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Where Have All The Doctors Gone?

America is facing a shortage of physicians. Here’s how you can find the care you need


a doctor with empty spaces showing missing doctors
Chris Lyons

“How can I find a doctor who can help me?”

As a physician, I get this question from friends and family all the time. And for most of my professional life, I was able to refer them to a medical colleague; a simple phone call was all it took to get someone an appointment within a reasonable amount of time.

But no longer.

The average wait for new patients to see a physician is 26 days, and that’s for mostly healthy people. In a medical emergency, the situation can become even more frightening: Twenty-two percent of acutely ill patients 65 or older who sought medical attention had to wait six days or more for an appointment, according to a 2021 survey by the Commonwealth Fund.

This is a crisis. And it’s a crisis that’s getting worse, rapidly.

“The backbone of our health care system, private practice, is on the brink of collapse,” warns Clarel Antoine, M.D., professor of obstetrics and gynecology at New York City’s NYU Grossman School of Medicine. “As a result, the nearly 70 million Americans on Medicare, many with chronic conditions, can expect longer waiting times for medical care.”

Due to an astonishing combination of professional missteps, failed policies and an aging population, America is facing an unprecedented shortage of physicians — one that is putting each of us at increased risk. Here’s what older Americans need to know about protecting themselves and their loved ones — and how you can ensure you get the care you need.

A health care crisis

Alli Phillips, 49, of Denver, developed swollen joints in her hands in April 2023, but when she called her physician’s office, she was told the first available appointment wasn’t until June. When the appointment finally came around, the doctor told Phillips that she suspected rheumatoid arthritis and referred her to a specialist. But the specialist had no appointments available until November.

In the meantime, Phillips’ knees began to swell, and she struggled to walk down steps and turn doorknobs. When her appointment finally came, her visit with the rheumatologist lasted only about 15 minutes. She left with a prescription for prednisone, which made only mild improvements to her symptoms. After two more 15-minute visits to the rheumatologist, Phillips finally hired a concierge doctor for $3,500 per year — a fee not covered by insurance. The concierge doctor took time to discuss multiple treatment options and long-term care, and prescribed methotrexate, a chemotherapy and immunosuppressant drug, to get her condition under control.

Phillips was lucky, her new doctor told her: The delay in treatment could have caused further joint damage, and she was fortunate to be able to afford the out-of-pocket expense. But, as Phillips says today, “How do people without resources to get around the system find the care they need?”

Even being an established, well-connected doctor doesn’t always help. One colleague of mine, working at a major medical center in the South, recently decided to move with his family to the Northeast. But as the process was underway, his wife was diagnosed with cancer. Even though she’d already received a diagnosis, and even though they were using the same insurance company, the insurer refused to cover her oncology treatment until she got a referral from a new primary care physician.

Despite being a prominent doctor himself, my colleague could not find a single physician willing to take his wife on as a new patient. The family was forced to go back to their previous state so his wife could receive care. Fortunately, she is doing well, but my colleague asks, “How do people do this without the connections we have?”

Too often, the answer is, they don’t. Although there were some 835,000 practicing doctors in America in 2023, according to the U.S. Bureau of Labor Statistics, we are currently experiencing a shortage because demand exceeds supply.

“My 82-year-old father almost died because it took us months to find him a doctor,” says Michelle*, 54, of New York City. One night in August 2023, Michelle’s father, Marvin, a retired engineer, called her. He was slurring his speech and had developed a facial droop — both classic signs of a stroke. She immediately sent him to a hospital.

“The doctors told him that he needed an MRI, but there was one problem — his pacemaker needed to be switched to an MRI-safe mode,” Michelle says. “I called every hospital and doctor I could — neurologists, cardiologists, even primary care doctors — but no one was available to get that done and the MRI completed.”

Over the next several months, Marvin experienced two more episodes. When he finally went back to the ER that November, he’d developed sepsis — from an infection in his heart — and tests revealed he’d suffered two more strokes. “Finally, he had open-heart surgery,” Michelle says. “But it left us so angry and frustrated that he had to nearly die to get the care he needed.”

To understand why doctors are in such short supply, it helps to think of the medical field as a bathtub. To keep the tub full, the faucet needs to be adding water at least as fast as the drain empties it. But that’s not what’s happening. The current shortage of physicians, combined with a number of other factors, has placed such an intense strain on doctors that many in the medical field are choosing to switch professions or simply retire early. And despite efforts by the Association of American Medical Colleges (AAMC) to graduate more doctors, those efforts to fill the tub simply can’t keep up with the drain.

Why don’t we have enough doctors?

In 1980, a U.S. government report concluded that American teaching hospitals were graduating too many medical students. It predicted a surplus of 70,000 physicians by 1990, an alarming statistic. In response, medical schools established what became a 25-year moratorium on increasing class size, enforced by the AAMC and the American Medical Association (AMA).

