Public Health Explained - The Physician Shortage

Why do we have a doctor shortage? Why not just build more medical schools? How do we fix this?

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Transcript

SPEAKER_01 0:05

Welcome back to Public Health Is For Everyone. Public Health Explained. I'm MJ.

SPEAKER_00 0:10

I'm Elizabeth.

SPEAKER_01 0:11

So I recently broke my arm in three places.

SPEAKER_00 0:14

Wait, what?

SPEAKER_01 0:15

Oh, I forgot to tell you. Yes, I recently broke my arm in three places. I should say I broke my arm in one place three times. I feel like that's more accurate, but it doesn't matter. It's neither here nor there. Um, okay. I fell snowboarding and I shattered my form.

SPEAKER_00 0:28

Dude, that was like last weekend.

SPEAKER_01 0:30

Yeah, that was last weekend. Um, I thought I told you, maybe I didn't. No, you definitely didn't. Anyway, I shattered my arm and naturally I had to go see the doctor because this is an injury that you simply cannot ignore.

SPEAKER_00 0:43

No, you really can't.

SPEAKER_01 0:44

No. Called the doctor on Monday and they were able to see me relatively quickly. They saw me on Wednesday and took an x ray and everything to assess my situation. It wasn't emergent in a sense that I was fine. It was a bad fracture, but it wasn't so bad to the point where I had to go to an emergency room.

SPEAKER_00 1:00

It wasn't a compound.

SPEAKER_01 1:02

Like nothing was sticking out. It was bad enough that I can't really move my hands. Called them on Monday. They saw me on Wednesday. So a two-day wait, which is not that bad. In the grand scheme of things, two days wait for a non-imergent fracture is pretty good, in my opinion.

SPEAKER_00 1:15

Yeah, that's not bad.

SPEAKER_01 1:16

Other countries with better healthcare may disagree, but for America, that's honestly pretty good. And that got me thinking about something. This topic comes up periodically, and I certainly in my field hear about it all the time is the question, do we have a physician shortage? This question comes up all the time.

SPEAKER_00 1:32

Social media tells me we do.

SPEAKER_01 1:34

So the short answer is yes, we have a physician shortage. The long answer is yes, and it's complicated.

SPEAKER_00 1:40

I had a feeling.

SPEAKER_01 1:41

Yeah, either way, it's yes, we do have a physician shortage. I just want to cover this question very quickly in this episode to sort of explain what a shortage means and how they determine the shortage, and also like what are some solutions going forward.

SPEAKER_00 1:53

I have to admit, I am not a medical doctor. I'm not a physician, and didn't really know anything about medical school training until I was in grad school. And one of my lab mates was an MD PhD student. It was eye-opening listening to her talk about things with medical school training and the way she would just casually say things like, Oh yeah, of course you've got to go through a match, and of course there aren't enough training positions, and of course we have this physician shortage because they were topics that I was not aware of.

SPEAKER_01 2:24

Yeah, so we'll get into all of those things each a little bit. We're not gonna do a deep dive because my bandwidth is limited and this is truly like a dissertation-worthy topic. But before we get into that, that's talk about how this is determined.

SPEAKER_00 2:38

The number of physicians that we need?

SPEAKER_01 2:40

Yeah, how the shortage is determined. Because there's a difference between intuitively knowing that there's a shortage and actually looking into how bad of a shortage it is. One of the bigger party looking into the shortage is unsurprisingly AMC, which is the Association of American Medical Colleges.

SPEAKER_00 2:57

Okay.

SPEAKER_01 2:58

The organization in charge of medical school admissions and education. And it makes sense that they would be interested into a physician shortage because they are the gatekeeper of who gets to be the doctors.

SPEAKER_00 3:07

Are they the ones that have actually declared a physician shortage?

SPEAKER_01 3:11

Yes, so have many other people. So they're not special, but they're the ones researching this.

SPEAKER_00 3:15

Aren't they the ones that could stop a physician shortage?

