Closing Care Gaps: Physician Shortages, Medical Deserts, and Health Disparities

This article was updated on March 11, 2024.

Physicians, surgeons, and other healthcare providers are integral to the functioning of the healthcare system. However, in the United States, the number of physicians and surgeons—including specific medical and surgical specialties that are vital for vulnerable populations—is in decline. According to projections from the American Association of Medical Colleges (AAMC), the demand for doctors will outpace supply by 2033, leading to a shortage of between 54,100 and 139,000 physicians.

Some of the medical and surgical specialties that treat conditions more common in older Americans…are among those most significantly impacted by potential shortages.

Among the specialties most impacted are primary care physicians, of whom the AAMC projects a shortfall of between 21,400 and 55,200 by 2033. Primary care physicians treat adults for common issues, but, importantly, they also manage chronic conditions. Primary care physicians are vital to the functioning of the healthcare system because they can address the entire person due to their expertise in managing multiple treatments, medications, and the interactions between them. Studies have also shown that access to primary care physicians is positively linked to preventative care utilization and the early detection and treatment of disease.

Much of the growing demand for surgeons is due to an aging population in the United States. According to the AAMC, which uses estimates of population growth from the US Census to compile its projections on the supply and demand of physicians, the population of older adults (people 65 years of age or older) is projected to grow 45.1 percent.

In addition to the rise in the population of older adults, the prevalence of chronic conditions is another major factor increasing the need for physicians. Currently, more than half of adults in the United States live with a chronic disease such as cancer, heart disease, or diabetes. Some of the medical and surgical specialties that treat conditions more common in older Americans—such as cardiology, orthopedic surgery, and neurosurgery—are among those most significantly impacted by potential shortages.

Aside from the areas of medicine that will shape the extent of care delivered in the not-so-distant future, important asymmetries in the race and gender of physicians will continue to impact patient care.

Physician Demographic Shifts Endanger Vulnerable Populations   

On top of the shortages, imbalances in the demographic makeup of the healthcare workforce present an additional challenge to the provision of high-quality care. The representation of four groups in the healthcare workforce is lower than their representation in the general population: women, people of color, sexual- and gender-diverse individuals, and people with disabilities. This lack of diversity is crucial to note because studies show that patients from underserved racial, ethnic, gender, and sexual communities are more satisfied with their care and more likely to adhere to medical advice when they have a doctor with comparable life experiences.

The lack of racial and ethnic diversity within the physician workforce is unlikely to be resolved soon following the Students for Fair Admissions (SFFA) v. President and Fellows Harvard College and SFFA v. University of North Carolina Supreme Court decisions, which effectively prohibit the consideration of a person’s race in the admission process.

These decisions are particularly troubling in light of the medical profession’s history of unfair policies and licensing practices that discouraged Black Americans and other marginalized groups from becoming doctors. But these Supreme Court decisions mean that medical schools that are attempting to redress centuries of discrimination will have to exercise care in how their admissions and outreach programs are designed.

The maternal health crisis…which is most deeply and painfully felt by Black and Indigenous women, is particularly acute in rural areas where more than half of counties lack hospital services for…prenatal care.

People who speak any language other than English are often alienated in healthcare facilities that only communicate with patients in English, so language diversity in addition to demographic diversity is important in the healthcare workforce. Studies have linked low English proficiency with having less access to healthcare and poor quality of life outcomes. Obstacles placed in the way of ethnically and racially diverse aspiring physicians, whether they are trained inside or outside the United States, limit the ability to provide care to non-English speakers.

Medical Deserts in the Rural United States   

Though about 20 percent of the US population lives in rural areas, only about 10 percent of US doctors practice in rural areas. This localized paucity of physicians creates medical deserts or areas that have no or far too few doctors. Doctors aren’t incentivized enough to relocate or remain in rural areas. Care facilities in these areas have lower reimbursement rates, which translates to less pay, and are geographically isolated, which can negatively impact their careers.

