FSMB Census of Licensed Physicians in the United States, 2022

The public health emergency for COVID-19 that was declared in the US on January 31, 2020, by US Secretary of Health and Human Services Alex Azar formally expired on May 11, 2023.¹  The COVID-19 pandemic had a profound and lasting impact on health workers, patients, medical students, and regulators. It strained healthcare systems, disrupted routine services, magnified existing health disparities, contributed to an increase in mental health conditions and heightened the importance of public health measures.^2–4  The pandemic also highlighted the need to better support healthcare workers as concerns over physician wellness and burnout were further exacerbated.⁴  One of the most remarkable changes for physicians and their patients during the emergency was their increased utilization of telehealth and telemedicine, as opposed to in-person care, as many patients were fearful of visiting a doctor's office or a hospital emergency department and acquiring the SARSCov2 virus that causes COVID-19. As the pandemic progressed, the use of telehealth became even more commonplace, and its use remains about 38 times higher than before the pandemic began.⁵ 

To provide telehealth and more conventional health-care services, of course, physicians are required to maintain a medical license in the jurisdiction where their patients are located. Governed and statutorily regulated by their respective Medical Practice Acts, medical boards in all 50 states and its territories regulate the practice of medicine by licensing qualified healthcare professionals. The Federation of State Medical Boards (FSMB), founded in 1912, supports these boards as they advance patient safety and promote quality healthcare through data-driven approaches for uniform licensure assessment, education, advocacy, and research. Since 2010, the FSMB's biennial census of licensed physicians has helped medical regulators and healthcare policymakers stay informed of physician workforce trends as they consider ways to encourage public safety and physician wellness while addressing growing demands for healthcare services with increased physician supply.^6–11 

This paper marks the seventh biennial census of licensed physicians in the US by the FSMB and provides valuable information about the nation's available physician workforce, including information about the number of licensed physicians, the type of medical degree, location of undergraduate medical education, specialty certification status, sex, and age. Data in the current census are compared with data from the FSMB's 2010 physician census to illustrate how the physician population has grown and diversified, and to suggest how the current licensed physician population fits into the larger discussion of the physician workforce as the healthcare community seeks to address supply and demand issues for an aging nation.

Data for this census was retrieved from FSMB's Physician Data Center (PDC), a secure national repository of medical licensure, disciplinary, educational, and demographic data for all physicians actively licensed to practice medicine in the US, the District of Columbia, and the US territories of Guam, Northern Mariana Islands, Puerto Rico, and the Virgin Islands. To maintain the most up-to-date physician information possible, FSMB's PDC regularly receives data directly from state medical boards and partner organizations such as the NBME, the American Board of Medical Specialties (ABMS), the American Osteopathic Association (AOA), and the US Department of Health and Human Services. While specialty certification is not an absolute requirement for physicians to obtain a medical license in the US, the credential is recognized by hospitals and healthcare organizations throughout the country and provides useful information to state medical boards and the public about a physician's training and level of expertise in one or more medical or surgical specialties.

Physicians with active, full unrestricted licenses to practice medicine in the US and the District of Columbia during the 2022 calendar year were reported in this census. Temporary and limited licenses were excluded as were training licenses for residents and fellows and transitional licenses for assistant or associate physicians when such licenses could be clearly identified. This methodology is consistent with previous physician censuses published by the FSMB.^6–11 

There are 1,044,734 physicians (who possess a total of 1,540,283 licenses to practice medicine) in the US and the District of Columbia. This represents a physician workforce that is 23% larger than it was in 2010, when there were 850,085 licensed physicians. This physician workforce now serves a national population of more than 333 million people,¹²  representing a physician-to-population ratio of 313 licensed physicians per 100,000 people, an increase from 277 in 2010. Growth in the physician population, as in previous years, is largely derived from newly licensed physicians first entering the workforce pipeline. State medical boards issued 129,427 new licenses in 2022, a record high, and 27% more licenses than in 2020. Among these were 31,504 medical licenses issued for the first-time to physicians.