SPEAKER_01 3:19

Uh, yes and no. We'll talk about this in a little bit, but they are the gatekeepers of medicine. They run the medical school.

SPEAKER_00 3:25

Feels very mafia-esque.

SPEAKER_01 3:26

Yeah, it's very mafia-esque, but that's what they are in charge of. They are in charge of admissions, they are in charge of education of medical students, they are the administrator of the MCAT, which is the medical college admissions test. So literally the gatekeepers of medicine. They're looking into this because this is a serious concern for everyone, especially for those medical school people. So their report suggests a shortage anywhere between 15k to 86k shortage by 2036. So in 10 years. So a wide range.

SPEAKER_00 3:58

What's the scale of that? Like, how many doctors do we have in this country?

SPEAKER_01 4:02

From what I can see, 5% ish. We could check this right now.

SPEAKER_00 4:12

According to the Federation of State Medical Boards, I'm just looking at it, 1,082,187.

SPEAKER_01 4:21

So 15,000 to 86,000 is if you look at the percentages, it may seem low. Like, oh, 15,000 to 86,000, but we have like a million physicians, right? That's not that bad. But think about it 15,000, 86,000 people. That's a lot of physicians.

SPEAKER_00 4:37

Yeah, I was gonna say that doesn't sound small to me at all.

SPEAKER_01 4:40

It doesn't sound small, and they predict that it's gonna be roughly in this range in the next 10 years. And the range is wide because it's a prediction model, right? We don't know what's gonna happen in the future, so there's a big cone that sort of extrapolates from this year. The estimate from the federal government, namely the Health Resources and Services Administration, paints a worse picture. In 10 years, the HRSA projected a roughly 140,000 total shortages. Oh, good lord. Yeah, they are predicting you said it was a million doctors, so this is more than 10%. Oh my goodness. It sounds really bad. Now, why is there a discrepancy between the two organizations? And it essentially comes down to definition and methodology. I can't get into the details because I once again overestimated how much time I had to write this episode. But from what I can gather, it's three main reasons. Reason number one, the double AMC estimate is based on the assumption that the investment in graduate medical education will continue to increase according to current trends.

SPEAKER_00 5:38

Oh dear, that one's being violated.

SPEAKER_01 5:40

So they are taking the optimistic approach. They are saying we're gonna assume the investment keeps going, and this is our prediction. The government prediction seems to be just a straight at current levels. What are we looking at in 10 years? So without additional funding for these graduate medical educations that was promised, cough, cough, current administration BS, that shortage will likely be significantly higher, according to the double AMC, potentially double, if the expected increase in funding is not delivered. So that's one reason why their estimate is much smaller than the federal government estimate. Reason number two, double AMC estimate is, according to themselves, a purposefully conservative estimate. I don't know why they chose it, but maybe they wanted to now sound the alarms. I don't know. I don't know why they chose a purposely conservative estimate. It could be for a number of reasons.

SPEAKER_00 6:28

So I would guess that it is they're trying to be more optimistic because they think people are gonna look at their current optimistic estimate and assume that they are panicking or that they're exaggerating. Who knows? Yeah, we've seen that over and over again. I think most of our climate models suffer from the same thing. No one thought that people would believe the real numbers, so they went with, I guess, the lower bound.

SPEAKER_01 6:51

Could be. I am not a double AMC, so I don't know. But they said themselves that they are purposely conservative in this estimate. Also, maybe for modeling reasons, it just makes more methodological sense to be conservative. Who knows? That's fair. The last reason, the double AMC estimate is, as far as I can tell, only addressing functional shortages, meaning they aren't taking into consideration healthcare access or equity concerns. Oh. They are not saying this estimate will fix any equity issues. Because in order to fix current existing equity issues, we actually need more doctors than what this estimate projects.

SPEAKER_00 7:24

Okay, so we are going to be short, but that is only to maintain what we currently have.

