Yes, the United States faces a significant and growing shortage of doctors. The Association of American Medical Colleges projects the country will be short up to 86,000 physicians by 2036, and that number only accounts for current patterns of healthcare use. If underserved populations actually had the same access to care as everyone else, the U.S. would need roughly 202,800 more physicians than it has right now just to meet today’s demand.
Where the Shortage Hits Hardest
The gap is not evenly distributed across medicine. Primary care is expected to bear the heaviest burden, with a projected shortage of 70,610 primary care physicians by 2038. Family medicine accounts for the single largest piece of that deficit, at roughly 39,060 doctors short. Internal medicine follows at 20,660, then pediatrics at 9,320. Overall, the U.S. primary care workforce is on track to operate at only about 80% of what’s needed.
On the specialty side, surgical fields face some of the tightest squeezes. Vascular surgery is projected to have the lowest supply adequacy of any specialty by 2038, meeting just 66% of demand. Ophthalmology (72%), thoracic surgery (73%), and plastic surgery (74%) are close behind. These aren’t fields where you can easily shift patients to other providers, because the procedures require years of highly specialized training.
Rural Areas Are Already in Crisis
Over 101 million Americans currently live in areas the federal government has officially designated as primary care Health Professional Shortage Areas. That’s nearly a third of the country.
The rural numbers tell the story most starkly. Rural counties have about 120 physicians per 100,000 residents, roughly 40% of the 302 per 100,000 found in urban counties. More than 6% of rural counties had no physician at all as of 2019, compared to just 1.2% of urban counties. And the projected shortages will widen this gap further. By 2038, rural areas are expected to have only 61% of the primary care physicians they need, versus 83% in metro areas.
Some specialties virtually disappear in rural settings. Geriatrics, the branch of medicine focused on older adults, is projected to reach just 45% adequacy in nonmetro areas. Internal medicine hits 47%. For people in small towns and farming communities, the doctor shortage isn’t a future problem. It’s the reality they navigate every time they need care.
Why Demand Keeps Rising
The biggest demand driver is straightforward: the population is aging. People 65 and older made up 17% of the U.S. population in 2020. By 2040, that share will reach 22%. Older adults use healthcare services at significantly higher rates, needing more frequent visits, more chronic disease management, and more surgical interventions. The generation that will push these numbers is already entering retirement age, and the physician pipeline can’t keep pace.
At the same time, the physician workforce itself is aging. A substantial share of practicing doctors are at or near retirement age, meaning the profession is losing experienced physicians on one end while demand surges on the other.
A Training Bottleneck Decades in the Making
One of the core structural problems is a cap on federally funded residency slots that has been in place since 1996. Every doctor in the U.S. must complete a residency after medical school before they can practice independently, and Medicare is the primary funder of those training positions. Congress froze the number of residency slots each hospital could claim for federal funding at 1996 levels, and that cap has barely moved in nearly three decades.
Recent legislation has added slots, but at a pace that doesn’t match the scale of the shortage. The Consolidated Appropriations Act of 2021 authorized 1,000 new residency positions, phased in at no more than 200 per year starting in 2023. A follow-up act in 2023 added another 200 positions starting in 2026, with at least half reserved for psychiatry training. For context, the country needs tens of thousands more doctors. Adding a few hundred residency slots per year is a small patch on a large hole.
This means medical schools can increase enrollment, and many have, but graduates still face a bottleneck. There are only so many residency positions available, and without completing one, a medical school graduate cannot practice medicine.
Who Fills the Gaps
Nurse practitioners and physician assistants have increasingly stepped into primary care roles, particularly in underserved areas. Federal projections actually show a surplus of 72,910 nurse practitioners and 6,660 physician assistants by 2038. These providers can handle many routine primary care needs, from managing diabetes to treating infections, and their growing numbers will absorb some of the demand that physicians can’t meet.
But nurse practitioners and physician assistants can’t fully replace physicians in every context. Complex diagnoses, surgical procedures, and specialty care still require physician-level training. The surplus in one part of the workforce doesn’t cancel the deficit in another. It softens the impact for patients who need straightforward primary care while leaving the specialist and surgical shortages largely untouched.
What This Means for Patients
In practical terms, the shortage shows up as longer wait times for appointments, shorter visits when you finally get one, and fewer choices about who provides your care. If you live in a rural area, it may mean driving an hour or more to see a specialist, or relying on telehealth for conditions that ideally need an in-person exam. Emergency departments absorb overflow from patients who can’t get timely primary care, which drives up costs and strains hospital resources.
The shortage also concentrates in the specialties that an aging population needs most. Geriatricians, the doctors specifically trained to manage the complex health needs of older adults, are projected to fall short by 1,570 nationally, with the worst gaps in rural communities. As more Americans enter their 70s and 80s, many will find that the type of doctor best suited to their care simply isn’t available nearby.