Since the FSMB began tracking the licensed physician population in 2010, the physician population has grown, diversified, and aged as reflected in categorizations of the physician population by medical degree, location of undergraduate medical education, specialty certification, age, and sex (Table 1). The vast majority (89%) of physicians have a Doctor of Medicine (MD) degree and 11% have a Doctor of Osteopathic Medicine (DO) degree. Although licensed physicians with an MD degree comprise a substantial amount of the physician workforce, the number of licensed physicians with a DO degree continues to grow at a much faster pace. Between 2010 and 2022, the number of licensed osteopathic physicians increased by 89%, compared with an 18% increase for MDs. The number of physicians holding specialty certifications in their area of medical expertise has also increased over time; 85% of licensed physicians are now board-certified by either the ABMS or the AOA, up from 77% in 2010.

The licensed physician population represents a broad geographic cross-section of the US, in terms of where they received their (undergraduate) medical school education. Licensed physicians graduated from 2,200 medical schools in 169 countries. Slightly over three-quarters (77%) of licensed physicians are US or Canadian medical graduates (collectively referred to as USMGs) while 23% are international medical graduates (IMGs). The largest number of licensed IMGs in the US graduated from medical schools in India (21%), followed by the Caribbean (20%), Pakistan (6%), the Philippines (5%), and Mexico (4%) (Figure 1).

While the overall number of licensed physicians from domestic and international medical schools has increased by 24% and 27%, respectively, between 2010 and 2022, physicians graduating from medical schools in the Caribbean has been the largest growth segment by far, with a 115% increase since 2010. Within this group, there has also been sizeable growth among licensed physicians from the Caribbean who are US citizens, increasing from 48% in 2010 to 67% in 2022 (Figure 2).

The number of licensed female physicians continues to increase, although men still comprise the majority of all licensed physicians. In 2022, 37% of the physician workforce were women, compared to 30% in 2010. The licensed female physician population has increased by 54%, compared to an 11% increase for male physicians since 2010.

The average age of licensed physicians continues to gradually rise since this metric was first reported by FSMB in 2010. The mean age of licensed physicians is now 51.9 years, more than a year higher than the mean age of 50.7 that was reported in 2010. The number of licensed physicians aged 60 years and older has increased by 54% between 2010 and 2022, compared with only a 19% increase for physicians aged 49 years and younger (Figure 3). Average ages vary considerably when looking at physician sub-populations: MDs are, on average, 52.6 years old compared to DOs, who are 46.1 years old on average; USMGs are, on average, 51.6 years old compared to IMGs, who average 52.9 years; and male physicians are 54.3 years old on average, compared to female physicians, who are 47.8 years old on average.

Additional analysis of the data by sex and age shows that a greater percentage of female physicians fall within younger age categories than male physicians—31% of female physicians are less than 40 years in age, compared to 20% for male physicians. By contrast, 38% of male physicians are age 60 years and older, compared to only 19% of female physicians (Figure 4).

Accurate information about the number (and demographic composition) of the physician workforce has historically been an important component of discussions about healthcare access. With disruptions resulting from the COVID-19 pandemic, and aging national and physician populations contributing to anticipated physician shortages or, at a minimum, a maldistribution of physicians throughout the country, there is clear benefit for a recurring and up-to-date census of the nation's licensed physician work-force. Comparing the current physician workforce with the FSMB's first census in 2010 helps contrast and compare how the licensed physician population in the US and the District of Columbia has grown and diversified. In addition, the age distribution of the general US population has important implications for a range of social and economic issues, including healthcare supply and the strain that an aging population places on the healthcare workforce.

Notwithstanding recent declines, which were driven predominantly by deaths from COVID-19 and drug overdoses, the average life expectancy in the US has risen significantly during the past six decades, increasing by nearly seven years since 1960 to 76.1 years for the overall population.^13,14  Coupled with falling birth rates over the past five decades,¹⁵  this has created a demographic shift in the US, one characterized by a larger proportion of older adults compared to younger age groups.