SPEAKER_01 7:30

The point is you can take the double AMC estimate, which says 15,000 to 86,000, or you could take the federal government estimate, which is around 140,000. Either way, bad. And we have reasons to believe that the double AMC estimate is low.

SPEAKER_00 7:44

Well, this is a super uplifting and cheerful discussion we're having right now.

SPEAKER_01 7:48

That's every episode uh for this podcast going forward because of the nightmare timeline that we live in. So hard to have a happy episode, you know? And I would just like to say that estimating physician shortage is an incredibly difficult problem from a methodological perspective, especially for an entire country. I wish I was smart enough to explain these methodological challenges, but I am not. So just take it from me that it's hard. The modeling of these things, difficult because they have to project into the future. It's relatively easy to say what's the shortage right now, right? But that doesn't really serve any functional purposes. What they want to do is project into the future, and that is a lot of assumption, it's a lot of math, it's a lot of models that I can't really explain how that works.

SPEAKER_00 8:32

Well, and and it's difficult because so many of the parameters or the settings, so to speak, they're having to estimate as well. So you're using estimates to make an estimate, and everything just gets very complex and wavy.

SPEAKER_01 8:46

You have to make a lot of assumptions, and there's also like data limitations, right? If you don't have the data for a particular measure, you just have to guess. So, yeah, very difficult problem. But at the end of the day, flat out, there is a shortage and it's gonna get worse.

SPEAKER_00 8:58

Absolutely believe you.

SPEAKER_01 9:00

I'm gonna get into a few nuances that I discovered when I was looking into this because it's a complicated problem, and I think discussing these nuances are enlightening. So, first nuance is the shortage calculation is defined by demand and supply. Healthcare demand is not the same as healthcare need. This is an important nuance to note. Oh, demand is simple. How many people are seeking healthcare? That's actually a relatively simple thing to extrapolate. You look at people seeking healthcare. That's it. People seeking healthcare and people needing healthcare are two very different things. To make the problem worse, know that the physician shortage discourse is only addressing demand. It is not addressing whether people need health care. Because if you need health care and don't seek it, you are not a part of the demand.

SPEAKER_00 9:50

Yeah, that is a very fair point. And I think it gets overlooked an awful lot. I know someone, she talks about how her family practices what she calls redneck healthcare in that they just don't go to the doctor. And her grandfather, at one point, he was sick and they actually convinced him to go. And he went and they diagnosed him with lung cancer, and his response was to move up to Maine and just live alone on the land until he died.

SPEAKER_01 10:18

I'm sure many reasons why they thought that decision was better for either cost or distance to a doctor, and I don't blame them, you know.

SPEAKER_00 10:26

Yeah, no judgment on that. It's fascinating to think about the fact that because he was not seeking health care, he's not being counted in the equation for shortages, despite the fact that this is clearly an example of shortage.

SPEAKER_01 10:42

Yes. So physician shortage issue is actually a lot worse because of the American healthcare system. Many people don't seek the healthcare that they need because of insurance reasons, or probably what your friend discovered, distance is actually a huge barrier as well, distance to the hospital. One of my favorite public health quotes is people don't want health care, they want health. And by using demand, we may perhaps be biased in our calculation because the person who seeks health care and types of person who need healthcare. Those are two very different types of people. Another nuance in this physician shortage is that it is not distributed evenly. This shouldn't be a surprise to anyone. In fact, the difference in shortages across location is, I would say, egregious. If you live in a large city, you may think, oh, that's not that bad. Well, yeah, because you live in a large city, right? If you live in New York City, there's Cornell, Columbia, and NYU Health System, like, and plus other hospitals in New York City.

SPEAKER_00 11:38

Right.

SPEAKER_01 11:39

And the friend that you mentioned probably don't have access to three academic health centers within driving distance.

SPEAKER_00 11:44

Nope. I mean, that's one of the reasons it's such a big deal to have a medical school in your state.

SPEAKER_01 11:50

Yes, absolutely.

