The First Reform Is Always Execution
There is a reflex in policy advocacy to reach for the big new bill — the expanded program, the higher cap, the sweeping reform. It feels like progress. Often it postpones it.
Take the physician workforce. Before a state lobbies to expand its waiver capacity, it should ask how many of its current slots it actually fills. Before a holdout state debates the perfect licensure framework, it should look at the compact already adopted by most of its peers. The unused capacity, the unimplemented program, the reform that passed but never got staffed — these are where the real losses hide.
PLG's discipline is to look at execution first. New policy is sometimes exactly what is needed. But a firm that reaches for legislation before it has examined implementation is selling motion, not results.
This is not a counsel of caution. It is a counsel of sequence. Fix the leaks in the system you have, then build the bigger one. For physicians and policymakers serious about closing the workforce gap, execution is not the boring part of the work. It is the work.
What the Shortage Maps Actually Tell You
Health Professional Shortage Area designations are some of the most useful — and most underused — data in healthcare policy. They tell you, county by county, where the physicians aren't. Read correctly, they are a map of where the next decade's access crisis is already underway.
Read carelessly, they become a statistic that scrolls past in a report. The trick is to pair the shortage map with the supply levers that could change it: Where do the unused Conrad 30 slots sit? Which shortage counties are in compact states versus holdouts? Where is residency capacity expanding, and where is it flat?
Overlay those layers and the map stops being a description of a problem and starts being a to-do list. This shortage county is in a state leaving waiver slots unused. That one is in a holdout state where compact adoption would open the telehealth door.
PLG builds and reads these overlays for a living. The data is public; the interpretation is where the value sits. If you want to know not just where the shortage is but what could actually move it, the maps are the place to start.
Conrad 30: The Waiver Program Hiding in Plain Sight
The Conrad 30 program lets each state place up to 30 international medical graduates in underserved areas every year by waiving the requirement that they return home after training. It is one of the most direct tools states have for filling shortage gaps — and many states leave slots on the table.
That is the part worth sitting with. In the states that need physicians most, the waiver capacity often goes unused, not because demand is missing but because the placement infrastructure, employer awareness, and administrative follow-through are thin.
There is a live policy conversation about expanding Conrad 30 beyond the current per-state cap, and it deserves more attention than it gets. But expansion only matters if states use what they already have.
PLG's position is straightforward: before lobbying for more slots, IMG-dependent states should be measured on how many of their existing slots they actually fill. The first reform is execution. We help physicians, employers, and policymakers understand where the waiver fits, where it stalls, and how to move a placement from eligible to working.
The Supply Side Nobody Is Funding
Every conversation about the healthcare shortage eventually circles back to demand — aging patients, more chronic disease, longer waits. Almost none of it addresses supply. Physicians are the supply side of American healthcare, and the country is not producing or retaining enough of them.
The numbers are not subtle. Residency slots have grown far more slowly than the population that needs care, and rural counties have been designated Health Professional Shortage Areas for years without meaningful relief. Throwing telehealth at the problem helps at the margins. It does not manufacture clinicians.
What works is policy that expands the pipeline: more residency funding, smarter use of international medical graduates, and licensure pathways that don't strand qualified physicians in bureaucratic limbo. These are not abstractions. They are levers, and most of them sit in state legislatures right now.
PLG works on the supply side. We track the bills, the slot allocations, and the waiver programs that determine whether a shortage county gets a physician next year or waits another decade. If your organization's future depends on having enough doctors, the policy fight is your fight too.