An aging rural physician workforce is nearing retirement age, leaving the rural population at a disadvantage for access to quality health care. Strategies such as expanding medical education programs to rural areas and utilizing the nurse practitioner (NP) population may forestall the growing disparities in access to health care for people living in nonmetropolitan areas, according to a study published in the New England Journal of Medicine.

Researchers used data on physician age and location from the US Census to establish recent trends in the age distribution of rural physicians and projected workforce growth through 2030. Physicians aged 28 to 74 years practicing in nonmetropolitan areas were included in the study.

From 2000 to 2017, the number of practicing rural physicians grew only 3% (from approximately 61,000 in 2000 to 62,700 in 2017). The number of physicians aged <50 years living in rural areas decreased by 25% during this time, from 39,200 in 2000 to 29,600 in 2017. In contrast, the number of physicians aged <50 years living in urban cities increased by 12% from 2000 to 2017, and in 2017 only 39% of urban physicians were aged ≥50 years and only 18% were aged ≥60 years.

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The size of the rural physician workforce is projected to decrease by 23% by 2030, from 12.2 physicians per 10,000 in 2017 to 9.4 per 10,000 in 2030. This projection stems from a reduction in the number of rural physicians aged ≥45 years, since a large proportion of this group will have retired by 2030. The supply of urban physicians is projected to remain at 29.6 per 10,000 by 2030. This projection provides evidence that the gap in physician supply between rural and nonrural physicians will widen through 2030.

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Possible solutions to increase the dwindling rural physician workforce include the expansion of graduate medical education programs in rural hospitals and increased salaries for physicians in rural areas to account for the higher average cost of providing care in low-volume areas.

Policymakers should also explore the rapidly growing nurse practitioner (NP) population as an option to help combat the rural physician shortage. Most NPs are trained in primary care, and a growing body of evidence has proven that the high quality of care that NPs provide as well as their cost-effectiveness would make them a great asset to rural populations. Medical schools, teaching hospitals, and other primary care clinics should work with the NP population to capitalize on the likelihood of NPs practicing in rural areas, to create NP residency programs in rural health, and to develop programs that make it easy for rural NPs to consult with physicians and rural health specialties.


Skinner L, Staiger DO, Auerbach DI, Buerhaus PI. Implications of an aging rural physician workforce. N Engl J Med. 2019;381(4):299-301.