Yet there was a significant flaw to that initial report: It failed to account for the nation’s rising population, which is now 110 million more than it was 45 years ago. By 2005, as the population grew and the potential for a severe physician shortage emerged, the AAMC and AMA reversed their recommendation, and in the past 20 years, more and more young people have trained to be doctors.

Yet despite the more than 97,900 students in medical school, 38,000 in osteopathic school, and 162,000 doctors currently in residencies and fellowships, the AAMC predicts a shortage of up to 86,000 physicians by 2036. By then, it projects that the U.S. population will have risen 8.4 percent since 2021. The population of those over 65 will increase by 34 percent, while the number of people 75 and older will increase by 55 percent.

“Medical education is a long journey, and even though medical school enrollment has risen, we need more residency positions [where med school graduates get hands-on training], which requires increased government support,” says David Skorton, M.D., president of the AAMC.

It’s not just that we don’t have enough doctors. Part of the problem may be that we don’t have enough of the right kind of doctors.

Becoming a doctor is expensive: The average medical student emerges with roughly $235,000 in debt. Now consider that the average primary care physician (PCP) in internal medicine, geriatrics, pediatrics or family medicine makes about $250,000 to $275,000 a year. Becoming a PCP just isn’t financially feasible for most recent graduates. Two-thirds of newly minted doctors are choosing to become specialists, which allows them to earn salaries upwards of twice what a primary care doctor can make.

“Primary care physicians are undervalued by government and insurance companies, and that is reflected in decreased compensation,” says Isaac Opole, M.D., president of the American College of Physicians. “It makes the field unattractive to medical students.”

Yet it is the PCP who provides the annual checkups that may detect problems early on, and who serves as the gatekeeper for referrals to specialists. Many people with private insurance, as well as those enrolled in Affordable Care Act plans, are required to see a PCP before they can access specialists in a majority of fields.

And while many med students are choosing to go into specialty care, others opt not to become physicians at all. Indeed, more than 50 percent of medical students and residents surveyed preferred to pursue careers that do not involve direct patient care, such as research or teaching, according to a 2023 report from Elsevier Health. One in 4 contemplate dropping out of medical school altogether, citing overwork, financial stress and mental health concerns.

In a study published in 2019, parts of chromosomes that shorten with age eroded six times faster than average for doctors in their first year of training after medical school; researchers attributed the accelerated aging to the doctors’ stress levels.

Lenore Tate
Lenore Tate, 72, a psychologist from Sacramento, California, who has congestive heart failure, must drive three to four hours each way to see her cardiologist. She often has to wait so long for an appointment she now has two doctors in case she can't get into see one when she needs it.
Preston Gannaway

Even as we struggle to bring more physicians into the fold, another crisis has emerged: More and more frequently, doctors are cutting their hours, seeing fewer patients — or just quitting the medical field altogether. To go back to the bathtub analogy, we’re opening the spigot, but there’s too much water draining out from under the surface.

Why your doctor doesn’t have time for you

Many doctors dreamed of medicine as a profession from early childhood. In past generations, it was common to see physicians practicing long past the age when they could retire. Yet a recent AMA survey found that 1 in 5 doctors were hoping to find a way out of medicine in the next two years. Among those 55 or older, that figure was 1 in 2. Why?

In reporting this story, I spoke with dozens of physicians, the vast majority of whom vented their frustrations with the current state of medicine. But just as tellingly, almost all of them also refused to talk to me on the record, fearing that speaking out could cost them their jobs.

Part of what’s driving this is the growing trend of private equity firms and corporations, such as CVS Health and Amazon, purchasing hospitals and private practices. One major medical group, with about 90,000 doctors in some 2,000 locations across the country, has spent billions of dollars acquiring physician-owned practices, home health centers and surgical centers. This past April, the Physician Advocacy Institute reported that just shy of 80 percent of all doctors were employed by hospitals or corporations, up 200 percent in just over 10 years.

Typically, when for-profit firms acquire practices, they approach these acquisitions utilizing a profit-based strategy. What does that look like?

The doctors I spoke with off the record explained that corporate entities now govern their allotted time with patients, often allowing just 15 minutes per visit, a situation that isn’t healthy for either the doctor or the patient. “They control every aspect of a doctor’s professional life, and it’s all about the money,” one doctor told me. A 2024 JAMA Internal Medicine report said that 61 percent of doctors surveyed found private equity ownership unfavorable for health care.

And then there’s the paperwork. For every hour seeing patients, the average doctor now spends two hours doing administrative tasks, according to the AMA. A primary driver of paperwork: the electronic health record, or EHR.

