As demand for healthcare in rural America increases, the number of rural physicians and practices in rural areas is actively shrinking. On this blog, we often cite an AAMC article stating that while 20% of Americans live in rural communities, only 11% of the nation’s doctors practice in those areas. However, the latter figure may be shrinking. A new report by the Physicians Advocacy Institute (PAI) and Avalere Health reveals a significant shift in the number of independent physicians and practices in rural areas, as well as a decline in the overall number of physicians practicing in these areas.
As Regional Vice President of Physician Recruitment for Jackson Physician Search, I work with clients who are feeling the sting of this overall decrease. How is this shift impacting rural healthcare and, more specifically, rural physician recruitment?
A Startling Decline in Rural Physicians
The PAI report reveals a startling decline in the overall number of physicians and medical practices in rural areas. Between 2019 and 2024, the total number of physicians practicing in rural areas decreased by 2,500, representing a 5% decline. The reduction in the percentage of independent physicians and independently owned practices is far more significant (43% and 42%, respectively). A closer look reveals that more than 40% of independent medical practices were closed or acquired by hospitals, health systems, or corporate entities. Still, there was a net loss of 3,300 medical practices, representing an 11% decline.
Rise in Corporate and Hospital Employment
At the end of the five years, corporate entities nearly doubled their ownership of practices in rural areas and employed 57% more physicians compared to 2019. Hospitals and health systems increased their employment of physicians by 15% and practice ownership by 11%. These numbers may suggest physicians are flocking to rural hospitals, health systems, and corporate-owned groups, but of course, if you are actively recruiting for one such organization, you know this is not the case. While it’s true that physician employment is on the rise in rural areas (as is true everywhere), there is a net loss of physicians — independent or employed — practicing in rural areas.
The rural physician shortfall has real consequences for rural communities where residents already face higher rates of chronic illness, later-stage cancer diagnoses, and greater distances to care.
Why Are Physicians Disappearing?
The decline in the number of rural physicians isn’t solely due to consolidation. Other factors include:
- Aging workforce: Nearly half of US physicians will reach retirement age within the next decade. Primary care and psychiatry are expected to feel the hit the hardest.
- Urban training: Most medical students and residents receive their training in cities, forming social and professional ties that make rural relocation less appealing.
- Financial pressures: Lower reimbursement rates and higher operational costs make rural practice less financially viable.
- Burnout and lifestyle considerations: Rural physicians may face heavier workloads, professional isolation, and limited resources, which can lead to higher turnover rates.
Rural Physician Recruitment Strategies
The shrinking number of physicians in rural areas is making the already challenging task of recruiting physicians to rural areas even more urgent. Over the years, my colleagues and I have written extensively about rural physician recruitment strategies, and now more than ever, it is crucial to incorporate the following to attract and retain talent:
1. Incentivize Rural Practice
First and foremost, make rural physician jobs financially attractive. Leverage loan repayment programs, offer competitive compensation packages, and provide recruitment incentives to attract and retain providers in rural areas.
2. Target Candidates with Rural Backgrounds
Physicians from rural areas are significantly more likely to return to practice in similar communities. Recruiters should seek out candidates, active and passive, with rural roots or a demonstrated interest in rural health.
3. Leverage Team-Based Care
With physician shortages unlikely to abate soon, integrating advanced practice providers into rural care teams will help share call burdens and reduce physician workload.
4. Offer Enhanced Support
In addition to personnel support, develop policies that reduce administrative burdens and offer technical assistance to prevent burnout.
5. Expand Telehealth Services
Invest in telemedicine infrastructure to not only improve access but also enable physicians to work remotely when needed.
6. Embrace Flexibility
Consider part-time, locum tenens, or job-sharing arrangements to attract physicians who may not want full-time rural practice but are open to periodic service.
7. Partner with Rural Residency Programs
Notify residency programs in the region of your job openings and offer rotations for medical students.
8. Consider J-1 Visa Waivers
Explore options to sponsor J-1 visa waivers that encourage international medical graduates to practice in underserved areas.
9. Encourage Community Engagement
Encourage collaboration between healthcare providers, local governments, and community organizations to address social determinants of health and create supportive environments for providers.
10. Promote the Positive
Know the many benefits of rural physician jobs and highlight those that speak to the needs of specific candidates
Intentional Rural Physician Recruitment
The disappearance of rural doctors is not inevitable, but it demands urgent, coordinated action. By understanding the evolving situation and adopting innovative, evidence-based recruitment strategies, rural healthcare leaders can help ensure that their communities continue to have access to the care they need — and that the next generation of rural physicians finds both opportunity and fulfillment in these vital roles.
If your rural health organization is starting a physician search, the team at Jackson Physician Search is eager to assist. We have a proven track record of success in rural physician recruitment nationwide and can leverage our experience to enhance your efforts. Contact us today to learn more.
About Helen Falkner
As the daughter of a physician and an Iowa native, Helen has witnessed firsthand the impact a great physician can have on a community. She joined Jackson Physician Search at the company’s headquarters in Alpharetta, GA, as an entry-level Research Consultant in 2012. Through her consistent success as an individual contributor and manager, Falkner progressed quickly to Partner in 2018 and assumed her role as Regional Vice President of Recruiting for Jackson Physician Search’s Western Division in October 2020. In January 2021, she relocated to the firm’s Denver office, leading a team of successful physician recruiters while actively continuing to recruit for her clients.
