The United States faces a projected shortfall of up to 124,000 physicians by 2034, according to the Association of American Medical Colleges. Nursing shortages are equally stark. The instinctive policy response is straightforward: train more people. But workforce shortages are rarely just a supply problem — they're also a deployment problem.

Policymakers have two broad levers available. They can increase the pipeline of new healthcare workers through expanded training capacity, loan forgiveness, and immigration reform. Or they can redesign how existing workers practice — restructuring teams, shifting tasks, and removing regulatory barriers that prevent professionals from working to the full extent of their training.

These aren't mutually exclusive strategies, but they compete for political attention and funding. Understanding how each approach actually performs in practice matters enormously, because the wrong emphasis can waste a decade of effort while shortages deepen. This analysis examines three policy domains where this tension plays out most clearly.

The most visible policy response to workforce shortages is expanding training capacity. Congress has periodically increased Graduate Medical Education (GME) funding — the federal dollars that support physician residency slots — most recently adding 1,200 new Medicare-funded positions through the Consolidated Appropriations Act of 2021. For nursing, federal programs like the Nurse Corps and Title VIII grants aim to boost enrollment and graduation rates.

The challenge is time. A new medical school slot created today won't produce a practicing physician for seven to fifteen years, depending on specialty. Nursing programs face a different bottleneck: not student demand, but a shortage of faculty to teach them. Schools turned away over 91,000 qualified nursing applicants in 2021, largely because they couldn't hire enough instructors at academic salaries that compete with clinical pay.

Retention-focused policies — loan repayment programs, rural practice incentives, and workplace safety regulations — attempt to keep existing workers from leaving. The National Health Service Corps offers loan forgiveness in exchange for practice in underserved areas, and evidence suggests it successfully places providers where they're needed. But retention rates after the service commitment expires are mixed, and burnout-driven attrition has accelerated since the pandemic in ways that financial incentives alone may not address.

Supply-side policies are necessary but structurally slow. They address tomorrow's workforce, not today's crisis. And they carry an implicit assumption — that the current model of care delivery is the right one, and we simply need more people to staff it. That assumption deserves scrutiny, because the model itself may be part of the problem.

Takeaway

Expanding the training pipeline is essential but operates on a decade-long timeline. Policies that only increase supply without questioning the care delivery model risk producing more workers for a system that already uses them inefficiently.

An alternative policy approach starts from a different question: instead of asking how many workers do we need, it asks how are we using the ones we have? The answer, in many settings, is poorly. Physicians routinely perform tasks that nurses, pharmacists, or community health workers could handle safely and effectively. Scope-of-practice laws — which vary enormously by state — often prevent this redistribution.

Team-based care models offer one solution. The Veterans Health Administration has been a proving ground, deploying Patient Aligned Care Teams that distribute clinical responsibilities across physicians, nurse practitioners, pharmacists, and social workers. Evidence from the VA and similar models shows that well-structured teams can manage larger patient panels without sacrificing quality, and often improve chronic disease outcomes.

Task-shifting — formally reassigning specific clinical activities to different professional categories — has strong evidence internationally. The World Health Organization has endorsed it in resource-limited settings for decades. In the U.S., the policy mechanism is typically expanding scope of practice for nurse practitioners, physician assistants, and pharmacists. Twenty-seven states and Washington, D.C., now grant nurse practitioners full practice authority, meaning they can evaluate, diagnose, and prescribe independently. States that have made this change show no measurable decline in care quality.

The political obstacle is professional turf. Physician organizations have historically opposed scope-of-practice expansions, framing them as patient safety issues. The evidence doesn't strongly support that framing, but the lobbying is effective. Practice redesign policies often face fiercer opposition than supply-side spending, precisely because they redistribute authority rather than simply adding resources.

Takeaway

The most politically difficult workforce policies are often the most immediately effective. Redesigning how care teams function can stretch existing capacity right now — but it requires confronting entrenched professional boundaries.

The United States has long relied on internationally trained healthcare workers — roughly 28% of physicians and 16% of registered nurses are foreign-born. Immigration policy is therefore, whether intentionally or not, health workforce policy. Visa processing delays, restrictive quotas, and burdensome recertification requirements function as barriers that constrain supply during the very moments shortages are most acute.

The J-1 visa waiver program illustrates how immigration and workforce distribution intersect. International medical graduates can receive visa waivers by committing to practice in underserved areas — a mechanism that simultaneously addresses geographic maldistribution. But the program's effectiveness is limited by annual caps and inconsistent state-level administration. During the COVID-19 pandemic, calls to expedite visa processing for healthcare workers gained traction, yet structural reform has been minimal.

Domestic licensing mobility presents a parallel challenge. A nurse licensed in Ohio cannot simply practice in Pennsylvania without navigating a separate licensing process. The Nurse Licensure Compact, which now includes 41 states, has made progress by allowing mutual recognition of nursing licenses. For physicians, the Interstate Medical Licensure Compact covers 40 states but still requires a separate application process. Telehealth expansion during the pandemic revealed how much these barriers constrain access — and how quickly care can scale when they're temporarily removed.

Both immigration reform and licensing reciprocity share a common policy logic: trained professionals already exist but are blocked from practicing by administrative and regulatory friction. Removing these barriers doesn't require new training investment, new facilities, or long timelines. It requires political will to harmonize systems that were designed in an era when healthcare was local, not mobile.

Takeaway

Some of the fastest routes to easing workforce shortages involve not training new workers but unblocking the ones who are already trained. Regulatory friction is an invisible but powerful constraint on healthcare capacity.

No single policy lever will solve healthcare workforce shortages. Supply-side investments are slow but foundational. Practice redesign is faster but politically contested. Immigration and licensing reforms are the lowest-hanging fruit — yet often overlooked because they lack a natural political champion.

The most effective workforce strategy treats these as complementary instruments, not competing priorities. The policy failure is not choosing the wrong approach; it's treating each in isolation and assuming one will be sufficient.

What should concern us most is the gap between what evidence supports and what politics permits. When scope-of-practice reform stalls because of lobbying, or visa processing delays keep trained physicians sidelined, the cost isn't abstract — it's measured in patients who can't find care.