“The EHR is the bane of existence for every doctor in the country,” says Opole. The EHR was designed to eliminate a paper-based tracking system and make patients’ health records easier for various health professionals to access. But in practice, doctors say, its primary focus is documenting for regulators and billing for insurers. To handle rising administrative demands, doctors have begun cutting back on office hours, resulting in even less time available to see patients. A 2023 Mayo Clinic study noted that 40 percent of doctors it surveyed intended to reduce their work hours in the coming 12 months.

The study estimates that the slashing of work hours, in addition to the 26 percent of doctors who said they were thinking of quitting their practice in the following 24 months, would decrease the workforce by the equivalent of 20,234 physicians — a number that equals all medical school graduating classes combined.

“The doctor-patient relationship requires time to establish a trust, which comes with patients sharing stories of their life with you as it relates to their health,” John Dooley, M.D., an internist in private practice in Washington, D.C., shared with me one evening while driving home at 9:30 p.m. from a grueling day of work. “That doesn’t happen if you only give them 15 minutes.”

Where are all the doctors going?

To a person, physicians told me they are burned out. Simply put, they are being asked by the business world that owns their practices to do medicine, at times, in ways they view as not in the patient’s best interest. Meanwhile, those who cling to their independent practices are finding it impossible to hold on given the financial pressures on them.

Michael Hotchkiss, M.D., recently sent an email to his patients, explaining why, despite his love for treating people, he was closing his obstetrics and gynecology practice in Waldorf, Maryland, after 45 years:

Dr. Michael Hotchkiss
Michael Hotchkiss, a doctor in Waldorf, Maryland, recently informed patients he planned to retire in 2025 after 45 years of working as an obstetrician-gynecologist.
Stephen Voss

“I am no longer able to continue practicing medicine in a manner that aligns with my convictions regarding the best interests of my patients.”

In a follow-up interview with AARP, the doctor lamented, “If I were independently wealthy, I would keep doing it. I absolutely love what I do, but it has become unsustainable. Enough is enough.”

What haunts him further is that he’s been unable to refer his patients — two-thirds of whom are 50 or older — to other nearby physicians: “We’re sending people who need doctors to Northern Virginia or Annapolis, but they have to travel 45 minutes to see a doctor who is accepting new patients. I don’t have anyplace closer to send them,” says Hotchkiss. “It’s horrible.”

This dilemma has translated into yet another troubling trend: More than 300 doctors now die every year from suicide, a rate twice that of the general population.

“We take highly intelligent people with a calling, put them in a demanding and often hostile work environment without any reasonable labor protections, and they cannot even meet their basic needs,” says Pam Wible, M.D., who runs suicide-prevention workshops for physicians. “They can find themselves on the path to taking their own life.”

The 2022 Dr. Lorna Breen Health Care Provider Protection Act, named for a physician who took her own life during the COVID-19 pandemic, provides funding to medical and other organizations to reduce and prevent physician suicide, and address the challenges they face today.

At a recent visit, my own primary care doctor, Paul Arias, M.D., shared that “the pandemic drove many doctors into retirement; others became ill and required disability and, sadly, some died. For those who remain, many fight daily with insurance companies to get approvals for a patient’s labs or procedure. It’s exhausting. Corporate America has taken over medicine.”

To increase revenue, reduce paperwork and regain control of their lives, more and more doctors are choosing concierge medicine, a system in which patients pay a yearly out-of-pocket fee in exchange for longer visits and shorter wait times. Costs can range from $2,000 to $10,000 annually, though some practices have upfront prices that are markedly higher. And since most Americans don’t have the financial resources to pay such high and nonreimbursable fees, this further drains the pool of doctors available, especially to older people on fixed incomes.

Meghan McCormick
Meghan McCormick suffers from a rare heart condition that needs specialized care. As a Medicare patient, she has struggled to find timely care: “Six month waits if you’re a new patient. When you have cardiovascular disease you can’t wait six months,” she says. She ended up with a pacemaker that she may not have needed.
Cassidy Araiza

Nancy F.*, 67, of Los Angeles, found out her PCP was going concierge, so she and her husband each shelled out $1,800 to join the service. But the level of care doesn’t feel “concierge.”

“Most of the time I’m talking to a PA [physician assistant] or nurse practitioner,” Nancy explains. “If I want to have the doctor more available to me, that’s $10,000 a year.”

Nancy has also been struggling to find a neurologist to treat her migraines. “When I finally found one, I was told it would be a couple months before I could get in to see her — or I could pay $2,500 to join her practice and get an appointment sooner.”

Doctors have also turned to shift work, a model in which they manage patients in a hospital during set hours, thereby protecting their time off. These hospitalists, as they are called, transfer care to the next doctor on call when their hours end. In 2000, there were only a few hundred hospitalists; today, that number exceeds 60,000.