The US population of adults 65 years and older is expected to grow by 42% by 2034,¹⁶  and will further challenge the stability of a strained healthcare system. Individuals 65 years and older, according to estimates, tend to use significantly more healthcare resources and have, on average, 7.1 office visits to a physician each year compared with 3.2 visits for the population as a whole.¹⁷  Similarly, hospitalization rates are highest among this segment of adults, as individuals 65 years and older will, on average, have $7,030 in annual healthcare expenditures compared to $3,404 for adults 25 to 34 years old.¹⁸ 

The physician population is aging in parallel with the general population. The average age for licensed physicians in the US continues to rise steadily; the 2022 FSMB census reveals a mean age of 51.9 years, compared to 50.6 years in 2010. Furthermore, 22% of the physician population is 65 years of age or older, widely viewed as the traditional retirement age in the US.

Burnout and Early Retirement. An aging population, residual stress from the pandemic and other employment-related factors are clouding the physician retirement picture throughout the US. Higher levels of physician burnout during the pandemic prompted questions about whether more physicians will opt for early retirement; an estimated 63% of physicians experienced at least one symptom of burnout during the pandemic.⁴  A 2022 survey of physicians and healthcare administrators found that 40% of medical practices had a physician retire early or leave the practice due to burnout, up from 33% in 2021.¹⁹  Most physicians, however, attribute their burnout to dissatisfaction with their current employer (62%), and only 25% attributed it to COVID-19 pandemic stress. Poor communication, administrative burdens, micromanagement, overwork, and a lack of recognition were among the more common factors cited for physician dissatisfaction about their employers.²⁰ 

Supply and the Physician Pipeline. Considering population demographics, disease prevalence, healthcare utilization patterns and policy changes, the Association of American Medical Colleges (AAMC) regularly publishes physician workforce projections forecasting the future supply and demand of physicians in the US. The AAMC's most recent report projects a shortage of primary care physicians between 17,800 and 48,000 by 2034 as well as a shortage across the nonprimary care specialties between 21,000 and 77,100 physicians, and a significant shortage in surgical specialties between 15,800 and 30,200 physicians by 2034.¹⁶ 

The pandemic spurred changes in assessment, undergraduate medical education, and residency programs for students on the path to obtain a medical license. The United States Medical Licensing Examination and the Comprehensive Osteopathic Medical Licensing Examination, for example, at first postponed and eventually eliminated a performance-based exam using standardized patients for all medical students, and many educational programs throughout the country temporarily moved to online instruction.^21,22  While some medical students had limited access to clinical practice, others experienced an accelerated track to healthcare's frontlines during the pandemic.² 

Medical students and physicians in training adapted and largely took on unexpected challenges throughout the pandemic, and US medical school enrollment and matches to residency programs are again on the rise. The 2022-2023 academic year enrollment numbers reached all-time highs of 96,520 medical students, and the National Resident Matching Program—the ranking system designed to match applicants to positions in US residency programs—had its largest number of applicants and matches to-date this year.^23,24 

The nation's healthcare system faced several hurdles during the COVID-19 pandemic and prolonged challenges remain as aging in the general and physician populations create increased demand for healthcare resources and amplify workforce supply concerns. There are, however, reasons to be cautiously optimistic. The US remains at the forefront of advances in medical technology and medical school enrollment is on the rise. During the pandemic, large numbers of practicing physicians, medical students, and other advanced practice clinicians demonstrated incredible resilience and an impressive ability to adapt. Medical licensing boards also showed they could respond quickly to a crisis through expedited licensure, license renewal flexibility, and by providing resources to support healthcare workers and the public. Efforts to expand telehealth services have improved access to healthcare, particularly in rural and underserved areas, and the Interstate Medical Licensure Compact (IMLC) has enabled greater healthcare access by expediting eligible physicians to be licensed to practice medicine in multiple states. The IMLC was created before the pandemic but enabled more than 15,000 physicians to deliver healthcare across state lines, whether in person or via telemedicine.²⁵  As the nation progresses through the demographic and digital transformations ahead, striking a balance between meeting the healthcare needs of an aging population and the wellness concerns of an often-overworked physician will be difficult but essential. Reviewing the number and demographic composition of the available physician workforce is an important contributor to those conversations.

The authors would like to thank Bradley Dunn, Cassandra Davis, Elisabeth Davis, Lucie Maomanivong, Christine Scheeler, Dustin Dollar, Cyndi Streun, Jill Putnam, Christine Wells and Drew Carlson for their assistance with the preparation of this manuscript.