Rural Healthcare Hit by Steady Loss of Family Physicians

A report shows a steep drop in rural family physicians in recent years, raising concerns about the sustainability of primary care in underserved communities.

Rural healthcare is under duress, and a new study reveals that one of its most pressing challenges is a steady drain of family physicians.

The research, published in Annals of Family Medicine, found that the number of family physicians practicing in rural areas of the U.S. declined by 11% from 2017 to 2023. Using data from the American Medical Association Physician Masterfile to track actively practicing family physicians under age 65, researchers identified that there were 11,847 rural family physicians nationwide in 2017. By 2023, that number had dropped to 10,544 for a net loss of 1,303 physicians.

These losses come at a time when many rural areas have experienced population growth, in part driven by young adults seeking affordable living under remote work arrangements. Family physicians in rural communities also often wear many hats by providing maternity care, pediatric care, and emergency coverage on top of standard adult care.

“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 study’s lead author, Dr. Colleen Fogarty, professor and chair of the department of family medicine at the University of Rochester, said in a news release. “The speed at which this has happened is remarkable and terrible,” said Fogarty.

One encouraging trend that emerged from the study is that more women are entering rural family medicine. The proportion of female family physicians in rural areas increased from 35.5% in 2017 to 41.8% in 2023, mirroring a nationwide shift toward gender parity among family physicians.

That shift, however, comes with its own challenges. “Does the rural community have what working mothers need? 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,” Fogarty said.

According to Fogarty, several factors contribute to the downward trend. Fewer medical students are choosing family medicine as a specialty, and rural-origin students remain underrepresented among those specializing in family medicine. Meanwhile, rural physicians often carry heavy workloads due to the many roles that serve, which contribute to burnout, relocation, or early retirement.

To begin turning the tide, Fogarty and her colleagues propose more targeted efforts, such as rural-specific training pathways, stronger support for advanced practice providers, and incentives including better compensation and work-life balance. The University of Rochester, for example, is launching a new rural residency track in which physicians will complete their first year of training in a city before spending the final two years in continuity practices in rural communities.

“It's an important initiative that we hope will make a difference,” Fogarty said.

Unless health leaders, policymakers, and medical educators strengthen efforts to recruit, train, and retain family physicians in rural communities, the access and quality gap between urban and rural settings will continue to widen.