‘The Physician Shortage is Huge’

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The nation’s physician shortage means patients already often wait months to get an appointment, doctors often don’t take new patients, and rural areas suffer from a lack of health care.

But with the shortage projected to grow, health experts say those problems are only likely to worsen.

“People already have trouble … getting appointments. They can’t get in for two months or more,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

“That’s going to be happening more and more.”

According to the Association of American Medical Colleges (AAMC), the nation will be short as many as 86,000 physicians by 2036.

South Carolina is projected to be short 3,230 doctors by 2030 – 815 of them in primary care, according to the Cicero Institute, a nonpartisan public policy think tank, which ranks the state 36th nationally in the total number of physicians, and 38th in both primary care doctors and general surgeons.

The reasons for the shortage are varied.

The population is growing and it’s getting older, which means there are more people who need medical care.

According to the AAMC, the U.S. population is projected to grow 8.4 percent by 2036, with the population 65 and older growing by 34.1 percent and those 75 and older increasing by 54.7 percent.

“We are an aging population,” says Benjamin, “and our workforce … is aging as well.”

Indeed, thousands of physicians retire every year, said Michael Dill, director of workforce studies for the AAMC, which reports that doctors who are 65 or older make up 20 percent of the physician workforce and those between 55 and 64 comprise 22 percent, which means “a significant number of physicians will reach retirement age within the next decade — if they have not already.”

Dill added that physician work hours have been trending downward for years as well as doctors press for better work-life balance.

“There are about 1 million physicians, and one hour multiplied by a million physicians is a lot of FTEs (full-time equivalents),” Dill said. “And even a small downward movement represents large additions to the physician shortage.”

In addition, Benjamin said, medical education has gotten even more expensive, leaving graduates saddled with hundreds of thousands of dollars in debt. As a result, many who might otherwise go into medicine may choose other careers that pay well and don’t take as long to realize.

Moreover, he added, the administrative burden associated with practicing medicine is enormous, and in some cases, the reimbursement for care hasn’t kept up with the cost making it too expensive to have a practice.

There’s also a geographic distribution problem, Benjamin said. Physicians generally want to practice around other physicians and live in more urban settings, so rural communities have fewer providers, he said.

But arguably, at the heart of the shortage is the need for more medical schools and residency slots for graduates, experts say.

The nation graduated 21,590 medical students in 2024-‘25, according to the AAMC. And although that’s up thanks to an increase in the number of medical schools from 125 to 170 since 2006, the number hasn’t grown fast enough, Dill said.

The number of residency slots hasn’t kept up either, he said.

“In recent years, we’ve added a few thousand. But that’s not nearly enough,” Dill said. “We need to train more. We are treading water at best. Even those (patients) who have relatively good access to care have to wait.”

“We’re growing a few more medical schools so we can increase the output,” adds Benjamin. “But it’s a big endeavor, it’s expensive, and it takes years.”

The number of residency slots for graduates, which are paid for by Medicare, was capped by Congress in 1997, he said.

“We haven’t changed those slots in years,” he said, adding there is no desire in Washington to increase spending. “And we haven’t rebalanced for the kind of physicians we need.”

Nonetheless, efforts are underway around the nation and in South Carolina to tackle the shortage.

For example, Benjamin said, many states have tuition forgiveness programs to encourage doctors to practice there, some medical schools have similar programs for new doctors who practice in rural communities, and some hospitals fund residency programs on their own.

Hospitals in the Palmetto State are employing a variety of concepts.

The Medical University of South Carolina, for example, has graduated about 180 medical students annually for the past 20 years, said Dr. Terrence E. Steyer, dean of the College of Medicine and vice president for medical affairs.

But construction of a new 186,000-square-foot building, with $72 million in state funds, is slated to open next August and enable class size to increase to 240 over time, he said.

Philanthropic donors also understand the need, he said, noting that in July MUSC received an anonymous donation of $50 million – the largest ever – to grow the physician workforce.

“We know we need to increase class size,” he said. “We are using that endowment to help support the training of physicians and faculty we need.”

Another issue, Steyer said, is getting medical students to stay and practice in the state.

“We know that if you attend medical school in South Carolina, there’s a 50-percent chance you’ll stay in South Carolina to practice,” he said. “And if you do your residency here, it’s up to 75 percent.”

So MUSC’s goal is to get more people to go to medical school here and stay for their residency, he said, allowing that residency slots are a “huge problem.”

With the federal cap on funding for residency positions, there are only so many options, Steyer said. But the government allows new slots at hospitals that never had them before, and hospitals can add residents if they pay their salaries, he said, adding that MUSC has used both approaches.

“We are (funding) capped for about 300 residents a year, and this year we are training about 1,000,” he said. “We’re paying for 700 of them. It’s a significant investment from the health system to do that.”

MUSC is also working to expand hospitals across the state and the number of residency programs in those facilities, ranging from internal medicine to psychiatry, he said. So the number of slots will grow to 1,200 in the next three years, he said.

Meanwhile, he said, MUSC is combatting the shortage by increasing the use of telemedicine and other technology, such as devices that monitor blood pressure or blood glucose remotely, especially in rural areas, and using more non-physician providers, such as nurse practitioners and physician assistants.

“There’s a lot of team work and a lot of technology to improve care across the state,” he said. “We even have tele-hospitalists who round with nurse practitioners.”

The state has helped through a program that pays first- and second- year medical school debt for graduates who go into a residency program in one of six high-need specialty areas – primary care, pediatrics, internal medicine, obstetrics and gynecology, general surgery, and psychiatry, he said.

“The graduating class of 2025 was the first who saw these payments, and around 20 individuals qualified,” he said, noting that accounted for $1.2 million in debt.

