The Family Physician Workforce: The Special Case of Rural Populations
People living outside metropolitan areas, especially those living in rural counties, depend on family physicians. Resolving the disparities in physician distribution nationwide will require solutions to make rural practice a viable option for more health care workers.
About 62 million people in the United States live in counties outside metropolitan statistical areas (MSAs). In 2004, about 20,900 family physicians (FPs) and general practitioners (GPs) were practicing in these counties: one FP or GP for every 2,940 persons.1,2 When general internists and general pediatricians are included, the non-MSA primary care workforce totals 34,000: one physician for every 1,810 persons. This is far below the United States as a whole, which has one primary care physician per 1,321 persons (see accompanying table).2
Table. Physician Distribution in the United States in 2004
|Distribution||FPs and GPs||Primary Care*||Other Subspecialists||Total|
|Distribution: Physicians in specialty||FPs and GPs: 91,627||Primary Care*: 222,059||Other Subspecialists: 398,568||Total: 620,627|
|Distribution: Persons per physician nationwide||FPs and GPs: 3,202||Primary Care*: 1,321||Other Subspecialists: 736||Total: 472|
|Distribution: Persons per physician in non-MSAs||FPs and GPs: 2,940||Primary Care*: 1,810||Other Subspecialists: 1,626||Total: 857|
FP = family physician; GP = general practitioner; MSA = metropolitan statistical area.
Source: Information from Reference 2.
Family medicine's traditions of training in ambulatory and hospital care, caring for adults and children of either sex, and providing maternity and newborn care have made FPs the preferred rural health care professional. Family medicine has demonstrated a sustained emphasis on training students to prepare for service in rural areas through programs such as rural training tracks and post-residency fellowships in rural medicine. Between 1995 and 1999, primary care physicians provided 61 percent of all physician office visits in non-MSA counties compared with 50 percent in MSAs.3 In the same time period, 69 percent of all primary care office visits in non-MSA counties were made to FPs and GPs.
Using a more restrictive definition of "rural" provides a more realistic estimate of rural need for physicians. More than 35 million people reside in rural counties that have a community of at least 2,500 people but no town with a population of 20,000 or larger. In these areas, served mostly by FPs and GPs, 29,214 FPs would be required to provide one FP per 1,200 patients, a ratio that allows one FP to provide the new model set of services adequately.4
Family medicine has met its objectives for succeeding the GP workforce and producing an FP workforce ready to meet the needs of the United States. There is now a greater urgency in addressing the disparities in physician distribution to ensure adequate health care access for everyone in the United States.
- Green LA, Dodoo MS, Ruddy G, Fryer GE, Phillips RL, McCann JL, et al. The physician workforce of the United States: a family medicine perspective. 2004. Washington, D.C.: Robert Graham Center, 2004.
- AMA Masterfile. Analysis by The Robert Graham Center, 2004.
- National Ambulatory Medical Care Survey. 1995-1999. Hyattsville, Md.: National Center for Health Statistics, 1995-9.
- Martin JC, Avant RF, Bowman MA, Bucholtz JR, Dickinson JR, Evans KL, et al.; Future of Family Medicine Project Leadership Committee. The Future of Family Medicine: a collaborative project of the family medicine community. Ann Fam Med 2004;2(suppl 1):S3-32.
The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP.
Published in American Family Physician, Jun 1, 2005. Am Fam Physician. 2005;72(1):147. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.