Rural Physician Recruiting Challenges and Solutions
Physician Staffing Challenges Financial challenges facing rural hospitals often are compounded by physician staffing challenges. Just like professional sports teams, opera companies and gourmet restaurants, physicians tend to be located more frequently in large urban centers than they do in smaller, rural communities. There currently are approximately 6,750 Health Care Professional Shortage Areas (HPSAs) for primary care in the United States, about double the number identified by the Health Resources and Services Administration (HRSA) 15 years ago. Over 65 million people live in a primary care HPSA and 67 percent of HPSAs are in rural areas. The ratio of primary care providers to patients in these areas is less than one per 3,000. HRSA projects it would take over 17,000 additional primary care clinicians to achieve a ratio of one primary care doctor per 3,000 patients in the nation’s 6,700-plus HPSAs. HRSA also currently designates approximately 4,940 mental health HPSAs nationwide in which over 80 million Americans live. These are areas in which there is less than one psychiatrist per 30,000 people. Rural areas in particular struggle to maintain psychiatric services. Texas, a large rural state, has 185 counties with no psychiatrist (see The Physician Workforce in Texas , a study of Texas physician demographics and distribution completed by Merritt Hawkins on behalf of the North Texas Regional Extension Center). The chart below highlights the relative misdistribution of physicians, who tend to be concentrated in mostly urban states and diffused in mostly rural states.
Physicians per 100,000 Population by State
State
State
Alabama
206.0
Connecticut
337.8
Arkansas
198.1
Delaware
266.8
Idaho
189.6
Maryland
370.6
Mississippi
184.7
Massachusetts
432.4
Utah
207.5
Rhode Island
346.5
Source: Association of American Medical Colleges Physicians generally are trained in large metro areas and tend to stay in these areas after training. Many physicians are married to fellow professionals who may have limited job opportunities in smaller towns. The chart below illustrates the degree to which medical residents prefer larger communities to smaller ones.
Final-Year Medical Resident Practice Location Preferences by Community Size
Community Size 10,000 or less
0%
As these numbers show: • Only 3% of newly trained physicians prefer a community of 25,000 or less • The majority (78%) prefer a community of 100,000 or more • According to the NRHA, only 9% of physicians practice in rural areas though 20% of the overall population lives in rural areas
3%
10,001 – 25,000
5%
25,001 – 50,000
14%
50,001 – 100,000
16%
100,001 – 250,000
15%
250,001 – 500,000
17%
500,001 – 1 million
30%
Over 1 million
Source: AMN Healthcare 2023 Survey of Final-Year Medical Residents
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