Care gaps are the difference between the healthcare you need and the care you actually receive. You’re probably already familiar with the routine if you have a health condition that leads to chronic pain. You spend six months waiting for a specialist, your condition continues to spiral out of control while you wait for appointments, and your chronic pain is dismissed for years as physicians try to get you out of their offices as fast as possible during 15-minute visits.
Care gaps in healthcare, when explained for patients, come down to this: You need something, a screening, follow-up, or medication adjustment, and you don't get it. Sometimes you can't find a doctor who understands your condition at all. Sometimes the doctor you find doesn't have time to listen, hasn’t received your records from specialists, or was trained on outdated information.
These gaps are dangerous for patients with chronic diseases. For example, patients with hypertension end up in the ER without regular access to a competent doctor. Care gaps in diabetes management can lead to preventable complications without regular doctor visits. Women with daily headaches are told “it’s just migraines” for years when the problem is actually a cerebrospinal fluid (CSF) leak.
Pain patients abandoned by specialists are left with nowhere to turn.
The U.S. is currently facing a physician shortage that’s expected to reach 86,000 doctors by 2026. Nearly a quarter of adults report dealing with chronic pain, but applications for pain medicine fellowships dropped 45 percent between 2019 and 2023.
If you’ve ever wondered why patients often have to wait months for an appointment with a doctor, it’s caused by the physician shortage that’s the result of a hiring system that’s legally protected from competition.
Here's where it gets infuriating. Every year, medical graduates are assigned to residency positions through the National Resident Matching Program (NRMP), known as “the Match.” They can't negotiate their salaries or where they work. They get assigned, and it’s pretty much a take-it-or-leave-it situation.
These residents will not be able to practice medicine as a licensed physician as things stand in the US if they choose to leave the offer and never complete a residency.
In March 2026, the House Judiciary Committee released a report calling this practice exactly what it is: a monopoly. The report found that the Match "exercises monopolistic control" and found its anticompetitive conduct "contributes to the existing physician shortage, and leads to worse patient care."
This isn’t the first time attention has been brought to the NRMP’s monopolistic practices. Residents sued the program in 2002, arguing the Match violated antitrust laws by suppressing salaries and eliminating competition. Unfortunately, Congress stepped in with the Pension Funding Equity Act of 2004, exempting the Match from antitrust scrutiny. The case was dismissed, and the monopoly stayed intact.
The Match monopoly isn’t just a problem for medical school graduates looking to practice; it also limits the quality of care you receive. Here’s how the match monopoly affects your healthcare as a patient.
Residency programs don’t have to update what they teach when they don’t have to compete for students as employed trainees. Residents learn to keep their heads down. Medical residents are typically more concerned about surviving the program so they can practice medicine, which is why they are usually afraid to challenge attending physicians.
We've seen this firsthand at MedicalOfficeMarketing.org. We hired newly matched residents, who are called PGY1s, which stands for Post-Graduate Year 1; in other words, their first year of residency. We planned to work with these PGY1s on a project on spinal CSF leak patient experiences. Several residents asked to remain anonymous. Others backed out entirely, terrified that being associated with patients improving the medical education system could jeopardize their residency spot. That's the impact of monopoly culture.
The result? A shortage of physicians, and moreover, that these physicians are terrified to learn outside the box. This leads to poor working conditions even after these doctors have completed their residencies. Rushed doctor visits create care gaps as physicians see as many as 30 patients daily in 15-minute windows, while sorting through fragmented records. Care coordination gaps between specialists and PCPs mean your endocrinologist doesn't know what your cardiologist prescribed.
There's good news: change is slowly creeping in. State alternative pathway legislation for unmatched doctors is expanding. As of 2026, at least 12 states have created new licensure categories for unmatched graduates. Nineteen U.S. states have created laws allowing qualified international medical graduates (IMGs) to obtain licensure and practice without repeating a U.S. residency in an attempt to combat physician shortages, especially in rural areas, by utilizing experienced foreign doctors. This legislation is now expanding in states, such as California, where legislation has been proposed to allow U.S. citizens who are MDs or DOs and who could not match into a residency to have alternative training pathways with supervision to be able to practice in some capacity with careful oversight and success monitoring.
These alternative pathways for unmatched physicians are closing care gaps in rural areas where healthcare resources are sparse. These doctors see the same patients year after year and notice when something doesn't add up, like the woman whose headache never went away after a lumbar puncture 15 years ago, despite what their residency taught about "magical self-healing." Being in a rural setting is known to theoretically have a higher potential to push physicians to be more accountable to the small communities who know them well, to see patients long-term, and to be more resourceful.
If these alternative pathways in primary care in rural settings do come to fruition, the trainees of these programs have great potential to bring a measure of accountability with them if they eventually choose to progress in their careers and apply for a traditional residency in the future. If they match into a residency in the future, after having had a career as a supervised physician with some but not all privileges in a rural setting, they will bring unique knowledge with them compared to the fresh-faced residents straight out of a prestigious U.S. medical school.
These physicians who took the alternative pathway first will know what chronic disease looks like unmanaged. They will know that care gaps for patients taking multiple medications aren't abstract concepts. And when an attending physician repeats a medical myth, these residents will eventually have the confidence to say, "Actually, I've seen differently." Part of that confidence will be because the residents know that they have options to practice medicine beyond just the traditional residency at that point.
Here’s how to identify care gaps in your own healthcare while reform inches forward:
The House Judiciary Committee's March 2026 report puts on the record what patients and unmatched graduates have known for decades: the Match monopoly worsens the physician shortage and lowers the quality of care provided in the U.S. The committee states Congress can repeal the antitrust exemption and will continue oversight for reform. Now’s the window to force change with public comment and pressure.
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