Chris Denson
Columnist
Georgia’s doctor shortage is large, and growing larger. Facing that fact is crucial if policymakers are to address the problem. So is rejecting the pervasive inclination to continue building our physician workforce “the way we’ve always done it.” Here’s how bad the situation is. With about 28,000 practicing physicians serving more than 11 million people, Georgia’s physician-to-patient ratio is 23% worse than the national average. And yet, just to maintain even that poor ratio, our state must add more than 8,000 physicians – including 2,100 in primary care alone – within the next five years. Worse still, as the overall population grows and ages, and as more physicians reach retirement age, that need could grow.
The Georgia Public Policy Foundation has been sounding this alarm for years. Most recently, we testified before a House study committee on how other states utilize various healthcare professionals to supplement access to physicians in underserved areas. It’s not as if lawmakers have ignored the problem. In recent years, the state has taken steps to expand opportunities for physician training. In addition to the University of Georgia Medical School, scheduled to welcome its first class in fall 2026, the state legislature added $20 million to last year’s budget for new graduate medical education (GME) programs at hospitals south of State Route 540, the “Fall Line Freeway” that runs from Columbus to Augusta. This year’s budget includes $3 million for 150 new residency slots in primary care medicine. The state also submitted a proposal in June for $2.5 billion in total funds from the federal government for new GME slots. According to the Department of Community Health, this new Directed Payment Program will “require providers to invest significant funding from this revenue in programs such as creating new graduate medical education slots, achieving higher retention rates of Georgia-trained physicians and expanding OBGYN services throughout the state.”
However, even with these efforts, we must acknowledge that it still takes on average seven years of education and training before a primary care physician is fully licensed and can begin treating patients independently. If that is Georgia’s only avenue for providing more primary healthcare, it will not be able to keep up with retirements and other changes in the workforce.
Across the country, we see that states are utilizing five other types of healthcare providers to help address their own physician shortages: internationally licensed physicians (ILPs), graduate assistant physicians, pharmacists, nurse practitioners and physician assistants.
ILPs are foreign- trained physicians who are currently licensed to practice in another country and are in good standing. Today, these physicians must complete a multiyear residency before they are allowed to practice in Georgia, in which they compete against domestic medical school graduates for a finite number of spots.
Eighteen states currently provide foreign physicians a nontraditional pathway to practice, including Tennessee, Florida and North Carolina. Yet, legislation allowing them to practice under a supervised provisional license in place of the traditional residency program failed to make it out of the Georgia Senate in 2024 and 2025.
Graduate assistant physicians are medical school graduates who fail to match as residents, but can practice in what is essentially a preceptorship under physician supervision for a set period, typically one or two years, while they wait to reapply for residency programs. Twelve states currently have a version of this program, including Alabama, Florida and Tennessee, and all of them require these graduate assistant physicians to practice in a rural or underserved area.
Nurse practitioners (NPs) are allowed to treat patients without physician supervision in 28 states and the District of Columbia, while physician assistants (PAs) are allowed to practice independently in eight states. Of note, bills that expand the “scope of practice” of these healthcare providers remain some of the more politically contentious.
Utilizing pharmacists to the full scope of their training through a “standard of care” model is a quickly evolving concept at the state level that recognizes their presence in many rural communities. Currently, five states allow pharmacists full authority in the areas of drug administration, laboratory testing and independent prescribing.
While Georgia works to directly address its physician shortages, other states are providing a guideline for ways to increase access to primary care throughout underserved communities.
Chris Denson is the director of policy and research at the Georgia Public Policy Foundation.