The authors point out that more than 2.7 million Georgians live in primary care health professional shortage areas, and the state’s physician-to-patient ratio is 23% worse than the national average. By 2030, Georgia could face a shortage of more than 8,000 physicians.
The state’s response has included expanding medical education; the University of Georgia’s new School of Medicine, for example, adds 64 medical school seats. However, the authors point out that the problem is not confined to the number of students who can get into medical school, saying the pathway into medicine has bottlenecks at nearly every stage, from the cost and complexity of applying to medical school to the availability of residency positions after graduation. According to the article, Georgia has only 167 primary care residency slots each year. About one-third of those residents ultimately leave Georgia to practice elsewhere. And at the same time, state funding for primary care residency positions and rural specialty programs has been reduced.
A functioning workforce pipeline requires policymakers and institutions to look across the entire journey — from who has access to the field in the first place to who makes it through training, where graduates complete their clinical education and, ultimately, where they choose to work.
As states continue to turn to higher ed to produce more graduates in high-demand fields like teaching, nursing, and behavioral health sciences, there is a need for more coordination between institutions and local and national government to ensure those graduates can become employed in their fields. The cost and opacity of applying to medical school is also a barrier, as students who can afford expensive applications and advising — or who have access to people who already understand how the system works — have advantages over equally capable students who do not. We cannot simultaneously lament shortages in critical professions and continue to build and uphold pathways that are easiest to navigate for people who already have money, information, and professional networks.
Georgia's lesson, then, is not simply that the state needs more doctors. It is that capacity at one point in a pipeline cannot compensate for barriers and shortages elsewhere in it.
When a state invests in a new academic program or increases seats in an existing one, leaders should be asking more than how many students it can accommodate and look more broadly at the bigger questions: Are there enough clinical placements to support graduate training? Is there enough funding to support postgraduate training positions? Has the institution invested enough financial support to make the pathway accessible to all who may be qualified? What incentives exist to keep graduates in the state — and, critically, in the communities where they are needed?
Higher education cannot solve every workforce problem alone, but institutions can push back against state leaders treating workforce development as a series of disconnected enrollment targets.
Georgia’s physician shortage is a case study for what happens when goals are disconnected from outcomes. Higher ed leaders are susceptible to the same traps, setting enrollment goals by program or college without asking whether those goals collectively advance the institution’s larger objectives.
An institution that aggressively grows a program because it is attracting students, for example, may discover that it lacks enough faculty, clinical placements, or upper-level courses to support those students through completion. A university may celebrate growth in a high-demand major without asking whether students are actually completing it — or whether graduates are entering the workforce the program was designed to serve.
The lesson is not that enrollment growth is bad. It is that enrollment is only one measure within a system, not the system itself.
Higher education cannot solve every workforce problem alone. But institutions can help states — and themselves — stop treating workforce development, enrollment, retention, completion, and institutional strategy as separate exercises.
Are institutions enrolling the students they have the capacity to educate? Are those students able to complete the programs they entered? Are programs producing graduates for the fields and communities where they are needed? And are institutional incentives aligned closely enough that growing one piece does not undermine another?
Georgia's physician shortage offers a useful warning that a pipeline is only as strong as its narrowest point. And whether the goal is producing physicians or building a sustainable institution, adding capacity in one place does not fix a bottleneck somewhere else.
