Growing the pipeline where it matters most: Why expanding residency training is critical to solving the physician shortage

The physician workforce shortage is no longer a looming crisis. Healthcare organizations across the country are struggling to recruit physicians, particularly in primary care and other high-need specialties, while communities in rural and underserved areas face growing gaps in access to care. The solution starts with the pipeline, and that means investing in graduate medical education (GME).

Medical school enrollment has grown significantly over the past two decades, yet residency capacity has not kept pace, due in large part to longstanding caps on Medicare-supported GME positions. The result is a bottleneck that limits how many physicians can enter practice each year and where they end up practicing. For healthcare organizations trying to recruit physicians and for the communities that depend on them, this gap has serious consequences.

Expanding the number of residency slots, especially in states and communities that are hardest to recruit, is one of the most direct and effective steps policymakers can take to address the physician workforce crisis.

Where physicians train is where they stay

One of the strongest and most consistent findings in health workforce research is that physicians tend to practice near where they complete their residency training. According to data from the Association of American Medical Colleges, nearly 56% of physicians who completed residency training over a recent ten-year period are now practicing in the state where they trained. This is even more pronounced among family physicians who face urgent shortages.

This means that the location of residency programs is not merely an academic question, it is a workforce strategy. When residency slots are concentrated in large urban academic medical centers, the surrounding communities benefitfrom a steady supply of new physicians. But states and regions with fewer training programs are left competing for a shrinking pool of candidates interested in relocating. If we want more physicians practicing in the places that needthem most, we need to train more physicians in those places.

The recruitment data tells the same story

The on-the-ground experience of physician recruiters confirms what the research shows. According to AAPPR’s 2025 Benchmarking Report, the typical physician search takes 121 days to fill, and searches in surgical and specialty care fields average 176 days. Some specialties are even more challenging: dermatology searches take a median of 348 days, and oncology searches take 332 days. At the same time, only about 47% of physician searches were filled during 2024, meaning that many positions remain open into the following year or longer.

These challenges are felt most acutely in areas that are already hard to recruit. Organizations located in suburban and rural settings face a thinning candidate pool and often must invest more time and resources to attract physicians. Half of all physician searches in 2024 were to replace a departing provider, underscoring that recruitment is not just about growth but also sustaining access. Meanwhile, a large share of the physician workforce is nearing retirement age, adding further urgency to the pipeline problem.

Expanding residency capacity most direct path forward

Critically, new residency positions should be targeted toward the communities and specialties where shortages are most severe. That means prioritizing slots in rural areas, in states with low physician-to-population ratios, and in primary and behavioral health, fields where demand is greatest and recruitment is most difficult. Programs like Teaching Health Center GME and rural training tracks have already demonstrated that when residency training is placed in underserved settings, graduates are more likely to stay and practice in similar communities.

State and local leaders also have a role to play. Several states have launched their own GME funding programs to supplement federal support, recognizing that growing the local physician workforce requires training physicians locally. These efforts deserve continued investment and expansion, particularly in regions where federal GME funding has historically been concentrated elsewhere.

Employers and recruiters should be part of conversation

Healthcare employers and physician recruiters are often the first to see the effects of an undersized training pipeline, through longer searches, persistent vacancies and fierce competition for candidates. Their perspective should inform how training programs are designed. When employers and academic institutions work together, they can better align training with real-world workforce needs and help ensure that new physicians are prepared to practice in the settings where they are needed most.

The physician shortage will not resolve on its own. But the evidence is clear: expanding residency training in areas that are hardest to recruit is one of the most powerful tools available to strengthen the workforce and improve access to care. Where we train is where physicians will practice, and that is why growing GME capacity in underserved areas should be national priority.

Carey Goryl is CEO of the Association for Advancing Physician and Provider Recruitment. Eli Greenspan is Policy Advisor at Foley Hoag.