RURAL HEALTHCARE SUFFERING PHYSICIAN DRAIN
We’ve all heard stories or read articles about small towns and rural communities who have such serious need for medical care that they advertise to hire a physician. The lack of professional medical services in rural areas is reaching such a critical point that “desperate times call for desperate measures.” But resolving the Family Physician shortage in rural America is a decades-old challenge that has yet to find a solution.
The article referenced here does not offer a solution. Rather, it highlights the seriousness of the situation and quantitates the status of Family Physicians (FP’s) in rural settings. Most of the data here was obtained by evaluating the situations in non-metropolitan areas with populations under 20,000. These towns typically have a predominance of FP’s and few specialists. FP’s then are responsible for providing adult medical care (internal medicine), emergency care (ER doc), maternity care (OB-GYN), and infant and child care (pediatrics). FP’s become the key member of the rural healthcare workforce, and lead the healthcare team.
It continues to be very difficult to get young doctors to practice in rural settings despite the most well-intentioned, well-designed recruiting program after recruiting program. They have failed to increase the numbers. This study, unfortunately, quantitates the negative trend that has prevailed over the years 2017 to 2023.
In that period (2017 to 2023), the American Medical Association physician masterfile identified between 78,979 and 79,464 practicing Family Physicians in the U.S. During that 7-year period, the number of rural FP’s decreased by 11%, or by 1303 physicians. That’s an average decline of 26 FP’s per state over 7 years. That doesn’t sound like much, but some areas had higher decline rates and many others had lower rates of decline.
Women FP’s increased from 35.5% of the workforce in 2017 to 41.8% in 2023 or from 4210 to 4404, a small increase of 196. On the other hand, men fled practice leaving a decline from 7637 FP’s to 6140, a major decrease of 1497, or the percentage of male FP’s dropped from 64.5% in ‘17 to 58.2% in ‘23. On the opposite end of the spectrum, Urban FP’s increased from 49.4% to 51.9% (an increase of 2557).
The Annual loss of rural FP’s nationally was 1.9%/year with regional variations—the northeast has highest decline with a 2.7% average annual loss while the West had smallest decline—0.5% decrease/year. The authors call these stats an “alarming loss of FP’s in rural America.” Although there is an increase in female Family Physicians, it is insignificant when compared to the much larger, offsetting loss of male FP’s.
Reasons for the declining numbers of rural FP’s are numerous. Not everyone is cut out to live in rural areas where cultural and high level sports activities are unavailable, where you see your patients every where you go, and where people may expect more than you can deliver. Where you’re subject to being asked medical questions all the time, and not everyone likes you. AND where the business you run constantly faces financial strains due to dismally inadequate reimbursement and patients who simply don’t have the means to pay. If overhead expenses are greater than revenues, you have an unsustainable situation.
Suggesting that NP’s and PA’s should fill the void is not the answer. Their scope/range of practice is narrower, and they are much less experienced. They function better when the range of diagnostic and treatment challenges is much narrower and straightforward. The solution starts at the medical school admissions office where applicants with rural backgrounds are accepted at a higher rate, and incentivized to practice in a rural location. Supporting these future FP’s by student loan forgiveness and other incentives to remain in the community.
Declining numbers of rural Family Physicians is a big concern. The reasons are well known, but effective solutioņs remain elusive. For continued stability, however, one must be found.
Dr. G’s Opinion: I looked at a practice in Tipton, IN in 1974, at the recommendation of the Indiana State Medical Association. Tipton currently has a population of 5255, so it qualifies as a small town. The doctor there was a solo practitioner desperate for help, but I was not his man.
Reference: Fogarty CT, Byun H, Huffstetler AN. Family Physicians is Workforce Trends: The Toll on Rural Communities Ann Fam Med 2025 Nov/Dec;23(6):535-538.
