Is there a doctor in the house?

It’s no longer a surprise to most people trying to use the healthcare system, but communities across the nation are experiencing a serious shortage of physicians, especially primary care providers, and northern Wisconsin is no exception.

In fact, what is right now a serious problem is rapidly becoming a crisis. By 2036, the U.S. supply of doctors could lag demand by as many as 86,000 physicians, depending on specialty and location, according to projections by the Association of American Medical Colleges (AAMC).

Two federal workforce studies also outline the trajectory. The National Center for Health Workforce Analysis’s “State of the Primary Care Workforce, 2024” pegs the shortfall in primary care alone at 87,150 full-time equivalents by 2037. Even as nurse practitioners (NPs) and physician assistants (PAs) fill more of the care load, they cannot erase the shortfall.

Federal data in the Bureau of Health Workforce’s April 1 quarterly summary confirms the urgency — 7,749 primary-care shortage designations (known as Health Professional Shortage Areas, or HPSAs) exist as of March 31, with nearly two-thirds of them in rural areas. The overall shortfall for all physicians is expected to reach 187,130 full-time equivalent employees by 2037.

The maldistribution of primary care providers is especially troubling. AAMC data from 2022 show urban counties with an average of 286 active doctors per 100,000 residents, compared to just 98 in rural counties. Some counties — 7.8 percent nationally — have no primary care physician at all.

In Wisconsin, the outlook is just as dismal, and in northern Wisconsin, it is even worse. According to data compiled by the Rural Health Information Hub, officially designated HPSAs cover either part or all of 48 counties out of the state’s 72. 

In the Northwoods, none of Oneida County is designated as an HPSA, but all of Langlade, Florence, Forest, Price, and Vilas counties are designated as HPSAs as of July. Teri Theiler, president of Aspirus North Division, says the primary care shortages in the region are especially problematic. 

“Primary care, including OB/GYN, anesthesia and emergency medicine and certain surgical specialties remain the most difficult to staff in the Northwoods,” said Theiler, whose division includes Howard Young Medical Center and hospitals in Rhinelander, Eagle River and Tomahawk, among others. “This can create longer wait times for appointments and, in some cases, force patients to travel farther for specialty care.”

Theiler said Aspirus is counteracting the staffing shortage in part by growing the advanced practice provider workforce, expanding specialty consultations, and collaborating across their health system to bring services closer to home whenever possible.

Statewide, the health policy organization KFF (Kaiser Family Foundation) reported last December that there were 165 total Primary Care HPSAs in the state, sweeping in nearly 1.3 million of the state’s residents and meeting only 66.5 percent of the state’s health needs.

About 138 additional practitioners would be needed to remove the designations, KFF reported.

Locally, health care providers say they are actively working to fill those needs as they run head-long into the challenges of shortages, including the increased use of advanced health-care practitioners.

“While rural staffing continues to fall short of state and national targets — particularly in primary care — we’re proactively closing gaps through aggressive recruitment, telehealth expansion, and innovative workforce programs that expand the roles of nurse practitioners and physician assistants to ensure patients have timely access to care,” Theiler told The Lakeland Times this week.

For example, Theiler says Aspirus has been very successful in meeting behavioral health needs by leveraging the Medical College of Wisconsin-Central Wisconsin Psychiatry program in Wausau to fill several openings. 

State lawmakers have also been searching for policy solutions. For some years now, state Rep. Calvin Callahan (R-Tomahawk) has been lamenting the shortage and seeking legislative solutions. Callahan and his GOP colleagues finally succeeded this past session in enacting a bill that allows more internationally trained doctors to practice in Wisconsin, but Callahan had been sounding the alarm for years, and had introduced similar legislation since 2021.

That year, he characterized the situation in northern Wisconsin as urgent.

“In my district around Lincoln County, I already have constituents who must drive hours to see a specialist for appointments,” Callahan wrote in an op-ed. “Wait times for routine check-ups can be weeks. The healthcare system is already difficult to navigate, and a provider shortage will only make it harder to access medical care, especially in our rural communities.”

