In a country capable of extraordinary scientific achievements such as genome mapping, facial transplants, and Mars rover landings, a baffling contradiction persists: the failure to ensure timely medical appointments for its citizens. The official story blames this on “complex market forces,” “geographic maldistribution,” or the ever-present “burnout.” However, the underlying problem is simpler yet more disturbing: a formidable medical guild has recognized that scarcity yields profit, and is determined to maintain a partially limited availability.
A Sanctuary in White
As you stroll through the prestigious halls of our foremost medical societies, you won’t uncover an obvious conspiracy or rooms shrouded in smoke. Instead, you’ll find earnest references to “quality,” “patient safety,” and “educational integrity.” These terms fill the air like incense, concealing economic self-interest beneath a fragrant facade.
- The American Medical Association, the long-time high authority in this realm, often urges Congress to limit residency positions to a bare minimum.
- State medical boards painstakingly delay licenses for qualified international graduates, akin to customs agents examining suspect luggage.
- Prominent medical institutions caution that new campuses will compromise “standards,” a genteel euphemism for prestige and tuition income.
Publicly, they present themselves as champions of the Hippocratic tradition. Privately, they mirror medieval guilds that restricted entry to protect their gold coin purses. In contemporary terms: fewer practitioners lead to fatter paychecks.
The Human Toll of Deliberate Scarcity
While they polish their “quality” awards, patients are left stranded in medical wastelands that stretch from the Appalachian highlands to the sweltering neighborhoods of the Southwest.
A child in rural Mississippi may endure a nine-month wait for an appointment with a pediatric neurologist—an eternity when seizures gradually strip away a child’s future.
A veteran in West Texas travels 300 miles for a brief 15-minute cardiology appointment, with gasoline fumes serving as his only relief for chronic chest pain.
An elderly woman from the South Side of Chicago passes away in the back of an ambulance, endlessly circling overcrowded emergency rooms, as her heart attack’s critical hour slips away.
These are not isolated incidents in an otherwise efficient system; they reveal the system functioning exactly as designed. Scarcity is not coincidental—it’s a policy choice.
The Deceptive Idol of “Physician Oversupply”
When reformers suggest increasing medical school enrollment or Medicare-funded residency spots, the guild waves a banner of doom: “Beware the doctor glut!” However, this warning is as brittle as a papier-mâché pinata.
The United States ranks 30th among OECD countries in the number of doctors per 1,000 residents—awkwardly positioned between Turkey and Latvia. Simultaneously, the Association of American Medical Colleges foresees a shortfall of up to 124,000 physicians by 2034. To label this situation as “oversupply” is akin to standing ankle-deep in the Sahara and expecting a deluge.
Bread, Circuses, and Residency Restrictions
Why, then, does the shortage persist? Because the current path to becoming a physician is constricted by a bottleneck deliberately tightened in 1997 when Congress capped Medicare funding for residency positions. This limitation, meant to reduce expenses, effectively granted established practitioners a lasting scarcity dividend.
Imagine if the government froze airline pilot training slots at 1997 figures, then feigned shock as flight cancellations surged. This reflects the healthcare predicament—except the grounded flights are human lives.
Toward a Path of Abundance
Rhetoric alone won’t resolve this dilemma; actionable policy is crucial. Two straightforward steps, applied in tandem, can shift the dynamic from guild protection to public well-being:
Remove Residency Funding Caps
Index Medicare funding for training positions according to population growth and disease trends. Adjust hospital eligibility based on serving underserved areas, rather than lobbying influence.
Create New Medical Schools in Health Shortages
Provide federal loan-forgiveness programs and research funding to institutions establishing campuses in rural and urban regions. Let geographic needs dictate supply, avoiding institutional arrogance.
The Ethical Responsibility
Opponents will contend that expansion threatens to “lower standards.” Yet this argument, almost word for word, previously justified quotas that excluded women, Black physicians, and DOs from hospital roles. Excellence and accessibility are not mutually exclusive; Harvard doesn’t diminish because state universities produce educators, nor do Boeing engineers suffer because community colleges train mechanics.
For far too long, medicine has wrapped itself in a white coat of superiority, forgetting that this garment was meant to signify service, not status. In ethical deliberations, a credential’s luster shouldn’t