One of the biggest challenges we face in the near term is a projected shortage of physicians. The U.S. is expected to face an estimated shortage of 80,000 physicians by 2030, affecting both specialists and primary care providers. As a result, I see several ways to structure our approach to reduce the potential impact.

To overcome the forecasted physician shortfall, training enough clinicians is a top challenge, with multiple components:

• Clinical Training Capacity: There has been a rapid increase in the number of medical schools (about 25 new schools in the last decade), but the number of teaching hospitals has not kept pace, leading to competition for clinical training sites among medical students, osteopathic students, physician assistants, and nurse practitioners.
• Preceptor Shortage: This shift often means clinical productivity needs higher prioritization while maintaining high quality research and education..

There are two other important variables related to workforce development that require our attention and thought:

• Osteopathic School Students: Osteopathic schools often have much larger class sizes (250–800 students) compared to allopathic schools (about 110 students), further straining clinical training resources.
• Residency Bottleneck: The number of ACGME residency positions has remained static for about 30 years, despite growing numbers of U.S. and international medical graduates. There are approximately 36,000 applicants for around 20,000–25,000 residency slots annually, resulting in many qualified graduates without positions. (There are about 10,000 foreign medical graduates who are also vying for these residency positions.

Support for basic research

Clinical research is essential to advancing medicine and patient care. Particularly in an academic environment, physicians view research as a foundational component of growth; they want to be challenged, but we have to find ways to support them in their efforts.

• There is declining support for physician-scientists and basic science researchers.
• Fewer physicians are pursuing research careers, and an increasing number of PhDs are moving into the pharmaceutical industry rather than academic research.
• The foundation of biomedical discovery is being eroded, likened to “termites destroying the framework of a house”—damage that may not be obvious until it is too late to repair.

AI integration in healthcare and education

• The rapid adoption of AI in healthcare presents two main challenges:
  • Preparing Students: Ensuring graduates are competent in using AI tools at the bedside from the start of residency.
  • Using AI in Teaching: Incorporating AI as an educational tool within the curriculum.
• Most medical schools, except for a few elite institutions (e.g., NYU, Harvard, Columbia, Michigan), lack the financial resources and staffing to integrate AI into their programs.
• There is a high risk of graduating students who are not adequately prepared to use AI in clinical practice.

History tells us there are major shiftings in funding over time. We need to be thoughtful of these funding shifts and resulting impact on revenue, research, budgets and workforce planning. Historically, public medical schools received about 40% of funding from state governments, 40% from research, and 20% from clinical care. Now, 65–70% of funding comes from the clinical enterprise (health system), making medical schools highly dependent on clinical revenue. This shift means clinical productivity is often prioritized, despite the increasing demands of our teaching and research missions.

Accreditation requirements play a significant role in shaping how medical schools operate and evolve. These standards ensure a consistent level of quality in medical education, but can also create pressure on institutions to meet extensive documentation, curriculum and faculty demands. For schools committed to research and innovation, balancing accreditation compliance with supporting clinical research can be challenging as you manage resources.

• LCME Accreditation Standards
  • The Liaison Committee on Medical Education (LCME) sets 12 standards broken into 96 elements that schools must meet for accreditation.

Diversity Requirement (Element 3.3) previously required medical schools to have specific diversity goals in admissions, which conflicted with laws in at least 20 states prohibiting consideration of race or ethnicity. This conflict was recently resolved when the LCME removed Element 3.3, but it had been a significant compliance challenge.