonstrate that socialist systems can successfully address doctor shortages and achieve remarkable healthcare outcomes. Cuba has more doctors per capita than the United States, lower infant mortality rates, and longer lifespans. By prioritizing the well-being of the population over profit, Cuba shows that socialism can ensure access to quality healthcare for all.
Cuba’s success in ensuring universal healthcare access for its citizens can be attributed to its socialist system, offering a compelling counterpoint to the doctor shortage issue in the U.S.
Let’s take a closer look at the policy practices that make the Cuban healthcare system so admirable.
High Doctor-to-Patient Ratio: Cuba has the highest doctor-to-patient ratio in the world, with approximately 67.2 doctors for every 10,000 inhabitants, according to a 2020 report by the World Bank. Furthermore, according to Statistica in 2020, while Cuba sits at #1 for physician density worldwide, the United States sits at #53.
Emphasis on Preventive Care: The Cuban healthcare system emphasizes preventive care over treatment. Physicians often conduct community health screenings to catch and treat conditions before they become severe.
Comprehensive Healthcare Training: Cuban doctors undergo rigorous and comprehensive training, including a strong emphasis on serving rural and underserved communities.
International Medical Education: Cuba also invests in medical education for international students through programs like the Latin American School of Medicine (ELAM). This not only helps improve healthcare in other countries but also creates an international network of healthcare providers.
Community-Oriented Approach: Cuban healthcare is deeply rooted in its communities. Many doctors live in the communities they serve, fostering a strong doctor-patient relationship and a better understanding of community health needs.
State-Funded Healthcare: Cuba’s healthcare system is entirely state-funded, ensuring that citizens do not have to worry about the cost of seeking care. This eliminates financial barriers that often prevent people from accessing healthcare.
The Cuban Model: Can It Work in the U.S.?
While Cuba’s healthcare system has achieved outcomes on par with, or even better than, wealthier nations, implementing a similar model in the U.S. would require significant structural changes to the existing healthcare system. However, it is important to recognize that the extent of change necessary would mean confronting powerful interests that benefit from the current profit-driven healthcare system.
Let’s put how hard it is to make the change into perspective by analyzing how the capitalist class, who benefits from the exploitation of healthcare workers, as well as the negligence of our current system towards inner city, rural and native communities, are able to quickly mobilize powerful institutional tools in defense of the status quo.
Despite the undeniable support for Medicare for All, the lobbying giant known as The Partnership for America’s Health Care Future is determined to defend the current exploitative healthcare system. This coalition, composed of powerful industry groups and associations, aims to prevent any significant expansion of the government’s role in healthcare. They believe that the current system works well for the majority of Americans.
The recent movement to propagate lies that will scare people from a universal healthcare system was triggered specifically by the Democratic Party’s recent shift towards supporting Medicare for All, a proposal that threatens to dismantle the private health insurance sector and disrupt the carefully constructed healthcare system. Industry leaders worked with biased data researchers like “KNG Health Consulting” and the “Committee For A Responsible Budget” to spread misinformation and formed a united front against Medicare for All or any other proposals that would significantly expand government involvement in healthcare.
One KNG study, titled “The Impact of Medicare for America On The Employer Market and Health Spending,” largely focuses on the potential negative impacts on the private sector and employer-sponsored insurance if Medicare for America were to be implemented. It suggests that about one in four workers would lose access to employer-sponsored insurance by 2023, and one in three by 2032, emphasizing that workers at small firms would be disproportionately affected. Furthermore, it argues that total healthcare spending would increase, especially among those already covered by public insurance such as Medicare or Medicaid (The Partnership for America’s Health Care Future).
However, the study offers no substantial critique or consideration of what the state could effectively address with an expansion of the healthcare system. This one-sided perspective suggests a clear bias in the study’s approach, focusing primarily on how this hurts private pockets, without an equivalent investigation of its potential benefits for regular, working people.
Taking a close look at the KNG data used by the lobbying giant, we can see that the entire report suggests only ways in which the private sector would be negatively impacted by the implementation of Medicare. Further, it makes no attempt at criticizing what the state is capable, or incapable of addressing with a comprehensive expansion of the medical system. This perfectly illustrates how The Partnership for America’s Health Care Future is biased in its analysis, operating explicitly in the interest of the highest capitalist class, and not interested in searching for an objective truth.
The Partnership for America’s Health Care Future exemplifies the preparedness of influential stakeholders to mobilize and protect the status quo. Their concerted efforts and significant resources are fiercely directed toward preserving a system that maximizes profits, despite its shortcomings and inequalities.
Contrasting the biased representation of information presented by The Partnership for America’s Health Care Future, let’s take a look at a perspective on the matter from medical workers themselves.