SPEAKER_00 11:51

And it is a real problem when you're not educating physicians in your state. The state of Alaska doesn't have a medical school, and the state of Alaska needs physicians. So they have a reciprocal agreement with the University of Washington Medical School. I don't know how many spots, but a certain number of spots are set aside for people coming from the state of Alaska.

SPEAKER_01 12:14

Put a pin in this because we will come back to this when we talk about solutions. Another nuance about the physician shortage crisis is that this is not an American issue. From what I can tell, there are no countries anywhere saying, actually, we have enough doctors. Really? For once, it's not us. It's not just us. Oh, that's fascinating. Please correct me, listeners, if you are from a country where there's a lot of doctors. But from what I can tell, most countries, if not every country, is like, yeah, we need more doctors.

SPEAKER_00 12:40

Actually, it does a lot to explain why I feel like I've heard this discussion of it takes too long to get in to see a doctor. Basically, in every country that has a Reddit board that I can read.

SPEAKER_01 12:52

And obviously, there are differences between countries about like how healthcare is organized, what are the cultural norms for seeking health care? Every country is different. But from what I can tell, and listeners, please correct me via email if I'm wrong. For once, it's not just the United States, which is kind of nice.

SPEAKER_00 13:07

Yes. Do I love these universal problems? Not really. It'd be nice if there were a simple solution that someone else had figured out.

SPEAKER_01 13:14

Indeed. We're gonna focus more on the American side of things because that's just where we're based. So, why do we have a shortage and how can we fix it? And like many public health issues, it's complicated.

SPEAKER_00 13:24

I have been dying to ask this question. It seems like if we don't have enough doctors, we should just accept more people into medical school. Because medical school has a really low acceptance rate, right?

SPEAKER_01 13:35

Medical school is by far the strongest gatekeeper in the doctor training pipeline.

SPEAKER_00 13:41

Right. So why don't they just accept more people to medical school?

SPEAKER_01 13:45

Very good question. And uh the answer is they kinda can't. Let's go over a few things about medical school admissions. Point number one that I want to make medical school admission rates are very low. What this means is our shortage problem is not because not enough people want to be doctors. So many people want to be doctors.

SPEAKER_00 14:09

They were bragging about how 30% of the people from their program who want to get into medical school get into medical school. And that was a big deal because that's a huge percentage. 30 being a big deal should tell you something.

SPEAKER_01 14:21

Oh, it told me a lot. Most people who apply to medical school do not get into medical school, or they get into one that's not their choice. So the shortage is not because people don't want to be doctors. Maybe you're like because our standards are too high, they're gatekeeping too hard. I want to say no.

SPEAKER_00 14:36

There are an awful lot of students who are great students who have maybe not straight A's, but pretty darn close to it, who still don't get into medical school, right? That's my experience as a teacher.

SPEAKER_01 14:48

Medical school application, I can't get into the details, but it's a very complicated process, and it's certainly not just grades, and it's certainly not just MCAT scores. Every school has their own preferences and choice and culture. There are entire people's jobs who is to get people into medical school. Like medical school prep is an entire industry. That's how competitive this is. However, I don't think the standards are too high because there are still a lot of bad doctors out there. Yes, there are a lot of bad doctors. I am tangentially related to medicine. My wife is a physician and I used to be a pre-med, so I hang out with a lot of doctors and med students, etc. And you know, I think the standards are fine. You know, I'm not saying the standards are too low or anything, it's certainly still very competitive, but I do meet people that make me go, I can't believe a medical degree. It's not because of the standards are too high. And also, I would argue being a physician is a very important job. So the standards should be high.

SPEAKER_00 15:48

The standards should be high, but there's an awful lot of people who don't get into medical school who are just as good of a candidate as the people who don't get in. So it's not really the standards that's making the difference there.

SPEAKER_01 15:59

It's a selection process could probably be a little better.

SPEAKER_00 16:03

Seems to me if we think the selection process is a problem, the way to take that problem away is to open more spots.

