How to solve the current and future physician shortage

Over nearly 50 years, the medical school I founded has sent more than 20,000 physicians into the international health care system — more than any other single institution. 

Back then, I had an idea that the American medical establishment considered crazy, and reckless: To start an English-language medical school outside the U.S., using an American curriculum, close enough that graduates could train and practice in American hospitals. The logic was simple: If the U.S. was not producing enough doctors, others would have to help fill the gap.

That idea became St. George’s University in Grenada. And for all these years, I have been right in the thick of the physician pipeline into the U.S. health care system.

At the time of the university’s beginning, policymakers were warning of a “physician glut.” In fact, four years after St. George’s opened, the U.S. effectively stopped expanding medical education. In 1980, there were 127 U.S. medical schools; by 1990 there were 125. After rapid growth in the 1960s and 1970s, expansion had stalled following federal workforce projections — most notably a 1981 report that warned of an impending physician surplus and encouraged restraint.

Those assumptions went largely unchallenged for nearly two decades, but they were wrong. Today’s physician shortage is serious, but the problem ahead is even more profound than most projections suggest, because many of the assumptions behind current forecasts no longer hold.

First, one quarter of the U.S. physician workforce consists of international medical graduates. The vast majority of these doctors are foreign-born and foreign-trained, and many rely on hospital sponsorship to complete residency training. Any disruption to visa pathways — whether through rising costs such as the new $100,000 H1-B visa application fee, administrative barriers or political uncertainty — immediately constrains physician supply. A workforce that is structurally dependent on international physicians cannot be susceptible to the vagaries of politics.

Second, access to medical education is itself tightening. New limits on professional student borrowing will make medical school financially unreachable for many qualified applicants. At a time when we need more doctors, we are quietly narrowing the pipeline.

Third, the workforce is aging. More than 40 percent of active physicians will reach typical retirement age within the next decade. Each year the U.S. produces roughly 30,000 new Doctors of Medicine and Doctors of Osteopathic Medicine, but that output barely offsets attrition, let alone population growth. New medical schools — most opening with classes of 60 students or fewer — will not close the gap. 

Meanwhile, the population is growing older, sicker and more medically complex. Americans are not only living longer, they are demanding care that preserves function and quality of life. If the country expands coverage further and brings tens of millions of uninsured Americans into regular care, demand will rise again.

The conclusion is unavoidable: The current model of physician production cannot meet future needs, even under optimistic assumptions. So, what do we do?

The answer is not simply to build more traditional medical schools. U.S. medical education is tightly linked to large, expensive research enterprises, which makes schools slow to open and costly to operate. Research universities have driven extraordinary innovation, but tying every medical school to a full-scale research infrastructure has also constrained capacity. 

St. George’s demonstrated something different: A teaching-focused medical school, anchored to strong clinical training and targeted research exposure, can produce outstanding physicians at scale. We now need to think bigger.

One solution is to create a new system of teaching medical schools, with a dedicated accreditation pathway, formally partnered — or “twinned” — with established research institutions. These schools would focus primarily on education and clinical excellence, while maintaining structured access to research through their partner institutions. Some could be located domestically; others, as international medical schools have already proven, could operate outside the U.S. without compromising standards.

At the same time, we must address maldistribution. Schools like St. George’s are already moving in this direction, offering substantial tuition support to students from rural and underserved communities in exchange for commitments to return home to practice. Training doctors who already understand the communities most in need is one of the most effective ways to close access gaps. 

When St. George’s opened in 1977, the idea was dismissed as unrealistic. History has proven otherwise. 

Today’s physician shortage will not be solved by incremental adjustments or by hoping current projections are wrong. It will take the same kind of bold thinking that challenged orthodoxy 50 years ago. If we want a healthy nation, we must be willing to rethink how and where we train the doctors who care for it. 

Charles R. Modica is the chancellor of St. George’s University and author of the forthcoming “Docs on the Bay: The Dream that Became America’s Most Unlikely Medical School” (Post Hill Press, April 2026).

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