There are tremendous gaps in health care today that require the attention of physicians and leaders in organized medicine—but it all starts with timely access to quality care. Alarming projections about the physician workforce shortage to come ignore the fact that, for many patients in every corner of this country, that shortage has already arrived.
While the factors driving this situation complex, the solutions aren’t difficult to find. The process starts with removing the administrative headaches that fuel burnout and are contributing to early retirement decisions by physicians. A second critical solution is reforming an antiquated Medicare payment system that has seen physician reimbursement drop by more than 33% since 2001, creating enormous financial hardships for independent practices like mine in Flint, Michigan.
A third solution lies with greatly expanding the number of Medicare-funded graduate medical education (GME) residency slots, with particular emphasis on areas and specialties with critical shortages such as primary care and psychiatry. The AMA enthusiastically supports the newly introduced Resident Physician Shortage Reduction Act of 2025, which would add 14,000 Medicare GME positions over seven years and codify the Rural Residency Planning and Development Program. This bipartisan measure will help ensure patients have access to well-trained physicians in their communities by expanding training opportunities in both urban and rural hospitals with the greatest workforce needs.
How the crisis evolved
By a sizable margin, the federal government is the single-largest payer of GME, largely through Medicare funding. In the mid-1990s, Congress decided to limit the number of GME slots Medicare would fund, and that cap has had a tremendous impact on our health care system in the decades that followed.
For one, the cap has not allowed care to meet the major changes in patient population and demographics that have taken place. For another, the cap has exacerbated the existing physician shortage. At this point, the U.S. Health Resources and Services Administration estimates that more than 19,000 physicians are needed to overcome existing shortages in primary care and mental health care across the country.
Legislative relief
The physician shortage affects everyone. That’s just one reason the AMA continues to support bipartisan legislative solutions put forth at the federal level such as the Conrad State 30 and Physician Access Reauthorization Act (H.R. 1585). It’s interesting to note that both this measure and an identical companion bill introduced earlier this year in the Senate (S. 709) have drawn sponsorship and support from both political parties.
Under the Conrad 30 program, each state is allocated 30 waivers that exempt J-1 physicians from the requirement to return to their country of origin in exchange for providing three years of service to patients in medically underserved communities. Passing the measures outlined above would not only reauthorize the Conrad 30 program for three more years, but also gradually increase the number of waivers each state would receive going forward.
The AMA also supports (PDF) the Specialty Physicians Advancing Rural Care Act (S. 1380) another bipartisan measure now under consideration. This bill would create a loan-repayment program for specialty medicine physicians who agree to complete six years of service in a rural community experiencing a shortage.
Speaking of student loans, the AMA has expressed serious concerns that changes in the federal student loan program proposed in the 2025 budget reconciliation bill would make medical school unaffordable for a majority of students, including those who might be the most highly qualified applicants.
Easing administrative load
Ever-increasing administrative burdens that physicians face, particularly excessive prior authorization demands, drive burnout rates and have a clear impact on the workforce when they decide to cut back their hours or even leave the field entirely. The latest AMA survey (PDF) found that, on average, physicians complete 43 prior authorization requests each week. That burden takes time away from direct patient care, threatens the financial stability of practices and significantly increases burnout.
As I take on the immense responsibilities of AMA president, the importance of access to physician care is very much on my mind. In my inaugural address June 10 at the AMA Annual Meeting in Chicago, I talked about the importance of maintaining health coverage for the most vulnerable in our communities, the kinds of patients I see in my practice every day in Flint.
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One piece to the access challenge is adequate health coverage, but another is a thriving physician workforce to meet the growing health demands of our nation. That’s why it's absolutely critical that Congress take steps to reform the burdensome prior authorization process that we know delays care for patients and is a major driver of physician burnout.
Prior authorization hassles, even over the most routine, evidence-based treatments like prescribing insulin for diabetics, remain a source of endless frustration for me, my small staff and our patients. For example, just a few months ago a member of my staff had to call an insurer about a prior authorization issue because “Mukkamala” wasn’t coming up as a provider in their system. I have been practicing for a quarter-century, but somehow I did not make the list of physicians compiled by the largest insurer in my home state of Michigan. This is an isolated example, to be sure, but also a sign of a much larger problem: an unsustainable health care system.
Access to care is a critically important issue not only for me, but for everyone at the AMA. In our role as the physician’s powerful ally in patient care, we remain steadfast in our work to reform the Medicare physician payment system, reduce burnout, streamline prior authorization, and ensure that a robust physician workforce is in place and fully prepared to meet the health care needs of our nation today and tomorrow.
