The Health Resources and Services Administration projects a shortage of more than 81,000 full-time equivalent physicians by 2035, with 26 of 36 specialties expected to face deficits. Here is what the data shows about which fields are most exposed and why.
1. Thoracic surgery faces the most acute gap of any specialty. HRSA projects supply adequacy — the ratio of available physicians to projected demand — will fall to 69% in thoracic surgery by 2035, meaning the field will meet less than 70% of patient demand. The Society of Thoracic Surgeons estimates 900 cardiothoracic surgeons will retire by 2035 while overall demand rises 20%, producing a projected 31% shortfall. Fellowship training produces a limited number of new entrants each year, and no surge in the pipeline is projected.
2. Ophthalmology is close behind, with a structural retirement cliff. HRSA projects ophthalmology supply adequacy at 70% by 2035. More than one-third of practicing ophthalmologists are currently over 60. A 2022 analysis found that roughly 550 ophthalmologists retire each year while only about 450 complete residency programs — a net loss that compounds annually. Plastic surgery (75% adequacy) and nephrology (79% adequacy) round out the surgical and medical specialties with the deepest projected gaps.
3. Psychiatry is facing a supply collapse as demand grows. The American Psychiatric Association projects supply of adult psychiatrists will fall 20% by 2030 while demand rises 3%, leaving a shortage of more than 12,000 fully trained psychiatrists. HRSA’s January 2026 projections estimate a national shortfall of 43,660 adult psychiatrists by 2038. More than 60% of active psychiatrists are currently older than 55. More than half of U.S. counties already lack a single psychiatrist, and 40% of the U.S. population lives in a federally designated mental health professional shortage area.
4. Primary care faces a gap that residency expansion alone cannot close. The AAMC projects a shortage of between 20,200 and 40,400 primary care physicians by 2036. HRSA puts the 2035 demand for new primary care physicians at more than 44,000. Closing that gap would require residency production in family medicine and general internal medicine to increase by roughly 21%. HRSA estimates that even continuous graduate medical education expansion at a rate of 200 positions per year would offset less than 10% of the growing total shortage.
5. Rural communities will experience these shortages far more acutely than national figures suggest. HRSA’s 2023–2038 projections show that supply adequacy across all physician specialties will fall to 42% in nonmetro areas by 2038, compared to 95% in metro areas. For surgical specialties concentrated in academic medical centers, patients in smaller communities may find no local access even as aggregate national supply remains nominally higher. A Yale School of Medicine study published in October 2025 found physician attrition rates climbed from 3.5% to 4.9% between 2013 and 2019 — a trend that, if it continues, would push projected shortfalls well above current estimates.
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