Unlike KNG Health Consulting, The American College of Physicians (ACP) is a scientific medical journal that does not work on a client-contract basis. Further, it is directed by physicians themselves rather than the interests of wealthy shareholders. In an official policy paper on commercialization in healthcare, The American College of Physicians states that “the profit motive in medicine may contribute to a bloated, complex, and fragmented healthcare system (Crowley, 2021).”
Yet, while the peer-reviewed paper from The ACP is certainly better information than that propagated by The Partnership for America’s Health Care Future, it still lacks a key component, as it fails to recognize profit as fully incompatible with an equitable healthcare system.
ACP’s paper provides a list of suggestions for protecting patients in our profit-orientated healthcare system. It criticizes profit’s influence on the patient-physician relationship, and it criticizes the role of profit in the ongoing exploitative medical decisions which working-class Americans pay for. For example, in a survey of physicians published in 2017, a study found that “71% believed that unnecessary procedures were more likely to be done if physicians could profit from doing them (Crowley, 2021).”
The ACP paper uses the word “profit” well over 100 times. Clearly, physicians have figured out the problem. Yet, they still want to reconcile the profit-based system. “We just need to have the appropriate guardrails in place to protect against the outsized influence of profits,” said Thomas G. Cooney, MD, MACP, chair, Board of Regents, ACP. But it is precisely this passivity towards profit in healthcare that has led to such stagnancy in the progression of the United States healthcare system.
It can be argued that the hesitancy in naming profit as inherently contradictory with equitable health outcomes is not due to our resolve to find a solution within capitalism, but rather, it is dominantly credited to our inability to imagine anything other than a capitalistic system. This illusory capitalist realism is ultimately distracting us from the material reality, which is that very few people are benefiting from our complacency, while many suffer the consequences of living in the country with the highest rates of avoidable mortality (The Commonwealth Fund, 2020).
Lies of Omission Surrounding the US Doctor Shortage
The public discourse surrounding the US doctor shortage often fails to address the systemic economic drivers behind it, particularly the influence of class interests. While it is widely acknowledged that healthcare services are severely lacking in rural areas, low-income urban communities, and Native reservations, the avoidance of the term “class” obscures the underlying factors that contribute to these disparities.
For instance, there is an emphasis on high-tech, specialized medical fields over primary care, as specialists often enjoy higher pay and prestige, as evidenced by the over 150,000 dollar difference in annual pay (Healthgrades). This incentivizes medical students, who often carry significant debt, to pursue specialist careers rather than primary care. Consequently, primary care, which is crucial in underserved communities, is devalued and overlooked.
Moreover, medical schools, operating primarily as profit-driven institutions, exacerbate the problem by prioritizing applicants who can afford high tuition fees. This approach leads to a lack of diversity among medical students and future doctors. Studies have consistently shown that doctors from underserved communities are more likely to return and serve those communities (Xierali and Nivet, 2018). By overlooking applicants from disadvantaged backgrounds, medical schools perpetuate the shortage of doctors in underserved areas.
The privatization of healthcare services further promotes unequal access to care. When healthcare is treated as a commodity, the wealthy can afford high-quality healthcare, while the poor are left with inadequate care or no care at all. This disparity in access exacerbates the doctor shortage in underserved areas, as there is less financial incentive for healthcare providers to serve those who cannot afford to pay high prices for medical services.
Additionally, the undue influence of private interests in healthcare policies contributes to the doctor shortage. Private insurance companies and pharmaceutical companies often resist policies that would expand healthcare access and address the shortage, such as universal healthcare. These private entities prioritize their own profits over the well-being of the population, hindering efforts to tackle the doctor shortage effectively.
To address the doctor shortage and ensure equitable access to healthcare, it is crucial to stop naively ignoring these underlying factors. This includes advocating for policies that prioritize primary care, diversifying medical school admissions to include students from underserved backgrounds, and shifting towards a healthcare system that prioritizes public health over private profits. By addressing these issues, we can work towards a healthcare system that provides adequate care for all, regardless of their socioeconomic status.
The Future of Healthcare in the United States
The future of healthcare in the United States is uncertain and highly dependent on the decisions made today. With the aging population, the demand for healthcare services, especially in underserved communities, will continue to rise. If the current doctor shortage is not addressed, it will worsen health disparities and compromise health outcomes.
To ensure a future where healthcare is universally accessible and equitable, it is crucial to adopt strategies that address the root causes of the doctor shortage, emphasizing the alienation and exploitation of healthcare workers and challenging the profit motives of the capitalist system. This includes reassessing medical school admissions criteria, incentivizing doctors to serve in underserved areas, and increasing funding and resources for rural, inner city, and Native communities.
