More new physicians are completing graduate medical education—an estimated 29,627 this year compared with last year’s 28,980 projection. That may be due to the new consolidated GME reporting requirements as well as the anticipated increase in 200 GME slots each year from 2023 to 2027 via the Consolidation Appropriations Act of 2021.

The number of advanced practice registered nurses and physician assistants would more than double over the next 15 years if the current growth trajectory holds, the AAMC said. Nearly 70% of the current APRNs provide primary care. These clinicians don’t cost as much to train and can provide primary care at similar levels as physicians, research shows.

“The numbers are still of concern, but we do see some improvement as GME slots and nurse practitioners are added,” said Dr. Janis Orlowski, AAMC’s chief healthcare officer. “While nursing schools continue to increase the number of NPs and physician assistants, the question is if they will be able to find job opportunities.”

If a surgical team adds an NP, that could allow a surgeon to spend more time in the operating room. But that efficiency could top out if a second or third NP is added to the rotation, Orlowski said.

Advanced practice practitioners, similar to physicians, also tend to migrate to urban providers with higher volumes. Thus, it’s still hard for rural providers to find clinicians, even with the growth in APPs, immigrant visa programs and the federal GME boost, said Michael Topchik, the national leader of the Chartis Center for Rural Health.

While the Consolidation Appropriations Act prioritizes underserved areas, including rural communities, that additional supply is only “a drop in the bucket,” Topchik said.

“More than three quarters of the health professional shortage areas are in rural areas,” he said, noting that it’s even more pronounced in frontier communities. “Recruitment, retention and retirement remain a deep, intractable problem for rural providers.”

More than 2 in 5 active physicians in the U.S. will be 65 or older within the next decade. In addition, 40% of the country’s practicing physicians felt burned out at least once a week before the COVID-19 crisis began, which led to reduced hours or early retirement, the AAMC found.

When a doctor leaves a rural area, it has a cascading effect, Topchik said. When a rural community loses a general surgeon, it may have to cut its anesthesia, obstetrics, infusion and other services. Hospitals take a financial hit and health outcomes suffer as patients have to travel farther, he said.

“The attrition on a day-to-day basis due to recruitment, retention and retirement issues is eviscerating the ability of a safety net to provide what heretofore were vital services,” Topchik said.

Bipartisan support for medical education has built some positive momentum, experts said. The Resident Physician Shortage Reduction Act of 2021, which was recently introduced in both the U.S. House of Representatives and the Senate, would add 2,000 federally supported medical residency positions each year for seven years. Hospitals are also continuing to expand GME slots even without additional Medicare funding.

“The pandemic has shown how important it is to have a strong and diversified workforce,” Orlowski said.