The Association of American Medical College’s oft-cited annual physician shortage report squarely places the cause for the growing physician shortfall on more physicians leaving practice due to retirement or burnout in tandem with a growing population of senior citizens living longer and, thus, needing health care.

But the United States’ physician shortage crisis is also the result of decades of federal and state policies that impact the number of people choosing medicine, limits on their educational opportunities once they decide to become a physician and flexibility to make changes once licensed. Many of these policies are still in effect, and new ones are continually becoming law.

Here are just a few policies that created, or are creating, hurdles for physicians:

• The U.S. Dept. of Health, Education, and Welfare commissioned a study by the Graduate Medical Education National Advisory Committee (GMENAC), which concluded in 1981 that the nation was looking at a massive physician surplus and recommend actions to limit physician training. This report was used for decades as the basis for efforts to curtail the number of practicing physicians, including reducing federal support for medical school scholarships and freezing federal funding for residency training. One of the most impactful actions following the GMENAC report was a moratorium on new medical schools and reductions in medical school enrollments, according to the Niskanen Center.

• With each state responsible for providing medical licenses and enforcing medical-licensing laws, physicians who want to move to another state find it cumbersome to do so. Recent emergency measures during the COVID-19 pandemic have lifted some of those barriers, but they aren’t permanent or unilateral across the states. This precludes physicians from providing care to communities in need, especially those that are rural and underserved, either in person or via telehealth, according to Governing.

• Reductions in spending in public health departments has resulted in the loss of at least 38,000 state and local public health jobs since 2008, according to a report released in July by the Associated Press and Kaiser Health News.

While none of the above policies are singularly responsible for the physician shortage, as a group and in conjunction with physician retirement rates and population trends, it’s clear the physician shortage path is complex.

Physician Retraining & Reentry was created to help increase the number of primary care physicians in the U.S. PRR aims to bridge the ever-growing gap of health care need.