In 2024, more than 7,000 medical school graduates—highly trained, rigorously educated, and ready to care for patients—found themselves locked out of the next critical phase of their careers: residency. The bottleneck, where there are significantly fewer residency slots than medical graduates, has left thousands of would-be physicians stranded in professional purgatory, their skills unused even as the nation faces mounting healthcare shortages.
But there is a way for these unmatched medical graduates to enter the workforce while expanding healthcare access: practicing as Associate Physicians. Some states are already embracing this reform to varying degrees, as the Goldwater Institute and the Beacon Center of Tennessee examine in their new report, Removing Barriers for Associate Physicians to Expand Healthcare Access. Rather than wait another year to reapply for a residency program, these medical graduates practice under the supervision of a licensed physician, bringing their clinical skills and medical education into real-world settings.
Over the past decade, 11 states have embraced Associate Physician licensing, with eight currently offering the license and seven more proposing similar reforms in 2024. By integrating these highly trained professionals into clinical settings, states can alleviate physician shortages, expand access to care—particularly in underserved areas—and prevent the unnecessary waste of medical talent.
The movement, though promising, remains in its infancy. Regulatory barriers continue to hinder widespread adoption, making Associate Physician licensure difficult to obtain. For policymakers considering this reform, it is critical that they maximize the applicant pool by allowing the role of Associate Physician to become a career. They should also reduce supervisory burdens on licensed physicians. Many physicians want to serve as supervisors in an effort to support their field, but are often overburdened by professional and bureaucratic demands that make it nearly impossible.
A comprehensive analysis by Goldwater identified five strategic interventions that could significantly lower entry barriers for medical graduates seeking Associate Physician licensure:
1. Include a Wide Population of Applicants
States with broader eligibility for Associate Physician licensure see higher license usage. Including international medical graduates could help states produce more Associate Physicians to care for the population.
2. Place No Constraints on Where They Can Practice
Limiting Associate Physicians to rural areas reduces workforce participation due to logistical challenges.
3. Treat It as a Life Profession
No matter why graduates are unable to complete a residency, alternative pathways should exist for individuals who complete medical school and want to apply their training in the workforce. Whether they use the license as a pathway to residency or pursue it as a career, this role should have no cap on the number of years an individual can work and practice.
4. Do Not Mandate Applications to a Residency Program
Half of the states with Associate Physician licenses require medical graduates to reapply and be unsuccessful in the MATCH. There are several reasons individuals may not want to do a residency program or depart from a residency early.
5. Decrease Burdensome Requirements for the Supervising Physician
States should ease restrictions on licensed physicians supervising Associate Physicians. Burdensome rules—such as mandatory pre-existing relationships, extensive training, and board-mandated agreements—deter physicians from taking on supervisory roles. Simplifying requirements would encourage participation and expand the workforce.
Free-market solutions offer a viable path to addressing the nation’s healthcare shortages.
Granting non-residency medical school graduates the ability to put their skills to work would help fill the growing gap in medical access, especially for those who need it most. Even modest reforms have measurable impact. A 2023 Cato Institute study found that Missouri’s addition of 292 Associate Physicians expanded its primary care workforce by 3%.
Unlocking this untapped resource requires action, however. Without meaningful reform, the cycle of wasted medical talent will continue, leaving patients without access to care. States must act decisively—lowering bureaucratic barriers, incentivizing physician supervision, and integrating Associate Physicians into the healthcare system. If policymakers seize the moment, they can transform bureaucratic bottleneck into a powerful solution for America’s healthcare shortage.
You can read the report here.
