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Researcher: 'There is a Maldistribution of Physicians in the United States'

Analysis  |  By Christopher Cheney  
   August 28, 2020

Although there is a looming nationwide physician shortage, the more pressing clinician workforce problem is the distribution of doctors, a Stanford researcher says.

Recent research on rural emergency physicians reflects a maldistribution of physicians nationwide, the lead author of the study told HealthLeaders.

Physician demand will grow significantly higher than supply through 2033, according to a report published earlier this year by the Association of American Medical Colleges. The AAMC report projects the shortfall at as many as 139,000 physicians by 2033.

The recent research, which was published in the Annals of Emergency Medicine, shows there is a shortage of emergency physicians in rural areas of the country. The study includes two key findings:

  • Compared to 2008, the total number of clinically active emergency physicians has increased by nearly 10,000, but emergency physician density per 100,000 of U.S. population has decreased in large rural (-0.4) and small rural (-3.7) areas.
  • This year, most (92%) emergency physicians practice in urban areas, with 6% practicing in large rural areas and 2% practicing in small rural areas.

"In the context of the work that we have done, there is a maldistribution of physicians in the United States. We see compared to the 2008 data, the situation in 2020 is more pronounced, with a decrease of physicians in the large rural and small rural areas," said the lead author of the study, Christopher Bennett, MD, MA, an assistant professor of emergency medicine at Stanford University School of Medicine in Stanford, California.

The study also found there are more emergency physicians approaching retirement age in rural areas compared to urban areas. This year, the median age of emergency physicians in urban areas is 50, and the median age of emergency physicians in large rural areas is 58 and 62 in small rural areas.

"The thing that is concerning about the number of emergency physicians in rural areas who are approaching retirement age is that you would presume to see in 10 to 20 years in the future that these are physicians who will no longer be working clinically. Given that there is concurrently a tendency for newer medical school graduates to work in more urban areas, that will likely compound the density difference in rural areas," Bennett said.

Although his team's research shows there is a mainly a distribution problem now in the U.S. physician workforce rather than a nationwide shortage, Bennett said several factors such as the aging of the general population will likely result in a widespread shortage of clinicians.

"The AAMC's projected shortage is in the context of a growing population, a growing population of older people who are going to see doctors more often, a population of people who need both primary and specialty care, and limited support for graduate medical education," he said.

Addressing the rural emergency physician shortage

It will take a multifaceted approach to increase the number of emergency physicians practicing in rural areas of the country, Bennett said. He said those strategies include:

  • Training more emergency physicians in rural areas, with the hope that more young doctors will end up practicing in rural areas
  • Offering financial incentives to practice in rural areas such as student loan forgiveness and higher salaries
  • Federal support to incentivize emergency physicians to work in rural areas

"The number and distribution of doctors is a complex national issue; and if we are going to increase the number of emergency physicians practicing in rural areas, it is going to take national-level interventions. It is a complex problem, and it is going to take a complex solution to fix it," Bennett said.

Christopher Cheney is the senior clinical careโ€‹ editor at HealthLeaders.


More than 90% of emergency physicians practice in urban areas, recent research shows.

The density of rural emergency physicians has decreased over the past decade, the study shows.

Unless there are interventions, the research indicates that the shortage of rural emergency physicians is likely to worsen because of the aging rural emergency physician workforce.

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