Why Don’t U.S. Medical Schools Produce More Doctors?

The percentage of doctors imported from abroad has skyrocketed from 9 percent in 1981 to 25 percent in 2024. U.S. medical schools have simply failed to keep up with the increased demand for medical services by not expanding the number of doctors they train. It was a policy choice to import significantly more foreign-educated doctors rather than train more in the United States. That policy choice was enforced by monopoly control over the accreditation of U.S. medical schools, which hindered new entrants and forced the U.S. health care system to look abroad for doctors. Given that aging baby boomers are increasing demand for medical care, removing the accreditation cartel blocking the expansion of domestically trained doctors is critical.

hat would happen if the U.S. military needed 1 million people in the Armed Forces but decided to cap domestic enlistment at 750,000 U.S. citizens and to recruit the rest abroad? Or what would happen if U.S. policy was designed to import 25 percent of its lawyers or teachers from elsewhere in the world, not because this country lacks people who are interested in and capable of pursuing those professions, but simply because the U.S. would rather hire foreigners for those jobs? That would be absurd—and it happens to be exactly how the system for training and hiring doctors in America operates today.

The primary reason for the huge increase in foreign-trained doctors is simply that there are too few U.S. medical schools2

Unless otherwise noted, the term “U.S. medical school” includes both those trained in allopathic schools that grant MD degrees and osteopathic schools that grant doctor of osteopathic medicine (DO) degrees.
training too few students. There is no shortage of people applying to U.S. medical schools. In fact, it is getting significantly more difficult to get into medical schools. According to the Association of American Medical Colleges, there were 62,443 applicants to allopathic (doctor of medicine (MD)-granting) medical schools in 2021, of whom 23,711 were admitted.3

Association of American Medical Colleges, “2021 Fall Applicant, Matriculant, and Enrollment Data Tables,” https://www.aamc.org/media/57761​/download?attachment (accessed on May 3, 2024).

This acceptance rate of 38 percent is down from 46 percent in 2011 and 52 percent in 2002. If U.S. medical schools had the same acceptance rate in 2024 as they had in 2002, the current percentage of medical residents that would need to be filled by foreign medical students would be 9 percent—the same as it was in 1981.

It was a policy choice to import significantly more foreign-educated doctors rather than train more in the U.S. That policy choice was enforced by monopoly control over the accreditation of U.S. medical schools, which hindered new entrants and forced the U.S. health care system to look abroad for doctors.

This policy choice has oddly escaped critical attention. If U.S. auto companies decided to staff their factories by limiting the hiring of U.S. workers in favor of importing 25 percent of them from abroad, there would rightly be a political outcry. But because the problem has been obscured by inaccurate claims from leading medical organizations, policymakers have not focused on this issue or considered the need for policy solutions.

This Backgrounder documents the trends and policies that contributed to the sharp rise in foreign-trained doctors and offers policy solutions.

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