The race is on to “flatten the curve.” With only 925,000 hospital beds in the country, and the potential for more than 20 million cases of coronavirus requiring hospitalization, there’s a huge potential shortage of both beds and ventilators in American healthcare facilities.

But there’s another shortage that’s being discussed far less – that of healthcare professionals, and especially trained physicians.

Most Americans operate under the assumption that healthcare in the United States is a mostly free market, made up of doctors, insurance companies, and the occasional government entity interacting with one another for the good (and bad) of patients.

What this view misses are the myriad other actors who play a role that is arguably just as important: organizations like the Association of American Medical Colleges (AAMC), the Accreditation Council for Graduate Medical Education (ACGME), and medical schools themselves.

Much of the nationwide debate over healthcare focuses exclusively on demand for prescription drugs, for medical technology, or for insurance coverage. What’s thought about far less are supply-side considerations –– in particular the reality that one of the biggest drivers of healthcare costs is the supply of doctors, nurses, and technicians.

Just who can become a doctor in the first place is ultimately determined by the medical schools who serve as gatekeepers to obtaining a medical education. But the pipeline doesn’t end there. One of the most important steps to becoming a doctor occurs after students’ classroom education is complete and the time comes to apply for residency.

That process is called “Match,” and is run by the little-known National Resident Matching Program, a non-profit formed in the 1950s with the stated goal of streamlining the hospital-resident application process. Students make rank-ordered lists of where they’d like to be placed, and a private algorithm, largely unchanged since Match’s founding, places them in the hospitals where they will reside post-med school.

The problem for the healthcare system comes not with the matching process itself, but from all of the students who end up unmatched with a residency program. Despite spending four years and hundreds of thousands of dollars to obtain an MD, many potential doctors each year find themselves holding a degree with no place to practice.

Their only choice becomes scrambling for open opportunities, reapplying the following year, or searching for clinics willing to hire medical professionals who won’t be able to get board certified.

Last year alone, “1,162 medical school seniors were not accepted into residency programs … [and] 811 prior-year U.S. med school grads didn’t match to a residency.” That’s nearly 2,000 potential doctors left looking for work at a time when they couldn’t be needed more.

Ultimately, the power to streamline the residency process results in the power to limit how many Americans become doctors each year. Just like state certificate-of-need laws make it difficult for hospitals to increase their number of beds, the process run by the alphabet soup of overseeing organizations serves as a bottleneck on the supply of doctors in this country.

In any other industry, the law of supply teaches us that as the cost of a service soars, so does the number of people seeking to provide that service. Yet, in the case of healthcare, the result has been an increase in hospital administrators, but a shortage of doctors.

The AAMC itself has found that “[t]he United States will see a shortage of up to nearly 122,000 physicians by 2032 as demand for physicians continues to grow faster than supply.” And this is before the increased need for doctors as the coronavirus pandemic intensifies.

What’s being done to address this shortage? Certainly not enough.

Even if Match operated perfectly and all residency slots are filled, there’s still the problem that there just aren’t enough residency slots nationwide. Medical schools themselves have been expanding and new ones are opening, but the number of residency positions remains stagnant due to their dependency on funding from Medicare. In the AAMC’s words, “the number of residency positions has increased only 1% a year, far lower than the 52% growth in medical school spots since 2002.”

It’s true that educating medical students is an expensive endeavor, and some argue the costs typically run greater than the price of tuition. Cadavers and other clinical expenses aren’t cheap, which is why the federal funding that comes with residency positions is so coveted: Grants tied to residents dwarf their insurance costs and the salaries paid to them.

The United States is long overdue for a difficult conversation about how to best prioritize funding for the medical field. But the solution to the supply problem should be easy: start prioritizing the expansion of residency opportunities as much as the number and capacity of medical schools themselves.

All Americans who are willing and able to become doctors should be able to do so, and no organization – public or private – should prevent them from doing so. As the latest coronavirus crisis shows, our very health and wellbeing may depend on it.

Image credit:  Blue Planet Studio

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