SPEAKER_01 16:12

So why don't we just build more medical school, right? It's a very natural next step. Why don't we just build more medical school? The main reason is there's no reason to increase the number of medical school unless they know that these graduates will have somewhere to go. Physician training doesn't stop at medical school graduation, it's the residency program that makes them board certified, which allows them to practice. So there are a lot of people, a lot of institutions that would love to build more medical schools. But because training physician is such a massive investment, both time and money, you're not gonna build a bunch of schools and then tell your students actually you have nowhere to go after graduation. It just doesn't make sense.

SPEAKER_00 16:51

I guess we should talk about the whole match system.

SPEAKER_01 16:55

Yes, match day is one of the most chaotic days of the year. It's basically when you graduate from medical school, you need to do a residency in order to be a board-certified physician and therefore be able to practice medicine. And in order to do that, you need to be matched into a residency program. And these programs are scattered all throughout the countries, operated by hospitals, a lot of them by large academic centers, because they have the resources to host these programs. And it's a one-to-one match. So the residents can decide these are my preferences, and the programs can say, these are the spots I have available. And then through a magic black box that I can get into, the match protocol selects candidates to fit in those programs based on a wide-ranging list of criteria, and that's called a match. And it has a 92% match rate. So most people will get matched because again, they don't build more medical school without knowing that there's a spot for them to go. So it's pretty controlled. And for people who don't match, there is a backup system that scrambles and look for places that they could be. So the real bottleneck of this is really the how many residency programs they are. That's the true bottleneck.

SPEAKER_00 18:03

I have heard this because it's heartbreaking if you go on social media on match days, the number of people who will post things like I didn't match.

SPEAKER_01 18:12

Most people will match, and a lot of people won't have any issues with this. I will say, of the people who don't match, there's a big chunk of them that are from international medical schools. There's a big chunk of them that, for lack of a better term, hubris, they say, I will only match into surgery.

SPEAKER_00 18:29

Ah.

SPEAKER_01 18:30

So that's the main reason why we have a doctor shortage because there's a hard cap on how many residency spots there are. So the next question to ask is why don't we create more residency spots? Yes. What determines how many residency programs there are? In short, the government. Oh God. While it's not impossible, it is incredibly expensive for any hospital to self-fund an accredited residency position. It's a lot of money to make sure it meets the standards for what counts as accredited residency program. And keep in mind, hospitals love residents. They are paid less, they work more hours, they want to have these residency spots, but they simply can't fund it themselves. This means essentially all residency spots are subsidized, and the vast majority of them, 90% of them, are subsidized by a combination of federal and state funds. Some institutional fundings and private endowment fundings exist, but that's only around 10%.

SPEAKER_00 19:26

Okay. I suppose I should be grateful that they're not doing it the way some places do it for grad school. And they say we can have a spot, but we are not paying you, and you have to take out loans to make it through.

SPEAKER_01 19:39

It doesn't happen to my knowledge, but then again, anything is possible. You never know. Some people might be desperate enough that they self-fund a residency program. I doubt it, because it's very expensive. But I don't know. That is something to be grateful for. Residency spots are funded mainly by the federal and state government.

SPEAKER_00 19:57

Then the natural question to ask then is why doesn't the government just put more money into it since they know that the shortage is happening? I'm glad you asked. Are you really?

SPEAKER_01 20:07

Yes, because otherwise I can't continue. In 1997, there was a cap on the number of residency spots available by the federal government.

SPEAKER_00 20:17

Oh my have they just never revised it?

SPEAKER_01 20:19

That capped has been raised once in 2021. Oh and you're like, why is there a cap? Why is there a cap on these things? The answer is um, like many political decisions, it's a combination of many things. But one of the biggest advocates for this cap is the AMA, the American Medical Association. Got to be kidding me. They lobbied hard for this cap because if there is a shortage, people are paid more.

SPEAKER_00 20:51

Oh my god. I don't even know why I'm surprised. Of course it comes down to this.