If it wasn’t already here, that shortage is now here, with the worst yet to come, and policymakers and health-care providers are scrambling for solutions. But solutions must derive from causes, and, as might be expected, the causes are many, and they come with multipliers.

The causes of the shortage

For one thing, the U.S. is aging fast. Between 2021 and 2036, the AAMC models show, the 65-and-over population is projected to increase by 34 percent. That means more chronic conditions, more specialist visits, more surgeries, and more primary care needs.

The bottom line is, an aging population means more demand. Meanwhile, doctors are aging, too — nearly 47 percent were already over 55 as of 2021, which means retirements are just around the corner.

And there is the burnout factor, which is especially acute in so-called medical deserts. In an article for the National Rural Health Association in June, Daniel Siegel of Synergy Health Partners observed that rural physicians are 82 percent more likely to experience burnout than other workers, leading to even faster retirements. By 2030, Siegel estimated, rural physician numbers are projected to decline by 23 percent more, even as patient demand grows.

Surgeon burnout presents an especially profound problem, Siegel wrote.

“Unlike urban hospitals that often have backup providers or specialized support, rural facilities operate with limited staff, meaning even a single surgeon’s reduced performance or departure can jeopardize surgical services for an entire region,” he wrote.

The burnout effects are amplified in rural areas where patients with conditions requiring urgent intervention — appendicitis, trauma, cancer — may experience worse outcomes or forego care altogether, Siegel stated.

“Furthermore, the loss of surgical capabilities may lead to the financial decline of rural hospitals, many of which rely on surgical procedures to maintain revenue streams,” he wrote. “This can trigger a cascading effect that threatens the viability of other departments, ultimately placing additional strain on the remaining health care workforce and creating a vicious cycle of overwork, dissatisfaction, and attrition that can lead to a heightened risk of hospital closures.”

The National Center for Health Workforce Analysis corroborated Siegel’s concerns about burnout, reporting that burnout among primary care doctors spiked from 42 percent in 2020 to 49 percent in 2023, with family physicians and internists ranking among the top five specialties for burnout.

The reasons are familiar: lower pay compared to specialists, the demands of paperwork and electronic records, and work-life imbalance. Surveys indicate that many physicians are reducing their clinical hours or leaving practice early.

For her part, Aspirus’s Theiler says rural settings have a smaller candidate pool and fewer medical training programs, which limit the number of providers exposed to practicing in smaller, rural communities. 

“Recruitment is further challenged by national competition for physicians, lifestyle preferences among younger doctors, and the limited number of residency slots available nationwide,” she says.

Still, there are upsides to rural settings, Theiler points out: “However, for those interested in a rural lifestyle, the Northwoods is regarded as an excellent option.”

The National Center for Health Workforce Analysis report also asserted that lower compensation was a serious issue in an emerging trend of medical students veering into specialty care rather than pursuing careers as primary care physicians.

“Primary care is among the lowest-paid physician fields,” the report stated. “Further, salaries for NPs and PAs working in primary care are lower than the average salaries of their counterparts outside of primary care. The average NP salary in 2021 was $113,000, and a reported average salary for NPs working in primary care was $100,820 in 2022.”

The 2023 median salary for all PAs was $130,020; PAs working in primary care earned a median annual salary of $115,000 in 2023, the report stated.

Another issue is that of training bottlenecks caused by a shortage in medical residency programs, which are required for physicians to earn their licenses. There is certainly no lack of medical students; in fact, medical school enrollment is at an all-time high — nearly 100,000 students nationwide, according to the AAMC. Medical school enrollment has grown steadily from 85,122 in 2014 to 99,562 students in 2024-25.

Yet even here, clouds may be forming on the horizon because enrollment is up, but student applications are down, possibly foreshadowing a downward trend in the numbers.

“The number of applicants declined for the third consecutive year, but at a slower rate than in previous years,” AAMC reported this year. “The 1.2 percent decline compares with decreases of 4.7 percent last year and 11.6 percent the year before. The number of applicants in 2024-25 reached the lowest total (51,946) since 2017-18.”

