'You're willing to help the team, but only for so long': What rural physicians need to stay

For physicians in rural practice, the hardest gap to close may not be pay. It may be backup.

Nearly two-thirds of current rural clinicians (65%) said they lack adequate specialist and colleague backup, according to a report from the Medical Group Management Association (MGMA), Jackson Physician Search and LocumTenens.com. That was a wider deficit than compensation, which 42% said did not fairly reflect their scope, call and workload.

The stakes are high: 59% of current rural clinicians said they are at least somewhat likely to leave their position within two years. Among those who lack adequate backup, the share rose to 67%.

The report, "Rural Healthcare Specialty Priorities," was released at the MGMA 2026 Annual Conference. It is based on an August 2026 online survey of 227 respondents with rural experience: 168 clinicians and 59 administrators.

Helen Falkner, president of Jackson Physician Search, and Pamela Ograbisz, DNP, FNP-BC, FAANP, vice president of clinical operations at LocumTenens.com and LT Telehealth, discussed the findings in a conference session moderated by MGMA Senior Editor Chris Harrop.

Is the rural physician still there?

In most cases, yes, but with little room to spare. The report sorted respondents' descriptions of local coverage into three groups:

• Adequate.
• "Local but thin," meaning physicians are still there but another departure or reduction in hours could create a serious gap.
• Alternative or absent, meaning access depends mainly on temporary, visiting or virtual coverage, or barely exists.

Adequate coverage was the exception. Only 21% rated family medicine adequate, while 68% called it local but thin. Internal medicine was 76% local but thin, and general surgery and ob-gyn were 61% each. Majorities said losing local access would have significant consequences, including 77% for pediatrics, 74% for emergency medicine and 70% for family medicine.

Harrop described those services as one physician departure away from collapse.

Why does backup matter so much?

The report links the backup deficit directly to the specialty gaps. "When the local general surgeon, obstetrician or psychiatrist is absent or stretched thin, the family physician down the hall is the one without backup," the authors wrote.

Clinicians described what happens when specialty coverage is unavailable or understaffed:

• 40% take on clinical work beyond their usual scope.
• 36% spend more time coordinating transfers or external referrals.
• 35% experience more stress or burnout.

And 17% said the gap makes them consider leaving their current position.

Ograbisz, a 27-year nurse practitioner, said clinicians will step up when a colleague leaves, but not indefinitely.

"I think, as someone who's done that, I can tell you that you're willing to help the team, but only for so long, right?" she said. "So, how are you going to assist me so that I can keep doing my job and keep doing it well?"

Rural practice still has strong appeal. Nearly half of current rural clinicians, 49%, would recommend it to a colleague in their specialty, compared with 22% who would not. Quality of life and connection to the community topped the reasons they stay (53%), followed by compensation (41%).

What do ob-gyn gaps mean for patients?

Ob-gyn had one of the lowest adequacy ratings in the survey, at 7%. The report noted that 146 rural hospitals have stopped delivering babies since the end of 2020 or announced plans to do so in 2026.

"OB is a unique specialty with lots of challenges that compound on top of one another," Falkner said.

A sustainable ob-gyn call schedule is one in three to one in four, she said, but most rural units are staffing one in two. Candidates also want modern resources and support.

"Everybody wants a robot and real backup anesthesia, NICU, pediatric support, emergency C-section support," Falkner said.

The average time to fill an ob-gyn position nationally is about nine months, she said, and it can be double that in rural settings. Thin coverage makes positions harder to fill, and current physicians risk burnout. "So the unfortunate thing is, it's self-reinforcing," she said.

Ograbisz said there are areas in Georgia, where she lives, in which women must drive 75 miles for ob-gyn care.

"I want you to think about that," she told the audience. "People are pregnant and maybe overwhelmed. New baby, never done this before, and you have to drive 75 miles for any kind of care you're going to get.

"How is this possible? Why are we not employing midwives? Why are we not utilizing more resources?" she said. "Again, there are so many options that we can do, but we're falling short, and the people who are paying the price are the patients."

Where do APPs and telehealth fit?

Across specialty assessments from respondents who needed a coverage decision within 12 months, 68% rated permanent physician recruitment viable long term, making it the strongest long-term option. Physician plus advanced practice provider (APP) teams were second at 55%, and they ranked first in psychiatry at 85%. Telehealth depended heavily on specialty: 70% rated it viable long term for psychiatry, but majorities said it was not viable for ob-gyn, emergency medicine or general surgery.

Ograbisz, who oversees LocumTenens.com's telehealth operations and APP programs, was direct about where she stands on adding APP teams or telehealth.

"Given what I do for a living, I'm going to tell you it always makes sense," she said.

She described joining a cardiothoracic surgery group of seven surgeons and three physician assistants who mainly assisted in the operating room. After the group added an outpatient clinic and expanded the APPs' role into the intensive care unit and inpatient floor, the surgeons could stay in the operating room while the APPs followed patients through recovery.

"That's what APP and MD teams do together," she said. "So these breed efficiency, and in the end, will bring you much better outcomes."

Behavioral health showed the widest split between groups: 47% of administrators named it a high-impact specialty, compared with 25% of clinicians. Ograbisz said psychiatrists generally have full practices, and many have shifted much of their work to telehealth, while administrators feel the pressure in emergency departments holding psychiatric patients.

"We do not have enough people to manage that crisis, and so I think that that's where the disconnect comes," she said.

Would physicians come back?

Many might. Among former rural clinicians, 45% said they would be very or somewhat likely to consider rural practice again. Their top conditions were competitive compensation (47%) and better specialty coverage and colleague backup (45%). Current rural clinicians named the same two improvements first, each at 49%.

Former clinicians also listed inadequate backup as the second most common reason they left (31%), behind workload or burnout (33%).

Flexible arrangements may open another door. Falkner described an ob-gyn search in Glendive, Montana, that had been open for three years. Physicians told the recruiter they would not relocate but would pick up shifts, so the hospital decided to staff one full-time position with three ob-gyns working 10 shifts a month each. It hired a physician from a traditional practice in Billings, Montana, who had a passion for rural medicine but did not want the full-time grind. She works 10 shifts a month and is paid full time with benefits.

"Today they have two of the three, and they now have their ob-gyn coverage in the community," Falkner said.

What can physician leaders do now?

The report's first recommendation is to treat backup and call as part of the coverage plan, designing and budgeting call schedules, cross-coverage and specialist support alongside the staffing model.

Falkner said ongoing communication with physicians is essential to spotting gaps before they become vacancies.

"That communication piece is really table stakes for retaining and being able to identify emerging coverage gaps or emerging physician needs," she said.

Engagement with a new physician should not end at the signed contract, she said, but continue through onboarding and beyond.

"That engagement and communication piece is key in recruitment," Falkner said. "It's even more important when it comes to retention."