How Government Creates Shortages of Doctors

France, the Netherlands and the United States limited slots for medical students.

Patients wait to see a general practitioner in Westmaas, the Netherlands (LHV)

Rural France is running out of doctors. Politico Europe reports that 7 out of 68 million French citizens don’t have a referring general practitioner. 30 percent live in a region where access to physicians is poor.

France is not alone. Small towns in the Netherlands and the United States are also medically underserved.

Partly the shortage is due to young doctors and nurses preferring to live and work in cities, much like young professionals in general.

Higher-than-usual burnout rates during the pandemic exacerbated the shortage.

But government policy also plays a role. All three countries for years kept the supply of doctors low while demand for health care, as a result of longevity and advances in medicine, went up.

France

France scrapped a cap on medical school slots in 2020. (Another long-overdue liberalization thanks to Emmanuel Macron.)

From 1971, the country had limited the number of medical students who could advance beyond their first year under the so-called numerus clausus. In 1972, the number was put at 8,600. It fell to a low of 3,500 in 1993 before climbing back up to 7,000 in 2007 and 8,000 in 2017.

Proponents argued the cap would control costs, but this never made sense. People don’t choose to get sick. Reducing the supply of health professionals doesn’t reduce demand for their services.

France’s medical association knew that. They supported a cap not in spite of the shortages it would cause, but because of it. It meant doctors could raise their fees.

It will take years to make up the shortfall. France has fewer doctors per capita than its neighbors: 33 per 10,000 compared to 41 in the Netherlands, 44 in Germany and Spain, and 55 in Portugal.

Netherlands

Dutch universities still cap the number of first-year dentistry and medical students. Here it’s called the numerus fixus. This year there are 243 slots in dentistry and about 3,000 in medicine.

There is no shortage of surgeons, but the Netherlands has a shortage of general practitioners. One in three are understaffed. It is not uncommon to move into a new town and be refused by the local GP. This most often happens in Drenthe and Zeeland, two lightly populated provinces, and the Achterhoek, a region on the border with Germany.

To fill the gaps in dentistry, practices recruit abroad. One in five dentists working in the Netherlands were educated elsewhere, often in an EU country like Portugal or Spain. Still there aren’t enough.

The government regulates prices, since basic dental procedures aren’t covered by insurance. When it lifted price controls in 2012, dentists more than doubled their rates.

United States

The United States has the fewest doctors per capita among rich nations: 26 per 10,000.

It used to be the other way around: before Congress curtailed medical residency slots in 1980 — an American version of the numerus clausus — the United States had relatively more doctors than other democracies.