These doctors are well-equipped to handle day-to-day issues when you’re hospitalized. But this trend further decreases the pool of physicians available for routine wellness visits. And, as in the case of Marvin, the stroke victim, a hospital visit may leave you with no one to follow up with after you’re released.

The special danger to older Americans

Despite an aging population, there are fewer than 7,000 geriatricians in the U.S. today. We face a projected shortage of more than 2,000 geriatricians by 2037, according to Health Resources & Services Administration (HRSA). Although there has been growth in available geriatric fellowship slots, a substantial number of positions remain unfilled.

“There is a perfect storm coming,” says Bruce Scott, M.D., president of the AMA, “with increased patient complexity, decreased reimbursements and increased demand for prior authorizations from the insurance company. The combination of these makes it increasingly difficult for physicians to accept new patients and, in some cases, even keep their doors open. We can’t afford to lose even one more doctor.”

With no influx of geriatricians on the horizon, one option is training primary care and specialty doctors on the specific changes that aging patients experience.

“To effectively meet the health needs of an aging population, we need to create an age-friendly workforce,” says Nancy E. Lundebjerg, CEO of the American Geriatrics Society. “We need to create a well-defined curriculum not only in medical school but also in residency programs focused on the older adult. We believe there should be a requirement that all Medicare-supported training include a focus on older adults.”

“We must create seamless care that is age-friendly. This includes home-based care, telehealth visits, hospitals, emergency rooms, office practices, clinics and nursing homes,” says Terry Fulmer, president of the John A. Hartford Foundation, a nonprofit focused on improving care for older adults. A report from the National Academy of Medicine identified a multipronged approach, including boosting the skills of those caring for aging patients, developing new models of care, and increasing and retaining an eldercare workforce.

How to get the care you need

We turn to our doctors during times of vulnerability, and we want them to be available. Only about 1 in 3 Americans have a high level of confidence in the medical system, but two-thirds of us trust our doctors, according to 2023 Gallup polls.

So when we discover our doctor is retiring or simply has no time to see us, it can be ​unnerving, to say the least.

To ensure you get the care you need:

  • Become friends with the nurses or schedulers in the doctor’s office. Learn their names and make sure they know yours. They can let you know if a cancellation has occurred and keep your name on a waiting list.
  • Schedule your next appointment while you are at your current one. That’s your best shot at securing a spot on the calendar.
  • Make sure to fill out all health forms online in advance of your visit. You may have only the smallest of windows to talk with a provider, so make sure you’ve provided as much information as possible to maximize your time in the doctor’s office.
  • Ask about telehealth options. If the physician’s practice cannot see you in the office, speak with the scheduler to see if a telehealth visit is possible. In surveys, about 87 percent of doctors reported using telemedicine, but only 37 percent of adult patients had taken advantage of it within the previous 12 months, according to CDC data. Or ask if one of your doctor’s colleagues or another provider in the practice can see you.
  • Ask your doctor for a referral — and to reach out on your behalf. If your doctor is retiring, moving or turning to concierge medicine, and following them is not an option, ask them for a referral. If they can recommend someone else in their group, even better — that comes with the advantage of your medical records being readily available. Either way, ask your doctor to personally contact that clinician on your behalf; you may have a better chance of being accepted as a new patient than if you just cold call with a referral. And always check to see if that new physician accepts your insurance, including Medicare.
  • Ask your insurance company for a list of names of physicians. If you are on Medicare, go to Medicare.gov and click on the Providers & Services tab to find and compare doctors by location. You may want to consider a physician who is not geographically convenient to your home but who meets your other needs.
  • Don’t be shy about going to urgent care or the ER if necessary. In many cases it’s better to get someone to look at you today than to wait weeks for your regular doctor.
  • Monitor your health at home. Learn more about home care devices that can help to detect important changes in your health, such as a blood glucose monitor, pulse oximeter (to measure oxygen levels), blood pressure monitor, or electrocardiogram (ECG) to track heart rhythms. Calling a doctor’s office to report a change in a vital sign can speed up an appointment, give you some worthwhile reassurance — or urge you to get to an emergency room.
  • Do some research. Use the internet wisely. Physician reviews may not be particularly helpful, as they are not only subjective but often filled with complaints; satisfied customers are less likely to post reviews. What is useful, however, are a physician’s board certification, specialty training, insurance plans and hospital affiliations. As with all relationships, there needs to be a good fit, founded on confidence, compassion and communication.

The health care system touches all of us: Millions of American workers are currently employed in health care in some capacity, many in government, for insurance companies, or in corporate oversight. But in the end, it is often doctors on the front lines, bearing the blame and anguish when diagnoses are wrong or treatments go badly. It’s incumbent upon all of us to understand why our system is in crisis and to support efforts to make it work better for everyone.

*Some names have been changed to protect patient privacy.

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