Am Fam Physician. 2013;87(11):online
Author disclosure: No relevant financial affiliations.
The United States is facing a primary care physician shortage, but the most pressing problem is uneven distribution, particularly in poor and rural communities. Providing adequate access to care for the nearly 30 million uninsured people living in these communities will require potent incentives and policy.
There are about 80 primary care physicians per 100,000 people in the United States; however, the average is 68 per 100,000 in rural areas and 84 per 100,000 in urban areas. An unequal distribution implies that many areas have relative primary care shortages, especially rural communities and areas of measurable social deprivation. Most states and primary care service areas currently have shortages by any measure because the physician workforce is concentrated in urban and suburban areas (see accompanying table).
| Geography | All (%) | Primary care (%) | |||||||
|---|---|---|---|---|---|---|---|---|---|
| NP | PA | Physicians | NP | PA | Family medicine | General internal medicine | General pediatrics | U.S. population (%) | |
| Urban | 84.3 | 84.4 | 91.0 | 72.1 | 75.1 | 77.5 | 89.8 | 77.6 | 80 |
| Large rural | 8.9 | 8.8 | 6.5 | 11.0 | 11.6 | 11.1 | 6.7 | 9.6 | 10 |
| Small rural | 3.9 | 3.7 | 1.7 | 7.7 | 6.9 | 7.2 | 2.4 | 7.3 | 5 |
| Isolated rural, frontier | 2.8 | 3.0 | 0.7 | 9.1 | 6.3 | 4.2 | 1.1 | 5.5 | 5 |
Unlike many Western nations, the United States does not manage or actively regulate the number, type, or geographic distribution of its health workforce. As a result, health care professionals choose how and where to work. Equitable distribution of the workforce and access to care largely rely on market forces, with important but insufficient intervention from government, medical schools, and safety net programs. The result is incongruency between the geographic location and specialty choice of the health workforce and enduring health care needs of the U.S. population.
To eliminate physician shortages at a population-to-physician ratio of 2,000:1, the goal set by the Health Resources and Services Administration, the supply of physicians would need to be increased by 2,670 in rural areas and 3,970 in urban areas. The average ratio across the United States is 1,485:1. Achieving this ratio for all communities would require nearly 7,000 more rural physicians and nearly 13,500 more inner-city physicians. Many people in the most underserved communities are uninsured. As health reform provides insurance to millions more Americans, lack of access to primary care because of distribution problems will be significant.
New incentives and policies for distributing primary care physicians to areas of greatest need, as well as a larger absolute number of these physicians will be needed to ensure access for the newly insured.