The rate of decline is not as precipitous as it might seem — student applications soared during Covid — but they are nonetheless below 2019-20 levels, from 53,369 applicants in 2019 to 51,946 in 2024-25.

The more pressing problem is the lack of residency slots, which has failed to keep pace with the number of medical graduates. In an editorial published this June in Cureus, “The Wrong Fix: Why America Doesn’t Need More Medical Schools to Solve the Physician Shortage,” Shaheen Lakhan, a board-certified neurologist who has earned bipartisan plaudits for his work, said the real problem began when Congress froze Medicare-funded residencies in 1997.

“In March 2025, 47,208 applicants (including U.S. MD and DO [doctor of osteopathic medicine] seniors and international graduates) vied for only 37,667 first-year residency positions,” Lakhan wrote. “A total of 9,541 qualified medical graduates went unmatched, unable to obtain a residency slot, and therefore unable to become licensed physicians.”

Such stories are far from rare, Lakhan wrote.

“Every year, thousands of graduates are left stranded by the shortfall of [residency] positions, a tragic waste of talent and ambition that also deprives patients of would-be physicians,” he wrote. “While a few unmatched graduates scramble into unfilled positions or reapply the next year, most face the grim reality that without residency, they cannot practice medicine in the United States.”

The bottom line was, Lakhan wrote, when all applicants are considered, only about 0.82 residency positions are available per applicant, meaning a significant fraction of doctors-in-training will inevitably go unmatched each year.

“The fix is not more medical schools, but more places to finish training the doctors we already have,” he wrote.

In other words, the “pipeline” is clogged, not at the start, but in the middle, and locally Theiler says Aspirus faces the same challenges.

“Current residency caps limit the number of physicians who can train in rural areas, which directly impacts the number who ultimately choose to practice here,” she said. “With more than half of rural physicians nearing retirement, this creates a looming gap.”

Theiler says Aspirus is addressing that situation by growing partnerships with academic institutions, supporting nurse practitioner and physician assistant education, investing in telehealth and creating pathways for students from rural communities to return home and practice locally. 

“We also partner with pipelines out of large midwestern cities where there are many training programs and host events for candidates to learn more about Aspirus and meet our practicing physicians,” she said.

The look ahead

Wisconsin — both the state and its health-care providers — is pursuing a number of strategies to combat the issue. 

For example, the University of Wisconsin’s Wisconsin Academy for Rural Medicine (WARM) is a program whose mission is to train students who will commit to working to improve health in rural communities, with the specific goal of addressing physician shortages in rural areas. 

While 28 percent of Wisconsin residents live in rural areas, WARM states, only 11 percent of physicians have rural practices. WARM reports that 82 percent of its graduates practice in-state, many in rural areas; 56 percent go into primary care; and 64 percent are in residencies in Wisconsin and bordering states. The state also funds the Wisconsin Rural Physician Residency Assistance Program (WRPRAP) and provides “Grow Our Own” residency expansion grants. 

In addition, the University of Wisconsin Department of Obstetrics and Gynecology Rural Residency Track has received a $750,000 grant from the U.S. Department of Health and Human Services (HHS) to support rural-specific training. Overall, HHS is making an $11 million investment in rural residency programs.

Then, too, Callahan’s push to allow internationally trained physicians to practice in Wisconsin was successfully enacted in 2023. As the Legislative Reference Bureau (LRB) states, his bill creates provisional licenses for internationally trained physicians to practice in the state, and physician assistants or physician associates who are licensed to practice internationally may apply for a license to practice as a physician assistant without having to satisfy certain educational requirements. 

Under the bill, provisional licenses to practice as a physician are automatically converted into permanent licenses after the license holder has practiced in the state and maintained good standing for three consecutive years, the LRB stated.

In testimony at a hearing on the bill last year, Callahan pointed out that, by 2030, Wisconsin will need 2,000 more physicians as nearly 40 percent of the state’s physicians reached retirement age.