And if they choose to practice for at least four years in a health professional shortage area – or every county but Charleston, Dorchester, Greenville, and Lexington – their third- and fourth- year is paid off as well, he said.

MUSC also has begun changing the times and ways care is delivered to meet patients’ needs, offering OB/GYN visits as early as 7 a.m. and during lunch hour, for example, so patients don’t have to miss work, he said.

And it’s developing pathway programs to get middle-school students interested in health careers, he said.

The University of South Carolina School of Medicine Greenville is working on the problem as well.

While it admits 110 students per class now, it hopes to increase that by expanding building eventually, said Dr. Phyllis MacGilvray, dean of the school.

In the meantime, it’s taking other approaches to graduating more doctors.

For example, she said, students who want to become primary care doctors can complete their degree in three years instead of four. This accelerated track, now in its second year, incorporates much of the fourth-year curriculum into their first, second and third years and allows for summertime rotations, she said.

And since much of their fourth year involves preparing for residency, these students are already slated to go into a family residency program in Greenville, Greer, or Oconee County, she said. Six students a year are accepted into that program and tuition is provided through scholarships, she said.

Interest in the program has tripled, according to USC, and MacGilvray hopes to see this program expand as well.

The school also has a pathway program – MedEx Academy – to get high school students interested in health careers, she said, noting 13 of the 110 medical students in the new class are graduates of that program, which also helps identify students who need additional resources to prepare for medical school.

USC School of Medicine Greenville has a graduate medical education program with Prisma Health, but it’s limited by residency slots as well, MacGilvray said.

“If you’re not getting federal funding, it’s hard to drastically change the landscape of how many you have,” she said. “But the physician shortage is huge. And it’s not just primary care.”

So the school has expanded residency slots in psychiatry and neurology as well as family medicine, she said.

MacGilvray says she also spends a substantial amount of time talking to potential donors, most of whom are retired Prisma Health physicians and community members who helped establish the medical school 13 years ago, to help fund scholarships, for example.

Meanwhile, the Center for Rural and Primary Health Care at the University of South Carolina’s School of Medicine in Columbia has 72 programs aimed at increasing the number of providers, according to its Director Kevin Bennett.

Among them is a loan forgiveness program launched in 2017 for doctors who practice primary care in a rural community, he said.

Nurse practitioners and physician assistants who practice in rural areas also get some of their schooling paid, he said, noting that adding an advanced practice registered nurse, a PA and a nurse midwife with center funding enabled a rural obstetrical clinic in Laurens County to stay open, which saw nearly 4,000 patients in the first half of the year.

“The shortage would be much worse without them,” Dill said.

“Physicians are extremely necessary, but it’s challenging to get a full-time physician in a rural community sometimes,” Bennett said. “There are a lot of counties that don’t have OB/GYNs or pediatricians. Most have a primary care doctor of some sort, but not every county. And if you get good prenatal care in your community, the odds of poor outcomes are dramatically reduced.”

Along with a lack of providers, rural residents often have trouble with transportation and are more likely to be uninsured, exacerbating the problem, he said.

And federal funding cuts could mean the difference between a hospital staying afloat or cutting service lines, such as surgery or emergency care, prompting physicians to leave the area, he said.

One successful effort, Bennett said, is a recently-introduced incentive program – essentially a hiring bonus – for doctors who practice family medicine, psychiatry, and OB/GYN across the state.

Payment ranges from $40,000 for the first year to $120,000 for four years, he said.

The center uses funds provided by the state rural health initiative to improve the workforce, for placement or training, and for specialty services to rural communities, he said.

“It’s difficult to say what the impact is,” he said. “But I think it’s easy to demonstrate a lot of rural communities will be going from nothing to something.”

Meanwhile, the center is working on hybrid models of care, such as a newly opened telehealth room in the Orangeburg Library where a health liaison helps people fill out Medicaid eligibility forms, provides them education or refers them to a provider, such as an NP from MUSC, Bennett said.

And a telehealth station was set up at South Carolina State University, also in Orangeburg, where the public has access to a virtual visit with an NP, he said.

“The surrounding areas are poorly served,” he said. “Around 60 to 70 percent of patients who have used the room don’t have a primary care doctor.”

Work is also underway on a larger pipeline to help students in rural communities become providers who will return home to practice, he said.

Most of these programs are just starting to kick off, Bennett said, so there’s no estimate of the impact yet.

Benjamin says the American Medical Association and other groups have been advocating for more medical schools and residency slots for years.

But now, he and MacGilvray say that the recently passed “One Big Beautiful Bill” constrains the growth of medical education by reducing funding and changing loan repayment programs. And that means fewer students of modest means will be able to afford a medical education, potentially negatively impacting the workforce as well, they say.

MacGilvray notes that the average medical school debt in South Carolina is $218,000 while it’s $250,000 nationwide.

“There’s a whole range of other funding cuts the federal government is doing now, like capping the indirect costs of grants, limiting the number of dollars going into academic centers, and constraining research,” Benjamin said. “All those things undermine the infrastructure we need to do medical school training.”

“We’re doing the best we can to keep up with all the changes that are happening, trying to increase our game when it comes to supplying competent physicians for South Carolina and the nation,” MacGilvray said. “But it’s stressful.”

Benjamin says the country has struggled with a lack of a strategic health policy for years and needs a national meeting to ainstorm solutions, adding, “We’ve been neglectful in addressing shortage.”

Steyer, meanwhile, says the need for more doctors is clear, but he hopes that everyone’s combined efforts will make a difference.

“I’m a practicing family physician and I see it every day – I have trouble getting my patients in to see a specialist,” he said. “Time will tell how well we put a dent in the need.”