Rural America Faces Critical Shortage of Family Physicians, New Study Finds
A concerning decline in the number of family physicians practicing in rural areas is exacerbating healthcare access issues as these communities experience population growth not seen in nearly a century.
The national shortage of primary care physicians has been a long-standing concern, but a recent study underscores the urgency of the problem, pinpointing rural areas as the epicenter of the crisis. Researchers found a year-over-year decrease in family physicians practicing in these regions, resulting in an 11% nationwide net loss between 2017 and 2023. The Northeast experienced the most significant losses, while the West saw the smallest decline.
Specifically, the study revealed 11,847 rural family physicians were practicing in 2017, a number that dwindled to 10,544 by 2023 – a loss of 1,303 physicians nationally. The West lost 67 rural family physicians, representing a 3.2% decrease, while the Northeast experienced a more substantial 15.3% loss, equating to 193 physicians.
“The data reflect what we already experience and know about physician shortages, but the year-over-year numbers for rural areas were astonishing to me. The speed at which this has happened is remarkable and terrible,” stated Colleen T. Fogarty, professor and chair of the family medicine department at the University of Rochester, and lead author of the study.
This exodus of rural physicians coincides with a significant demographic shift: young adults aged 25-44 are moving to rural areas at the highest rate in nearly a century. Driven by remote work opportunities and the appeal of a country lifestyle, this influx of new residents is creating increased demand for healthcare services in areas already struggling to provide adequate care.
The impact of even a single physician leaving a rural community is substantial. Family physicians typically serve patient panels ranging from 1,000 to 3,500 individuals. When a physician departs, patients are often forced to rely on already overburdened colleagues or travel significant distances to access care.
Several factors contribute to this troubling trend. Rural physicians often shoulder a broader range of responsibilities than their urban counterparts, leading to overwork and burnout. They frequently provide not only adult medical care but also emergency services, maternity care – including cesarean deliveries – and pediatric care.
According to Fogarty, a decline in the number of US medical students choosing family medicine as a specialty is also playing a role. Furthermore, medical students from rural backgrounds are underrepresented compared to their non-rural peers. While international students have historically helped offset this shortage, current uncertainties surrounding visa requirements for residents and practicing physicians add another layer of concern.
However, the study did reveal one encouraging trend: the proportion of women family physicians is steadily increasing. Females represented 44% of family physicians in 2017, rising to 49.3% in 2023. In rural areas, this percentage increased from 35.5% in 2017 to 41.8% in 2023.
This shift, however, presents its own challenges. “Does the rural community have what working mothers need?” Fogarty asked. “Healthy boundaries on work life are important; we need to get male and female family physicians the support they need so they are not working around the clock and diagnosing a medical issue while they’re at the cash register at the grocery store.”
Reversing this trend will require a multifaceted approach. Expanding the role of advanced practice providers to alleviate the burden on rural physicians, and offering improved compensation packages to attract and retain talent, are crucial steps. Medical schools also have a responsibility to prioritize the recruitment of candidates from rural areas and develop curricula specifically tailored to the unique challenges of rural healthcare.
Fogarty is currently leading a team at the University of Rochester School of Medicine & Dentistry Department of Family Medicine to create a new rural residency training track. This program, modeled after successful initiatives elsewhere, will provide residents with foundational training in a high-volume urban setting before transitioning to a continuity practice in a rural community for their final two years, with rotations involving local specialists. “It’s an important initiative that we hope will make a difference,” Fogarty said.
The research was published in the Annals of Family Medicine. The study utilized data from the American Medical Association Physician Masterfile to identify US family physicians practicing outpatient care between 2017 and 2023 and their respective locations, with contributions from Hoon Byun, DrPH, at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, and Alison N. Huffstetler, at Virginia Commonwealth University’s Department of Family Medicine.
Source: University of Rochester.
