There is ample discussion of both the current physician shortage and the predictions of future shortfall, according to the Association of American Medical Colleges (AAMC). The most imperative element of workers' compensation is medical care. The indemnity is critical, but is dependent on the medical care and provider opinions. Comp needs doctors, period, hard stop.
The Florida Supreme Court has concluded that attorney fees are the most imperative, somehow secondary to medical or indemnity, but that seems difficult to rationalize. It held "a reasonable attorney's fee has always been the linchpin." Castellanos v. Next Door Company, 192 So. 3d 431, 448-449 (Fla. 2016). That conclusion has drawn some criticism. No worker who was ever injured has ever gasped, "Call an ambulance, get me to a lawyer."
Shortage of physicians is thus worthy of our attention. Some may find comfort in a more empirical representation of the shortage predictions. Currently, there are many physicians in the U.S., according to the Association of American Medical Colleges (AAMC), which says there are:
"1,010,892 active physicians of which 851,282 were direct patient care physicians, corresponding to 302 and 254 physicians per 100,000 population, respectively."
Those figures are difficult to duplicate using the current U.S. population, 342,065,749. Using that figure, the "1,010,892 active physicians" and "851,282 ... direct patient care" this morning equates to 286 and 249 per 100,000, respectively. Some will say I'm quibbling; others will note that the population increases each moment, both generally and of physicians. These are all moving targets.
There is not geographic parity today, with "states in the northeast" exhibiting the higher populations of both care physicians and the broader "active" total. The shortage discussion is not something excluding the northeast, but is more acute or concerning in rural spaces.
How many doctors does America "need? That seems a more flexible analysis, subject to various perspectives and input.
The AAMC postulates that we face a "shortage" of 86,000 physicians by 2036. In ten years, they predict that this deficit is probable. Their reporting does not estimate how many doctors will be practicing in 2036, but only that there will be this shortage. The AAMC prediction sounds dire, but other organizations predict a shortage of nearly double the AAMC predictions.
Two postulates might anchor such a conclusion. First, that there will be only 924,892 (1,010,892-86,000) physicians practicing by that time (actual physician population decrease). Or that the current production and replacement will be sufficient to maintain the 1,010,892 but that it will be overrun by population growth (percentage loss of population per 100,000).
The population in 2036 is predicted to be 364,731,659. To maintain the volumes today, "302 and 254" or "286 and 249" respectively, would require a net gain in physician population by 2036 of about 66,000 physicians to an overall population of 1,077,000. This is an increase of about 7% (66,000/1,010,892).
That does not seem insurmountable. With population growth of 6.6% (364,731,659-342,065,749/342,065,749), matching a similar growth rate in physicians should not be challenging. Furthermore, with technology evolving in ways that both empower and force-multiply physicians, the potential may be that such increases in physician population are not only unnecessary but disadvantageous to the medical market generally (macro) and physicians (micro).
In the same vein as technology are the para-medical professions that have been aligning for years. Physician Assistants have flourished in the 21st century. In the last decade alone, "The number of board-certified physician assistants increased by 76.1 percent," according to the National Commission on Certification of Physician Assistants (NCCPA). That growth far outpaces population growth.
Similarly, the American Association of Nurse Practitioners notes that their profession has grown exponentially since it began 60 years ago. That association has reported annual growth rates exceeding 8%. That is an annual growth, compared to the 6.6% overall predicted population increase over the next decade.
Despite these increases in technology, Assistants, and Nurse Practitioners, American medical schools continue to graduate significant numbers of physicians annually. The "match" is a process through which medical school graduates enter residency programs. See Bid Day (April 2025). The program in 2025 was the "Biggest Match Day ever." In 2025:
"43,237 total positions (were) offered—up 4.2% over 2024. There were 1,734 more certified positions offered this year compared with last year, 231 more certified programs, and 877 more positions in primary care."
The volume of positions for residency increased by 4.2% in one year. Again, compared to the 6.6% overall predicted population increase over the next decade. This is notable from the perspective of percentage change.
However, these numbers also bear consideration of career arc and longevity. If this trust-dependent process introduces 43,237 new physicians annually, then the 1,010,892 total physicians in the marketplace are replaced every 23.4 years. (1,010,892/43,237). Stated differently, the current output should replenish the current physician population easily within a 30-year career arc.
In fact, that same production level should easily replace the population-adjusted need, 1,077,000, every 25 years. This is likewise comfortably within the 30-year career arc.
Despite this, there is persistent discussion of "shortage," and at significant numbers. The AAMC projected shortage is of concern for the market (macro), certain specialties such as primary care (micro), and more dire impacts for the rural environment subset (micro).
Thus, despite the math above, the AAMC recently applauded a legislative measure to create 14,000 more residency positions. Not born of market demand, but to be supported by Medicare (at least in part). These new positions would phase in over 7 years.
For the sake of argument, that might increase the annual figures into the future like this
The proposal is to increase the residency opportunities by 32% over seven years. The result would seemingly be to increase the volume of physicians in the US. In the next dozen years, this would presumably add 644,844 physicians to the marketplace. That is 64%, almost two-thirds, of the current U.S. physician population. Can the market really sustain that volume of supply?
Will those doctors enter the rural markets, serve the underserved, and solve the purported crisis driver - primary care? Or will these added positions train more specialists, for greater concentration in the same regions that enjoy supply advantages today?
Or is this whole analysis ignoring something? Is the unregulated monopoly that controls physician residency currently really producing 43,237 new U.S. physicians annually? Or are there portions of that total, and the proposed increase, that enjoy the experience, expertise, and training here and then relocate elsewhere in the world to practice medicine?
The Associated Press recently noted that:
"Hospitals in the U.S. are without essential staff because international doctors who were set to start their medical training this week were delayed by ... travel and visa restrictions."
This suggests that some of those coveted residency positions in U.S. hospitals provided opportunities to visitors from other nations. The article is clear that the volume is not known. Would those individuals be likely to remain in the U.S. following residency and add to the nation's physician population? If not, how many of the 42,237 do stay and practice here? How many in primary care, in rural America?
These points all raise important issues. Is there a shortage in gross terms (macro), or are there shortages in certain specialties (micro) or geographies (micro)? Is the path forward one of continued monopolization of residency participation and opportunity, or would a system with more free-market responsiveness more readily impact supply and demand?
The largest organization of physicians, the AMA, supports that there is indeed a shortage. It has issued an "all hands on deck" call to arms regarding the present and our present path. The actuality of micro and macro impacts and challenges deserves credible, calculated, and empirical study.
This may include analysis of if and why there are leaks in the system - early retirements, departures to other markets, etc. Is the market healthy in both recruitment and retention? This may include why and how services are compensated, and what adjustments might enhance physician attraction and retention in the challenged specialties and locations.
In the end, the questions remain numerous and complex. The challenge will be to quantify those questions, prioritize responses, and facilitate effective and efficient markets for the delivery of medical care, recruitment and retention of practitioners, and appropriate access to care in both local and regional perspectives.
The questions are varied, complex, and vexing. That is no reason not to answer them. As for workers' compensation, the physicians are needed here as much or more than elsewhere. While attorney fees may be "the" lynchpin, many injured workers will need to see a physician instead.
