Nationwide decline in rural family physicians raises new concerns

New research published in Annals of Family Medicine points to a steady and troubling slide in the number of family physicians practicing in rural America.

Using data from the American Medical Association (AMA) Physician Masterfile, researchers found the rural family physician workforce shrank by 11% between 2017 and 2023 — a period when many rural communities were already struggling with limited access to primary care.

The study, led by researchers at the University of Rochester Medical Center and the Robert Graham Center, tracked actively practicing family physicians 65 or younger. Their office addresses were mapped to Rural-Urban Continuum Codes, allowing the team to identify how many physicians were practicing in rural areas each year.

Lead author Colleen T. Fogarty, M.D., M.Sc., said the scope of losses exceeded what she expected.

"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 speed at which this has happened is remarkable and terrible," she said.

Persistent losses, sharper in some regions

The decline wasn’t uniform across the country.

The Northeast saw the steepest drop, losing 15.3% of its rural family physicians over the study period. The South and Midwest also posted double-digit declines.

The West saw only a modest decrease of 3.2%, but even that represented a downward trend.

Overall, the number of rural family physicians fell from 11,847 in 2017 to 10,544 in 2023 — a net loss of 1,303.

One of the study’s notable findings involves the changing gender makeup of the rural family medicine workforce. Women represented 35.5% of rural family physicians in 2017. By 2023, that share had climbed to 41.8%.

Nationally, women now represent just under half of all practicing family physicians.

Fogarty said those considerations matter when communities look to attract and keep physicians. "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," she said.

Gains in training programs aren’t closing the gap

The authors noted that the losses occurred despite growth in the number of U.S. medical schools, an expansion of family medicine residency positions and years of programs intended to strengthen the rural workforce.

They also pointed to early signs that the training pipeline remains uncertain. The 2025 National Resident Matching Program added 148 new family medicine positions, but 21 fewer students matched into the specialty.

Even small annual declines, they warned, have real consequences.

Losing a handful of full-time family physicians can leave thousands of rural residents without stable primary care.

What might help

The authors say reversing the trend will require targeted, region-specific strategies rather than broad, one-size-fits-all initiatives — pointing to a mix of long-term pipeline efforts and more immediate support for physicians already practicing in rural communities.

That includes recruiting and admitting more medical students from rural areas, expanding rural family medicine residency tracks, offering stronger loan-repayment incentives and building practice environments that help physicians — particularly women and those with young families — avoid burnout.

Fogarty noted that healthier work-life boundaries and stronger support systems are essential for keeping physicians in rural communities. She and her colleagues at the University of Rochester are developing a new rural residency training track based on a national model.

Residents will complete their first year of high-volume, high-acuity rotations in the city, then spend their final two years practicing in a rural community while working alongside local specialists.

“It’s an important initiative that we hope will make a difference,” said Fogarty. The first two candidates at Rochester will match in July 2027, beginning their rural training the following summer.