Ask any voter, and they’ll tell you Washington still has a long way to go to improve access to health care. The physician shortage is one clear example of that fact.
According to the government’s own reporting, the United States is projected to be short 141,160 physicians by 2038 – and communities outside America’s major metros will bear the brunt. The shortfall means fewer primary care physicians available for a check-up when your child is sick, fewer cardiologists and nephrologists to help manage chronic conditions like heart and kidney disease, and fewer OB-GYNs to provide care to mothers and new babies.
Unfortunately, the Southern and Western regions of the country are expected to face the worst shortages, particularly as population growth in our communities supercharges the demand for health care.
Already, the Texas Department of State Health Services predicts the state will see a shortage of 10,000 doctors by 2032. 225 out of 254 counties in Texas are designated as Health Professional Shortage Areas (HPSA), creating challenges for the more than 6 million Texans that live in these communities. What’s worse, most of the individuals residing in these rural communities are elderly individuals, making access to medical care all the more crucial.
Texas lawmakers have tried to make up for this shortage by passing laws to expand in-state residency positions and recruit new medical students. These are important steps, but we can’t address these chronic issues alone. Part of the blame falls on Medicare, which often sets the direction for the rest of the healthcare system. And it’s up to federal policymakers to fix it.
The Medicare Physician Fee Schedule (MPFS) – which dictates how physicians are paid under Medicare – drastically underpays physicians for the critical care they provide. Since 2001, Medicare physician pay has declined by 33% when adjusted for inflation. When Medicare payments fail to keep pace with the cost of practicing medicine, physicians have fewer resources to hire staff, open practices in high-need communities, or invest in new technology.
It’s a complex issue, but it has real and lasting impacts, especially for the remaining small, rural physician practices that are a lifeline for so many Texans. Over time, these challenging financial dynamics force independent physicians to consider limiting the Medicare patients they see, selling their practice to a large hospital system, or closing altogether. For patients, this means farther drives, longer wait times, and fewer choices for close-to-home care.
We cannot simply train more doctors if the system does not give them a sustainable path to practice medicine long-term. That’s why fixing Medicare’s physician reimbursement system must be part of the solution to America’s physician shortage.
Congress has long recognized these problems and has worked to prevent more serious Medicare cuts from coming into effect. But beyond these important short-term steps, lawmakers now face a historic opportunity to permanently address these problems through the bipartisan Patients First Act (H.R. 9693).
If passed, this legislation would modernize Medicare’s physician payment system by tying annual physician payment updates to inflation, helping practices keep pace with the costs of delivering care. It would also reform Medicare’s budget-neutrality requirements, which contribute to unpredictable payment cuts, and strengthen value-based care models that enhance efficiency and boost patient outcomes.
For Texas physicians, this will provide more stability and recognition of the ongoing work involved in managing patients’ health. For taxpayers, it’s a short-term investment that will help bolster preventative care and reduce costly interventions down the line. And for lawmakers, it’s a slam dunk to show that you are listening to Americans when they demand improvements to our healthcare system.
These reforms won’t solve Texas’ physician shortage overnight, but they are the exact types of common-sense reforms that conservatives should champion as the midterm elections rapidly approach.
Texas has taken important steps to train and recruit more doctors. Now Washington needs to do its part. Congress should pass the Patients First Act and give physicians — especially those serving rural and underserved communities — the support they need to serve more patients well into the future.
— Tom Giovanetti is president of the Institute for Policy Innovation (IPI), a 38-year-old conservative, free-market public policy think tank based in Dallas.