There’s a major irony in this question. Let’s take it step by step. In population terms, the US is still growing. It’s not as fast as some of the developing countries, but it’s doing rather better than many of the other developed countries. It’s an age phenomenon. In some countries like Japan, there will soon be population loss as the birth rate fails to keep pace with the deaths. More generally, the percentage of the population retired and not contributing to the tax system also means the cost of running each country will fall on a declining number of taxpayers when the medical costs of caring for an aging population are at their highest. Anyway, back to the irony: we used to have a high percentage of doctors per head of population. Governments used to ensure there were always enough doctors to build the health of our nation. As the Boomers worked their way through the education system, large numbers went into medicine and they have been keeping us going ever since. Except, along with all the other Boomers, most of these doctors are retiring and there are not enough coming through the medical schools to keep up the numbers. What makes this irony all the more sharp is the effect of the Affordable Care Act. This will bring millions more people into the healthcare system only to find there are not enough doctors to treat them.

The Association of American Medical Colleges estimates that, by 2020, we will be short about 90,000 doctors. As if his was not a serious enough problem, the reality is significantly worse in some states. If you are lucky enough to live in the northeastern states, there’s a good ratio of doctors per 100,000 population. Put the other way round, Mississippi has less than half the number of doctors practicing in Massachusetts. This reflects capitalism at work. There are more wealthy people to treat in Massachusetts. Doctors go where they can make the most money. Putting profit to one side, it’s always been more difficult to persuade doctors to work in rural states. As an example, Texas released 1,200 trained doctors from college last year. This is the second highest number of graduates in the US but Texas has one of the lowest numbers of doctors per head of population, i.e. assuming most newly qualified doctors stay in the state where they graduate, Texas is failing to train enough doctors. Were it not for the foreign-trained doctors, the shortage in Texas would be a crisis – another reason for allowing more immigration.

We need to see a major culture change with double the current medical colleges training thousands more doctors. Since some are deterred from practice by the cost of insurance, there’s a need to look again at the laws on medical negligence and medical malpractice. If the maximum number of people are to be encouraged into the profession, pay and conditions must encourage people to move into states where there’s already a dangerous shortage. Unless this happens, enlarging the number of people with health insurance plans will just produce frustration as they realize there are not enough physicians to treat them. So before you buy individual health insurance, ensure there are enough doctors to treat you in your state.