“So, what can we do to recruit more physicians to our state and help solve this issue?” he asked. “We need to eliminate barriers to employment for already fully-licensed physicians. Right now, Wisconsin has a redundant residency requirement. To practice in Wisconsin, fully licensed physicians who have been trained in a foreign country must complete a residency in the United States. This, paired with a cap on the number of available residencies they must compete for with U.S. and international medical students, limits fully-licensed, foreign-trained doctors from even attempting to get past this barrier.”

The law eliminates the redundant residency requirements, Callahan said. 

“These doctors have already gone through the training in their home country, sometimes having practiced for many years,” he testified. “Importantly, these doctors must have an offer of employment in Wisconsin to pass by the requirement.”

At the same time, Wisconsin expanded the workforce mix in 2025 by granting full practice authority to advanced practice registered nurses (APRNs/NPs). Combined with loan repayment programs such as the National Health Service Corps, that expansion is designed to enhance access in areas of shortage.

On the provider side, over at Aspirus, Theiler says the hospital system uses a multifaceted approach. 

“We partner with medical schools and residency programs to expose trainees to rural practice early,” she said. “Word of mouth is a powerful recruitment tool and we know that 55 percent of residents stay where they are trained, so we leverage physician and advanced practice clinician referral programs to help fill our positions.”

Theiler said residency caps do affect the pipeline — fewer slots mean fewer physicians entering practice overall, and fewer choosing rural placements.

“That’s why we advocate strongly for expanded rural residency programs and invest in mentoring, career development and local training opportunities to keep talent in our communities,” she said.

Theiler said telehealth has also emerged as a lifeline, along with the use of nurse practitioners and physician assistants. With telehealth flexibilities extended through 2026, Wisconsin providers are especially using virtual care in rural settings. 

“Telehealth has become an essential tool in extending specialty care across our large rural geography, especially for mental health and specialty consultations,” she said. “At the same time, our nurse practitioners and physician assistants play an increasingly critical role in primary and specialty care delivery. By working in team-based models, they expand our capacity and help us maintain timely access to care.”

Another benefit of that model, Theiler says: “A majority of our advanced practice clinicians live in the communities they serve.”

Incremental moves are being made at the federal level as well. The Resident Physician Shortage Reduction Act of 2025 would, if enacted, add 14,000 new Medicare-supported residency slots over seven years, with an emphasis on rural placements. The AAMC calls it a “critical step.”

Meanwhile, the Trump administration included a $50 billion Rural Health Transformation Program in the federal budget reconciliation bill. However, a KFF analysis in July by Heather Saunders and colleagues observed that the enacted reconciliation package would reduce federal Medicaid spending by an estimated $911 billion over 10 years, and that senators from both parties have raised concerns about potential impacts on rural hospitals and other providers.

The $50 billion Rural Health Transformation Program was intended to address those concerns, the analysis states, but it noted that the $50 billion in funding over five years for state grants wouldn’t nearly make up for Medicaid cuts in rural areas.

“Under the reconciliation package, federal Medicaid spending in rural areas is estimated to decline by $137 billion, more than the $50 billion appropriated for the rural health fund,” the researchers wrote. “Building on separate KFF estimates of state-by-state Medicaid cuts, this analysis estimates that federal Medicaid spending in rural areas could decrease by $137 billion over 10 years — about $87 billion more than is appropriated for the rural health fund.”

Back home, whatever the impact of state and federal policies might be, Theiler says Aspirus is pro-actively planning for the future.

“We are planning ahead by expanding the scope of practice for advanced practice clinicians, embedding telehealth into standard care, and building strong residency and fellowship ties to rural rotations,” she said. “We also prioritize retention — supporting physicians with resources, team-based models and leadership opportunities so they can build long careers in our communities.”

At the same time, she said, the system is investing in local pipelines, encouraging students in the region to pursue medical careers and come back to serve where they grew up.

In sum, health care providers and policymakers alike can see the radar and know the storm of physician shortages is coming, with the outer winds of the storm already buffeting the region. The challenge — and the cautiously optimistic hope — is that, working together, the policies and practices now being aggressively pursued will be enough to withstand the gale.

Richard Moore is the author of “Dark State” and may be reached at richardd3d.substack.com.