Why America Has So Few Doctors

As a matter of basic economics, fewer doctors means less care and more expensive services.

February 14th, 2022, The Atlantic

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By the time Elizabeth Erickson was a freshman at Davidson College in 2002, she knew she wanted to become a doctor. Because she understood that the earliest health interventions are among the most important, she set herself on a pediatrics track. After four years of premed classes, she went straight to medical school at Wake Forest University, which took another four years. Then came three years of residency at Duke University, plus one final year as chief resident. In 2014, she joined the faculty of Duke’s School of Medicine. Her dream was realized at the steep price of 12 consecutive years of learning and training, plus about $400,000 of debt.

Erickson’s story would be exceptional in just about any other country. But it’s hardly unusual in the United States, which has the longest, most expensive medical-education system in the developed world, and among the lowest number of physicians per capita. “There is a huge scarcity of primary-care doctors, like pediatricians, and many of us are operating in a scarcity framework without enough resources,” Erickson told me.

In January, I wrote that America needs an abundance agenda—a plan to attack the problems of scarcity in our housing, infrastructure, labor force, and, yes, health-care system. As the pandemic has made clear, we need medical abundance in the 21st century. That means more high-quality therapies, more clinics, better insurance, and better access to medicine. But it also means more doctors.

As I dug deeper into the roots of America’s health-care scarcity, I realized that I had to start by answering a simple question: Why does America make it so hard for people like Elizabeth Erickson to practice medicine?

Imagine you were planning a conspiracy to limit the number of doctors in America. Certainly, you’d make sure to have a costly, lengthy credentialing system. You would also tell politicians that America has too many doctors already. That way, you could purposefully constrain the number of medical-school students. You might freeze or slash funding for residencies and medical scholarships. You’d fight proposals to allow nurses to do the work of physicians. And because none of this would stop foreign-trained doctors from slipping into the country and committing the crime of helping sick people get better, you’d throw in some rules that made it onerous for immigrant doctors, especially from neighboring countries Mexico and Canada, to do their job.

Okay, I think you’ve caught on by this point. America has already done all of this. Starting in the late 20th century, medical groups asserted that America had an oversupply of physicians. In response, medical schools restricted class sizes. From 1980 to 2005, the U.S. added 60 million people, but the number of medical-school matriculants basically flatlined. Seventeen years later, we are still digging out from under that moratorium.

外刊精读249：剖析美国医生稀缺的深层原因 (选自The Atlantic 大西洋月刊)

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