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America Is Running Out of Doctors

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By EMANUEL SARKEES

Most people assume that when they need a doctor, a doctor will be available. That assumption is getting harder to hold onto. Right now, more than 83 million Americans live in highlighted Health Professional Shortage Areas, which is the government’s official notice that where they live does not have enough physicians to meet basic healthcare demand. That is not a projection of something yet to come. It is the situation today, and the numbers are moving in the wrong direction.

The Association of American Medical Colleges projects the United States will face a shortage of up to 86,000 physicians by 2036. The National Center for Health Workforce Analysis puts it even higher, projecting a shortage of 124,180 physicians by 2027 and 187,130 by 2037. The two organizations use different methods but they land in the same place. The country is training, retaining, and deploying far fewer physicians than its growing and aging population needs.

What makes this worth paying attention to right now is not just the size of the problem. It is the fact that this shortage was not some unavoidable outcome. It was built, step by step, and then never was corrected before the damage became permanent.

How the System Built This Problem

The most important driver that most people have never heard of is the residency cap. In 1997, Congress froze the number of Medicare funded graduate medical education positions, which are the residency slots that medical school graduates need to complete before they can practice independently. The system largely preserved the existing distribution of residency positions, which also resulted in preserving an imbalance in the physician workforce. Adding more residency positions does not guarantee that new physicians will enter the primary care specialties or communities where they are actually needed. The result is not a shortage of physicians, but a mismatch between the specialties being trained and what types of physicians the country needs. Medical school enrollment has grown since then. Residency slots have not kept pace. The result is a bottleneck where qualified graduates cannot finish their training because there are not enough funded positions available. Without more residency funding, the final step in the physician training stays limited no matter how many students start medical school.

Medical debt makes the problem worse in a way that directly shapes where physicians end up practicing. The average medical school graduate carries more than $216,000 in student loan debt by the time they finish their education. By the time residency and fellowship training wraps up, which can be six to eight years later, that number has often grown. When a new physician is carrying a quarter million dollars in debt, the decision about where to practice is not made on the factor of where patients need the most help. It is made for the reimbursement system where primary care physicians earn significantly less than procedural specialists, and where rural practices operate on margins that make competitive salaries hard to offer. This is not a flaw in individual physicians. It is math, and the system sets it up this way.

Burnout is the third piece to the puzzle.

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The Drug Changing Medicine

By EMANUEL SARKEES

The United States is in the middle of what researchers are calling one of the most significant pharmacological developments in modern medicine. GLP-1 receptor agonists, the drug class behind Ozempic and Wegovy, have become able to reduce obesity, lower cardiovascular risk, control blood sugar, and show signals improving areas like addiction and dementia. It is backed by large scale clinical trials and is actively reshaping how physicians think about chronic disease management. The accessibility, however, is not keeping up with the science. The people who will benefit most from GLP-1s are the same people who have no path to receiving them.

This is not a coincidence. It is the outcome of a pricing structure, an insurance system, and a policy environment that have consistently made the same choice, which is to let cost determine who receives care.

What GLP-1s Actually Do

GLP-1s were originally developed to treat Type 2 diabetes. They work by acting similarly to a hormone the gut naturally produces after eating, which signals the brain to reduce appetite, slows digestion, and stabilizes blood sugar levels. The effects have been significant enough that the medical community’s interest has expanded well beyond diabetes management.

A 2023 clinical trial, known as the SELECT trial, found that semaglutide, the active ingredient in Wegovy, reduced the risk of cardiovascular issues like heart attacks and strokes by 20% in patients with obesity who did not have diabetes. That finding alone drew serious attention from cardiologists. Early research is also exploring GLP-1s in alcohol use disorder, sleep apnea, chronic kidney disease, and Alzheimer’s. The amount of potential application is unlike anything seen from a single drug class in recent times.

The Price Problem

The issue is not whether these drugs work. It is whether the system is built to let people use them. Wegovy, the FDA approved version specifically made for weight management, holds a price of around $1,300 per month in the United States without insurance coverage. Ozempic, technically approved for Type 2 diabetes but widely prescribed off label for obesity, runs at a similar cost. As one analysis noted, GLP-1 pricing “increased 442% between 2021 and 2023, creating a market three times larger than cancer spending, with list prices reaching $1,400”. Novo Nordisk and Eli Lilly, the two companies that dominate this market, charge American patients prices that are dramatically higher than what patients pay for the same medications in other countries.

The actual price a patient pays has very little to do with that $1,349 list price and almost everything to do with how they access the drug. With commercial insurance that covers obesity, costs can fall to around $25 a month, though that requires a plan that actually covers weight loss medications and prior authorization that actually gets approved. The Wegovy pill is available directly through NovoCare at $149 per month, the lowest price point ever for an FDA-approved GLP-1 weight loss medication. Zepbound starts at $299 per month through LillyDirect for patients who pay out of pocket. The government’s TrumpRx platform offers GLP-1s at around $350 per month for cash-paying patients who do not have coverage. Compounded versions through telehealth platforms like Ro and Hers run anywhere from $99 to $349 per month, though the FDA is actively restricting that market. And as of July 1, 2026, eligible Medicare beneficiaries can access Wegovy, Zepbound, and Foundayo at a flat $50 per month through the new Medicare GLP-1 Bridge program. That is a 27-times spread between the lowest and highest price for the exact same drug, determined not by what the medicine costs to make, but almost entirely by who you are when you walk up to the pharmacy counter. And for the uninsured, low income patient with no Medicare, no qualifying commercial plan, and no compounding option, none of those prices are on the table at all. 

At $1,300 per month, the annual cost of Wegovy exceeds $15,000. For millions of Americans, that number is not just high, but is completely out of reach. That gap in pricing is not accidental. In countries where governments negotiate drug prices directly, the same medication costs a fraction of what Americans pay. The United States remains one of the only developed nations that does not regulate pharmaceutical pricing at the federal level, and patients suffer the difference.

Insurance coverage for GLP-1s follows a path that is both frustrating and familiar.

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