A prescription for more doctors

The Senate Health, Education, Labor and Pensions Committee recently met to discuss America’s growing shortage of medical professionals. True to his socialist roots, committee chair Bernie Sanders championed more federal spending to address the problem, starting with scholarships and loan forgiveness for doctors.

But the solution here isn’t more government. It’s less. Lawmakers should roll back counterproductive regulations that prevent health care providers from operating to the fullest extent of their training. Doing so would effectively expand the supply of care.Around 99 million Americans currently live in areas with primary care shortages. It would take more than 17,000 medical professionals to fill the gap.  That shortfall doesn’t affect every community equally. Almost seven in 10 primary care shortage areas are rural. Between 2010 and 2021, 136 rural hospitals shut their doors, often for financial reasons. Nearly one-quarter of rural Americans say their communities struggle to access good hospitals and physicians, according to a 2018 Pew Research survey.In other words, America’s doctor shortage is largely a problem of distribution. Policymakers can respond by encouraging qualified medical professionals to move where the patients are.For starters, state governments can pursue interstate licensing compacts, which allow medical professionals licensed in one state to easily get permission to work in other states that are members of the compact. Why shouldn’t a doctor licensed in Nevada be able to cross the border to treat patients in California?Unfortunately, that’s reality. Thirty-seven states and the District of Columbia participate in the Interstate Medical Licensing Compact, which provides physicians a streamlined way to get licensed in participating states.  The Nurse Licensure Compact, which offers similar privileges, has 40 participating states.  New York Gov. Kathy Hochul recently announced plans to bring interstate licensing to New York. The remaining holdouts should follow her example.State legislators can also roll back certificate-of-need laws, which require state officials to greenlight new medical facilities and services. These laws are in force in nearly three dozen states and the District of Columbia, according to a recent tally.Certificate-of-need laws make the introduction of additional supply of health care subject to the whims of politicians, rather than the discipline of the market. They give incumbent providers an opportunity to lobby against potential competitors. Patients living in states with such laws have to travel farther for care and have less access to cutting-edge medical technology.Lawmakers can also relax scope-of-practice restrictions that keep nurse practitioners, physician assistants, and other highly trained health care professionals from engaging in one or more elements of practice without the oversight of a doctor.  Studies show that these restrictions on NPs do nothing to improve the quality of primary care and that PAs are capable of performing up to 90% of primary care services. Allowing these professionals to operate to the full extent of their training would effectively expand the supply of care — and free up doctors to focus on more complex cases.Finally, hospitals and charitably minded organizations need to take it upon themselves to train more doctors, rather than waiting on the federal government to address the problem.In 2021, there were over 7,000 more applicants for medical residencies than available spots. Medicare will fund 1,000 more slots over the next five years. But that’s not enough to address our nation’s doctor shortage.Plenty of hospitals are sitting on tens or hundreds of millions of dollars in investment returns. Training the next generation of doctors would be a worthwhile use of those dollars.And philanthropies whose mission is to expand access to care should consider funding medical residencies. Such direct investments in boosting the supply of care could pay dividends for decades.Our nation’s shortage of health professionals is in large part a product of misguided regulations that constrain the supply of care. It’s long past time to undo them.Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is “False Premise, False Promise: The Disastrous Reality of Medicare for All” (Encounter 2020). Follow her on Twitter @sallypipes.