Many conversations about the U.S. healthcare workforce start with the same word: shortage. Legislators want to fund more residency slots. Medical schools are expanding enrollment. Policy papers project the deficit and call for structural reform.
I understand the instinct. But as a practicing physician who has worked inside the system for years, I want to offer a more inconvenient observation: we are not running out of doctors. We are running a system that is remarkably effective at preventing qualified physicians from doing the work they trained for.
The framing matters because it determines the solution. This isn’t a supply problem. It’s a distribution problem. The physicians exist. The system just isn’t getting them where they need to be. If you treat it as a supply problem, you fund more residencies. That takes a decade to produce results and does nothing for the patient who needs care today. If you treat it as a distribution problem, you remove the administrative barriers preventing trained physicians from working where they are needed. That is addressable now.
Consider the data on who is actually leaving. According to McKinsey’s most recent U.S. physician survey, approximately 35% of physicians say they are likely to leave their current roles in the next five years, with roughly 60% of those expecting to leave clinical practice entirely. That is not a pipeline problem. Those physicians are trained and credentialed. The system is making it too difficult for them to work.
The administrative process of connecting a physician to a new facility or opportunity is the actual constraint. When I look at the data on where physicians say the friction is concentrated, credentialing consistently ranks near the top. A Deloitte survey of physicians found that 64% identified provider credentialing as one of the biggest opportunities for workflow improvement, alongside prior authorizations and communications with pharmacists. Physicians are not complaining about the existence of credentialing. They are pointing to it as a process that is broken and ripe for technology-enabled change.
There are physicians picking up additional shifts, taking on telehealth gigs, actively looking for more opportunities to contribute. Forbes and other outlets have started writing about the physician side gig as a growing phenomenon, with data suggesting 40 to 50% of doctors are picking up additional work outside their primary roles. These are not burned-out physicians trying to escape medicine. They are physicians who want to work more and are being slowed down by paperwork.
McKinsey’s data reinforces what clinicians already know firsthand: 51% of physicians identify schedule flexibility as a key retention factor, yet only 59% of workplaces are actively pursuing such enhancements. The gap between what physicians want and what the system provides is not a funding gap. It is a friction gap.
Healthcare was largely built by people with administrative and business backgrounds, not clinical ones. That means the infrastructure reflects those priorities. The result is a system where the people best positioned to deliver care spend an enormous amount of time navigating processes that have nothing to do with care delivery.
Getting the diagnosis right is the first step toward the right treatment. We do not need more doctors as urgently as we need the ones we already have to be able to work.
Photo credit: Chinnapong, Getty Images
Marc Ayoub, MD, is the founder of Saile an Assistant Professor of Neurosurgery at the Donald & Barbara Zucker School of Medicine. A practicing neurocritical care physician, he built Saile as a healthcare staffing and credentialing platform that functions like a universal credential passport and direct‑to‑facility marketplace. so clinicians can take their file anywhere, plug into shifts faster, and help facilities unlock local talent without relying on expensive, legacy agency models.
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