Physician Shortages and Licensing

Key Takeaways

• Primary care wait times signal true physician shortage.
• Loan forgiveness and shorter med school could attract more primary care doctors.
• CMS fee schedule favors specialists; 3% shift boosts primary care pay.
• 22 states adopt alternative licensing for foreign-trained physicians.
• Washington’s pathway added 50 doctors, reducing underemployment.

Pulse Analysis

The United States faces a looming physician shortage that is poised to become a central issue in the 2028 election cycle. While half of Americans report difficulty affording care, the bottleneck in primary‑care access is a more immediate pain point, with patients waiting weeks for routine appointments. This scarcity is not merely a statistical artifact; it translates into higher emergency‑room utilization, longer hospital stays, and inflated overall costs. Policymakers are therefore under pressure to address both supply‑side constraints and the financial incentives that steer new doctors away from primary care.

Mansell’s policy blueprint targets three levers: education, reimbursement, and residency funding. Forgiving student loans for physicians who commit to primary‑care practice, coupled with accelerated medical‑school pathways, could make the specialty financially viable for a new generation of doctors. Simultaneously, adjusting the Medicare Physician Fee Schedule to raise primary‑care rates—already nudged by a modest 3% increase in the 2026 schedule—would set a higher benchmark for private insurers. Reforming the graduate‑medical‑education subsidy formula to favor primary‑care slots, rather than high‑revenue specialties, would also alleviate the residency bottleneck that leaves many slots unfilled in underserved areas.

A less‑discussed but equally potent solution lies in expanding licensing pathways for internationally trained physicians. Twenty‑two states have enacted alternative licensure bills that recognize foreign residency training, bypassing the traditional U.S. residency requirement. Washington’s recent legislation has already transitioned 50 foreign‑trained doctors from underemployment to full practice, directly expanding primary‑care capacity. Scaling these pathways nationwide could add thousands of qualified physicians, easing rural shortages and reducing wait times without compromising standards. Together, these reforms promise a more resilient, affordable health system that aligns physician incentives with public health needs.