SPEAKER_01 20:56

Yeah, they have since reversed their position. They actually reversed their position roughly, I think, a little over a decade ago, because even they are like, we need more doctors. But yeah, so and it's been raised for the first time in 2021, and this is the part that the WMC estimates was banking on because this uh increase is meant to scale over time. So the WMC is taking this into consideration. That being said, there's still like a limit because at the end of the day, it's government funding, right? And every time it comes to funding, it has to pass Congress, etc. etc. So there's still a limit on the number of residency spa that's available. You know, the government doesn't want to spend even more money on healthcare, even though they really should.

SPEAKER_00 21:38

I mean, cancer research is important too, and apparently they don't want to scale that with inflation.

SPEAKER_01 21:45

It's ridiculous all around, especially with this current administration. But just know that there's a cap on the amount of funding that goes into residency spots. It has since been raised, but not nearly enough. And there's always a hesitancy to raise it even more. For two reasons. One, doctors like their high salaries. Two, the government doesn't want to spend money. Those are the two main reasons why there's a hard limit on the number of physicians that we have. So the solution is just, well, we just need more government funding. Yes and no. Obviously, having more funding for residency program is going to be crucial to addressing the physician shortage crisis. You kind of can't get around it.

SPEAKER_00 22:22

If we don't have enough residency spots to cover or create all of the physicians that we need, then at some point you have to increase the number of residency spots. There's no way around that.

SPEAKER_01 22:34

However, it's a little bit more complicated. And if you were to zoom out and take a public health perspective instead of an economist perspective, I mean, coming back to the thing you brought up earlier, the no medical school in Alaska thing, the shortages are not evenly distributed. So here's my two cents. I'm not an expert in this. You can adjust funding levels all you want. The core of the problem, at least a big part of the problem, is no one wants to go to rural Idaho. Because after you do your residency training, when you become an attending, which is a full doctor, they can now go wherever they want. At the core of the issue is a distribution problem, too. How do you get people to stay in areas that need health care? By the time they are finished with training, it's kind of too late. I will share a personal anecdote. I guess not me personally, but when my wife was going to residency, during their final two years of residency, they are deciding where they want to go for either fellowship or becoming like a full physician. And those two years, they are bombarded with emails from a remote place that I won't name, where they are offering them a million, two million dollars a year salary to come work there because it is so remote. Right. And guess what? No one takes that offer.

SPEAKER_00 23:50

Yeah. Because it's the middle of no If I'm not mistaken, it's been a while since I've looked into it, but I believe Alaska, they have an agreement with the University of Washington, their medical school, and they get some number of spots for people whose education is paid either entirely or partially through the state of Alaska. And it is part of the agreement that they will pay part of it, you will get into this program, but you have to repay it by working in the state. And I think that's probably the only way anything like that could work.

SPEAKER_01 24:22

So that's one of the many solutions that they try to address these issues. I think those programs are very critical to ensure that people go to those more remote places. However, my two cent is that by the time you start that training process, it's kind of already too late. Oh, okay. In my opinion, that process needs to start even earlier because what are the chances that someone who's not from Alaska goes to Alaska? Very slim.

SPEAKER_00 24:48

Yeah, that's fair. Actually, I believe they prioritize people who grew up in the state.

SPEAKER_01 24:53

Yes, which is a good thing. It's much more likely for someone who is from that area to go back to that area to serve where they're from, to serve their community. That is much more likely than someone who's from, say, Southern California or Los Angeles or New York City, I don't know, Chicago, to like go to Alaska.

SPEAKER_00 25:10

Right.

SPEAKER_01 25:10

So I think one of the solutions is we need to look at the admissions process. Metaschool admission is so expensive and so time consuming. It automatically bias against a certain type of student. You need to have the resources, you need to have the connections to sort of pursue this path. And one of the solutions that we need to explore is that how do we encourage people from these underprivileged communities to pursue medicine? Because they are much more likely to return to the community that they're from and address these like equity issues. It needs to start way earlier than by the time they're done with training.

