By N. Adam Brown, MD, MBA 

The U.S. faces a predicted shortfall of between 37,800 and 124,000 doctor over the next 10 years. While physician shortages will affect nearly every specialty, primary care, pediatrics, and psychiatry will suffer the most. The shortages will make it even more challenging to provide care to a growing population, particularly in underserved areas. Don't believe me? The country's nursing shortage is just as bad as its doctor deficit and patient safety is already at risk as a result.

Congress is starting to pay attention. Senators Bernie Sanders (I-Vt.) and Bill Cassidy (R-La.) have asked for input into the root problems and solutions for the health workforce shortage.

As an emergency physician for nearly 20 years, I have some thoughts. Let's tackle some of the root causes first.

More than 62% of nurses and 42% of doctors consider themselves burned out. The suicide rate for these healthcare providers is two times the national average.

And yet, our system still makes it incredibly difficult for clinicians to seek help. Doctors and nurses worry about the consequences of asking for help. One study found 60% of surgeons who thought about suicide were afraid to seek care because they were worried it would affect their ability to keep their license.

Student debt also contributes to the country's clinician shortage.

Medical school enrollment has risen by almost 18% over the past 10 years. Clearly there are people who want to enter the medical field. But the average medical student exits medical school with about $250,000 in debt -- a figure that is seven times higher than the average for college graduates, three times higher than master's degree holders, and almost twice as high as PhD graduates. Students from underrepresented communities have even higher debt burdens. Most residents do not make enough to begin paying off loans. This results in compounding interest and rising debts. Compounding these financial challenges is the fact that the residency Match system is broken. In 2022, around 2,200 students were unmatched. Black and Brown students are more likely to go unmatched, as are international medical students. Residency is mandatory to practice medicine. If these students cannot practice, they cannot pay off debt.

If unaddressed, these problems will have serious consequences for care in the U.S.

Now, here's what Congress can do.

The country's fee-for-service model not only raises costs for consumers, it reinforces the commoditization of physicians. Clinicians want to help and heal. Value-based care programs tie payments for care delivery to the quality of care provided. These reforms reduce paperwork burdens and allow providers to focus more fully on patients. An October 2020 report from Deloitte concluded, "Value-based care is in line with physicians' intrinsic motivation to deliver the best care to their patients, as it drives improvements in quality, outcomes, and patient experience. Refocusing work from productivity to value can bring meaning to physicians' work and reduce burnout."

Second, lawmakers must invest in clinicians as they invest in infrastructure. The current generation of students is acutely aware of the impact rising student debt will have on their ability to buy a home -- or even go on vacation -- during adulthood. Family Physicians have called on Congress to expand funding for federal programs that offer loan forgiveness (such as the National Health Service Corps program) and to pass the Resident Education Deferred Interest Act, which would allow medical residents to defer their student loans interest free during residency. They have also said interest on medical student loans should be deductible on federal tax returns. Lastly, they asked Congress to strengthen the Teaching Health Center Graduate Medical Education program, which has trained more than 1,730 primary care physicians and attracts and retains physicians in rural areas and medically underserved communities. Our national health spending and healthcare system would see great return on these investments.

Finally, Congress must encourage licensing reform. The majority of states mandate that healthcare professionals and institutions declare any mental health treatment they have received, regardless of its magnitude or intensity. And a 2018 study showed that 32 licensing bodies were found to have questions regarding physician mental health that could be found to be illegal under the Americans with Disabilities Act. As a result, many people have been reprimanded by licensing boards, lost their job, and been subjected to other negative professional consequences. It's time that Congress step in.

These moves alone will not solve our clinician crisis, but they will help. Lawmakers have no time to spare.