The lack of doctors in rural areas is also tied to medical education and training since doctors tend to spend their careers near where they spent their residencies. Since the large academic medical centers are mostly located in urban metropolises, these areas retain the most physicians and surgeons. The location of academic medical centers also impacts the distribution of physicians regionally, making the Northeast—where there is a higher concentration of academic medical centers—the only region in the United States predicted to have a physician surplus. Conversely, the South, the West, and the Midwest, respectively, have the largest shortages.

According to the AAMC, of the more than 7,200 federally designated health professional shortage areas, three out of five are in rural regions. Research from the AAMC also demonstrates how the lack of available doctors translates to sometimes devastating consequences for the health and wellbeing of people living in rural areas. People in these parts of the country are more likely to die from cardiovascular disease, chronic lung disease, and accidental injuries. Residents of rural regions are also more likely to be diagnosed with cancer at later stages and have worse outcomes.

In addition to the overall lack of physicians throughout rural areas, there are also important, specialty-specific shortages in rural areas. The maternal health crisis, for instance, which is most deeply and painfully felt by Black and Indigenous women, is particularly acute in rural areas where more than half of counties lack hospital services for delivering babies and resources for the acceptable provision of prenatal care.

Strategies to Combat Physician Shortages and Medical Deserts

Though physician shortages in hundreds of communities and in critical specialties—such as primary care doctors and obstetricians in underserved areas and psychiatrists throughout the country—are already a reality, the AAMC’s projections are still mostly projections. The extent of the physician shortage will ultimately rely on how the United States addresses physician education, training, recruitment, and retention in the coming years.

There are some policy measures currently underway that could potentially reduce the extent of the physician shortage. For example, there is bipartisan legislation on the horizon to expand residency training options, provide greater student loan support, and create smoother pathways for foreign-trained physicians. The United States can also better meet the nation’s medical care needs by keeping physicians in the profession. This means making investments in burnout mitigation, especially for physicians from historically underrepresented and marginalized groups. Collectively, we are all better served by taking better care of those charged with taking care of us.

Since physicians tend to practice where they complete their residencies, to prevent medical deserts, rural America and other underserved areas need more residency programs. Currently, of the more than $16 billion Medicare spends on graduate medical education, around 98 percent of the residencies receiving funding are in urban hospitals.

To increase the number of doctors in rural areas and avoid care gaps, some medical schools have begun more intentionally developing the pipeline of rural doctors through targeted outreach and programs that train students to become doctors and serve their local communities. Medical schools are also creating rural training tracks, rotations, and other programs specifically designed to help emerging doctors develop a wide range of skills—like working in the ER, delivering babies, and working in clinics and hospitals—so the aspiring doctors can care for the needs of local populations who may not have access to specialists.

Medical staffing strategies can also be employed to mitigate care gaps. One option is to allow more advanced practice providers—such as nurse practitioners and physician assistants—to fulfill more of patients’ care needs. States can also increase their pool of physicians by waiving residency requirements for physicians who were trained outside of the United States. Such a law has already been passed in Tennessee.

Policymakers have also proposed expanding telehealth as part of an effort to curb demand in underserved areas. Though telemedicine has a valid place within healthcare systems, it should be used reflectively and intentionally to ensure that its use doesn’t exacerbate health disparities. For example, as reported by the Washington Post, when faced with a shortage of available physicians, one rural hospital in Texas installed video cameras and fiber optic cables in the ER so that an out-of-state doctor who interacted with patients through a video screen could serve as the only doctor on call. The tactic required the small hospital to lobby the state of Texas to change its law regulating telemedicine.

This incident demonstrates the need for long-term solutions over quick fixes that could harm patients and worsen the quality of care they receive. Only viable, sustainable policies and practices will ensure the physician population grows with the country’s population into the 2030s and beyond.

Our healthcare system is the backbone of our nation’s wellbeing, but the pending lack of doctors places the system at the precipice of a crisis. As they dwindle in numbers, there is an urgent need to make collective investments in a well-trained, diverse workforce of care providers. Therefore, cultivating a pipeline of physicians and surgeons from underrepresented populations and medically underserved communities is an urgent, important step forward for realizing health equity and fulfilling the nation’s healthcare needs.