SPEAKER_00 25:45

That is a fair point. I mean, we see this sort of decrease all the way back when you start with undergraduate education. Yeah. If you come from a place where it's unusual or uncommon for people to go to college, you are less likely to go to college. And if you are less likely to go to college, well, you're sure as heck less likely to go on for professional education like medical school. If you don't know anyone who's gone through medical school, you're already in a disadvantage because you don't know the things you should be doing to make yourself a appealing candidate, shall we say? Yeah, definitely. Yeah, like the unspoken rules and things people do. Or you don't know that maybe you need to start when do people start studying for the MCAT?

SPEAKER_01 26:31

Uh sophomore junior year, if you're doing no to one gap year.

SPEAKER_00 26:36

Yeah, and I assume you also it looks better to have volunteered in different programs, is that right?

SPEAKER_01 26:42

There's a lot of factors that play into admissions, but yeah, it's not just like, oh, okay, I'm just applying. It's a lot of pre-work.

SPEAKER_00 26:49

Well, and I guess you can sort of see it the way if anyone who's either gone through it recently or witnessed people going through just undergraduate admissions to get into the uh so-called brand name schools, there are a lot of tricks that people pick up from admission coaches, I think they're called.

SPEAKER_01 27:09

Yes, that is exactly what they're called. Yeah.

SPEAKER_00 27:11

Right. And if you don't know these tricks, you are at a disadvantage. Yeah, which is so crazy to me.

SPEAKER_01 27:18

It's a whole thing. I could talk for hours about med school admissions and stuff, but that's sort of the crux of the issue. The leaks in the pipeline starts very early for medical school. Like you said, there are some states where there's only one medical school, or like Alaska. I don't know, maybe they built a new one recently, but where there's no medical school.

SPEAKER_00 27:34

No, they haven't. They have not.

SPEAKER_01 27:36

If all your medical schools are in big cities and these large hubs, people who graduate from these programs, if they're not from there, not gonna go to like middle of nowhere, Alaska to practice medicine. They're not gonna go to rural Idaho to practice medicine. So, yes, we need more funding for residency programs. At the end of the day, that's what we need, but also zoom out, take a public health approach. Why are physicians not going to those places? Because there's no reason for them to go to their places, they're not from there.

SPEAKER_00 28:01

Right. It's all nice and good to say, oh, people should volunteer in these locations, but it's their life. And they've invested a lot of their life into their education in 10 years. I don't blame them for being like, no, I don't want to live somewhere else, or I've decided I want to live someplace where I want to stay for the rest of my life. Makes sense to me.

SPEAKER_01 28:21

And so that's my two cents from a public health perspective. But at the end of the day, residency spots. That's your answer. Why are there a shortage?

SPEAKER_00 28:28

We need residency spots, but also equity.

SPEAKER_01 28:31

Until we have more residency spots, they're not gonna build new medical school. Why would you? Why would you build a school and your students have nowhere to go, right? Yeah. I want to come back to one of my favorite public health quotes people don't want health care, they want health. And therefore, a one way to reduce this physician shortage is by good public health. Because if people are healthy, they won't seek health care.

SPEAKER_00 28:50

It's true. Prevention is much more effective than treatment in the end. It's cheaper and it is also more successful. Yeah, in many ways. Also doesn't require as many doctors. Excellent point.

SPEAKER_01 29:05

You know what doesn't make the physician shortage better? A lot of measles cases. Yeah, that definitely doesn't make the physician shortage crisis better. Absolutely vaccine preventable stuff. Anyway, well, that was a cheery note to end on, but there you go. Do we have a physician crisis? Absolutely. That's it. Thank you for listening, I guess. Thank you for listening to Public Health Is For Everyone and Everything Is Public Health Production. If you have any questions, concerns, or feedback, please email us at everything is public healthfmail.com. You can find all updates and bonus material on our website, everything is public health.com. And remember, public health is for everyone.