Too Many and the Wrong Clinicians

Expansions of clinicians are out of control. There appear to be no obstacles to accelerating numbers of clinicians. This is the result of more sources of clinicians plus expansions in US MD, US DO, Caribbean, non-citizen international, nurse practitioner, and physician assistant training.




Graphics indicate the most rapid increases in nurse practitioner workforce, rapidly leaving US population growth behind. The total number of physician assistants who could practice is much higher as only 60% are clinically active.

The US Population will increase only 29% from 2010 to 2040 but the active clinician workforce is set to increase by 100%.


There might be some decline in the growth of annual graduates for any source, but the last doubling of NP graduates from 8000 to 16000 in less than a decade indicates that high numbers are not a limitation. The ten times expansion since 1980 does not appear to be facing limitations. Nursing school graduates have also increased substantially, allowing more expansion of NP graduates.

Physician assistant programs are increasing and some programs are being expanded.

US MD schools were slower to the expansion, but have clearly moved into expansion phase as well.

Osteopathic and Caribbean school expansions are also continuing. An expected decline in non-citizen international graduates has not occurred.

These expansive changes will not recover primary care or workforce where needed - because health spending is still limited for these areas. Coordination of specific workforce and specific payments are required and the US fails in workforce and in payment designs. The expansions are not without impact. Clearly the expansions result predominantly in non-primary care workforce for Too Many and the Wrong Clinicians 

 Shortages of physicians have grabbed headlines for over a decade. Numerous health professional associations have used this to lobby for more funding to train more graduates. New sources of clinicians have been added. The question remains. Will Americans be able to access the clinicians that they need when they need them?

More clinicians may well add to problems without helping areas such as primary care or workforce where needed. My assertions:
More with Regard to These Three Areas at Too Many and the Wrong Clinicians 

Family Medicine Needs a New Beginning - Current Preparation, Admission, and Medical School Plus Health Policy Interact To Prevent Family Medicine Choice - and Health Access Result

Hotspotting Has Many Spots To Consider - Simple Interpretations Are Inaccurate, Many Different Characteristics Shape the Outcomes, Not Just Geographic Location

Retail Clinic Recoil - Many Side Effects Can Be Anticipated, And More to Come

Global Fails Local But Local Focus Succeeds Globally

What Veterans Need Is Family Practice - No Other Type of Clinician Comes Close to the Location or the Scope

Domino Decline By Design - as ERs Close, Those Nearby Face Challenges, as Small or Rural Hospitals Close or Practices Where Needed...

Declines in Health Care Delivery Despite Increases in Health Spending - If We Keep Accelerating Non-Delivery Costs, We Can Continue to Remain Behind Health Care Demand

Perverse Health Payment Dividing US - More for Fewer and Less for More, and Penalties for Those Caring for Those Most in Need

How To Resolve Health Access for 40 States Behind By Design

Health Care Delivery Is No Laughing Matter - Political Cartoons are Nice, but...


Blogs indicate that primary care can be recovered and should be recovered.

Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.

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