Beyond these measures, it is necessary to challenge the commodification of healthcare and strive towards a system that prioritizes health outcomes over profits. This will involve confronting powerful interests and advocating for a socialized medical system, or at least a starting point like a single-payer system such as Medicare for All, which has the potential to fundamentally transform the healthcare landscape in the United States.
Understanding and addressing the root causes of the doctor shortage, including the alienation and exploitation of healthcare workers and the profit motives of the capitalist system, is the first step toward creating a more equitable healthcare system. It is time to reject the lies and omissions surrounding this crisis and demand truth, transparency, and tangible solutions.
Works Cited
Artiga, Samantha, Rachel Arguello, and Philethea Duckett. “Health Coverage and Care for American Indians and Alaska Natives.” Kaiser Commission on Medicaid and the Uninsured. 7 Oct. 2013, https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-and-care-for-american-indians-and-alaska-natives/
Council on Graduate Medical Education. “Rural Health Policy Brief 1: Special Needs in Rural America: Implications for Healthcare Workforce Education, Training, and Practice.” COGME, July 2020.
Coughlin, Steven S., et al. “Continuing Challenges in Rural Health in the United States.” Journal of Environmental Health Science & Engineering, vol. 5, no. 2, 2019, pp. 90–92.
Crowley, Ryan, et al. “Financial Profit in Medicine: A Position Paper From the American College of Physicians.” Annals of Internal Medicine, vol. 174, no. 9, 2021, pp. 1447–1449. doi:10.7326/M21–1178.
“About Us.” Inner City Health Center. innercityhealth.org/about-us/
Figure 13. “Percentage of U.S. Medical School Graduates by Race/Ethnicity (Alone), Academic Year 2018–2019.” Association of American Medical Colleges, www.aamc.org/data-reports/workforce/data/figure-13-percentage-us-medical-school-graduates-race/ethnicity-alone-academic-year-2018-2019.
Goodfellow, Amelia et al. “Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review.” Academic medicine : journal of the Association of American Medical Colleges, vol. 91,9 (2016): 1313–21. doi:10.1097/ACM.0000000000001203
Health Affairs. “Solving Rural US Health Care Challenges With Frugal Innovation: Low Costs And High Returns.” Health Affairs Blog, 23 June 2021.
Khazan, Olga. “Why Are There So Few Doctors in Rural America?” The Atlantic, 28 Aug. 2014, https://www.theatlantic.com/health/archive/2014/08/why-are-there-so-few-doctors-in-rural-america/375006/.
Levine, David. “Addressing Disparities in Rural Health Care.” U.S. News & World Report, 23 June 2021.
Levy, Jonathan I., et al. “Racial Disparities in Asthma Triggers and Municipal Response: A Spatial Analysis of Housing Quality in Boston, Massachusetts.” Health Affairs, vol. 40, no. 6, 2021. https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01403
Moore, Christine. “Highest and Lowest Physician Salaries by Specialty.” Healthgrades, 17 Apr. 2023, www.healthgrades.com/health-content/highest-and-lowest-physician-salaries-by-specialty.
National Institute on Minority Health and Health Disparities (NIMHD). “Food Accessibility, Insecurity and Health Outcomes.” 2023, https://www.nimhd.nih.gov/resources/understanding-health-disparities/food-accessibility-insecurity-and-health-outcomes.html
NIH News in Health. “Health in Rural America.” NIH News in Health: The Monthly Newsletter from the National Institutes of Health (NIH), March 2022.
Saslow, Eli. “‘Out here, it’s just me’: In the medical desert of rural America, one doctor for 11,000 square miles.” The Washington Post, 28 Sept. 2019, https://www.washingtonpost.com/national/out-here-its-just-me/2019/09/28/fa1df9b6-deef-11e9-be96-6adb81821e90_story.html
Statista. “Ranking of the average number of physicians per 1,000 inhabitants by country 2020.” May 2021, www.statista.com/statistics/710580/physicians-density-by-country/.
Tse-tung, Mao. “Directive On Public Health.” Selected Works of Mao Tse-tung, 26 June 1965, www.marxists.org/reference/archive/mao/selected-works/volume-9/mswv9_82.htm.
The World Bank Group. “Physicians (per 1,000 people) | Data.” 2023, https://data.worldbank.org/indicator/SH.MED.PHYS.ZS
Xierali, Imam M., and Marc A. Nivet. “The Racial and Ethnic Composition and Distribution of Primary Care Physicians.” J Health Care Poor Underserved, vol. 29, no. 1, 2018, pp. 556–570. doi: 10.1353/hpu.2018.0036.
