Freakonomics Radio

650. The Doctor Won’t See You Now

October 24, 2025

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  • The closure of low-quality medical schools following the 1910 Flexner Report, while intended to improve standards, resulted in significant public health benefits, suggesting that low-quality doctors were actively harming patients. 
  • The current U.S. physician shortage, projected to reach 187,000 by 2037, is exacerbated by historical constraints like the federal capping of Graduate Medical Education (GME) training slots since the 1980s/90s, implemented when a physician glut was anticipated. 
  • Physician dissatisfaction and workforce challenges are driven not only by long hours but significantly by administrative burdens (like EHR use and insurance denials) and a system that prioritizes treating disease over investing in prevention. 

Segments

Physician Shortage Overview
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(00:01:31)
  • Key Takeaway: The U.S. has a physician ratio significantly lower than other high-income countries, leading to access issues like long wait times and geographical/specialty mismatches.
  • Summary: The U.S. has approximately one physician for every 340 people, a ratio lower than comparable nations, contributing to appointment delays. Shortages are uneven, with some cities having surpluses while rural areas suffer deficits. Specialties like family medicine and vascular surgery face the largest anticipated shortages.
Physician Burnout and System Complexity
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(00:02:25)
  • Key Takeaway: Modern physician work involves significantly increased patient volume and administrative tasks, such as insurance appeals and electronic record management, leading to frustration.
  • Summary: Surgeons report doubling their daily operations while simultaneously managing increased patient emails and spending countless hours appealing insurance denials for necessary care. Doctors feel constrained by insurance companies dictating treatments, sometimes suggesting AI alternatives over clinical judgment. This complexity erodes the autonomy physicians expect from their profession.
Demand Drivers: Aging Population
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(00:04:17)
  • Key Takeaway: The demand for physicians is set to surge due to the population over age 85 tripling by 2050, placing immense pressure on the existing workforce.
  • Summary: Life expectancy has increased substantially, meaning more people will require medical care in their later years. While gerontologists are helpful, primary care doctors and other specialists are also needed to manage the geriatric patient population. Improving overall life expectancy requires focusing on preventing diseases like cardiovascular issues and diabetes across all populations.
Medical School Slot Scarcity
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(00:14:34)
  • Key Takeaway: The high cost and competitive nature of applying to medical school systematically exclude many talented candidates, limiting the supply of new physicians.
  • Summary: Medical school slots have only increased by 10% over the last decade, failing to meet rising demand, despite an influx of highly talented applicants. The application process is expensive, often requiring applicants to write 50 to 100 essays across numerous schools, disproportionately affecting lower-income individuals. The constraint is more about the limited number of available slots than the capability of the applicants.
The Legacy of the Flexner Report
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(00:21:13)
  • Key Takeaway: The 1910 Flexner Report led to the closure of roughly 50% of U.S. medical schools, which paradoxically resulted in an 8% drop in infant mortality and a 4% drop in non-infant mortality.
  • Summary: Abraham Flexner evaluated medical schools based on scientific basis and laboratory science requirements, leading to the closure of substandard institutions. The resulting reduction in low-quality doctors saved an estimated 16,000 infant lives and 38,000 non-infant lives annually in the U.S. at that time. This historical event also created a unique divide between medical schools and public health departments in America.
GME Caps and Physician Status Decline
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(00:39:12)
  • Key Takeaway: Federal caps on Graduate Medical Education (GME) training slots, established decades ago based on an outdated fear of physician oversupply, now severely restrict the pipeline of new doctors.
  • Summary: Residency and fellowship slots are capped federally, a policy stemming from concerns in the 1980s/90s about having too many physicians, a reality that has not materialized. Only about 15,000 GME slots have been added over the last 20 years, contributing to the current deficit. This, combined with increased administrative work and societal shifts, has caused a decline in respect and trust for the medical profession.
Solutions: Incentives and Prevention
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(00:47:20)
  • Key Takeaway: Addressing the rural physician shortage requires financial incentives that go beyond current modest Medicaid payment increases, and decreasing overall demand necessitates a national focus on prevention over disease treatment.
  • Summary: Incentivizing physicians to practice in rural areas has proven difficult with existing policies, requiring greater financial commitment and political will. Furthermore, the system pays for treating disease rather than investing adequately in prevention interventions like cancer screening. Improving prevention access, especially in remote areas like rural Alaska, could reduce the long-term demand for acute care physicians.