During Covid Years, The Number Of Independent Doctors In Rural Areas Fell 43%

Glenn Highway (Photo, Country Journal) 

Report: Rural Patients Losing Access to Independent Physicians and Medical Practices 

The study showed that the corporate consolidation of medical practices and the resulting decrease in access to healthcare services in rural areas is accelerating. 

by Liz Carey. May 12, 2025 
From The Daily Yonder  

A new analysis has found that access to independent physicians and medical practices is falling in rural areas. 

Between 2019 and 2024, the number of independent physicians in rural areas fell by 43%, according to a study commissioned by the Physicians Advocacy Institute (PAI). The study also found that nearly 9,500 rural physicians left independent practice. The loss impacted the Midwest and Northeast the most, with Indiana, Iowa, Maine, Massachusetts, Minnesota, New Hampshire, New Jersey, Ohio, South Carolina, and South Dakota losing more than 50% of their independent rural physicians. Additionally, the study found 7,300 rural medical practices either closed or were acquired by health systems or corporate entities.

“We know that rural areas lost 2,500 physicians outright,” Kelly Kenney, the CEO of PAI, said in an interview with The Daily Yonder. “We know that 3,300 medical practices have closed. That represents five percent of practicing physicians in those areas and 11% fewer practices. We’ve been tracking consolidation trends for physicians and changes in practice ownership as hospitals and health systems, and private equity, race to acquire physician practices, and we know that those trends have been nationwide. What we didn’t know until this study is how it played out in rural areas.”

The data also showed that corporate entities added more than 3,000 physicians to their payrolls, a 57% increase, and nearly doubled their practice ownership in rural areas, controlling more than 6,000 practices by the end of January 2024. Overall, three-quarters of rural physicians were employed by health systems and corporate entities, and more than 60% of all rural medical practices were owned by non-physicians, according to the report.

Kenney said that could mean more closures of practices in rural communities. Once corporations come in and acquire practices, those practices are often closed based on profit margins.

“If you look at private equity, they tend to consolidate with other like practices across a kind of specialty or a couple of specialties, and then they will cut where things aren’t profitable,” Kenney said. “So our concern is that when you have higher rates of corporate ownership, you kind of create inherent access problems because we know that they do utilize fewer positions per capita, and we know that they may turn to staffing with more physician’s assistants and nurses where previously physicians were practicing.”

The trend coincides with an overall decline in physicians going into rural areas. Over the past five years, research has indicated that physicians are less likely to go to rural communities, and that the more specialized their field, the less likely they are to go into practice in a rural area. Ironically, rural residents tend to be sicker than their urbancounterparts, especially in areas that require specialists like cardiovascular health and diabetes.

Dr. Randy Wykoff, dean of the College of Public Health at East Tennessee State University, said ensuring physicians stay in rural communities requires helping others understand the value of living in rural areas, as well as recruiting students from those rural communities.

“Most medical training is in urban areas, and there’s sort of this mystique about being at the highest profile place and the most effective organization,” Wykoff said in an interview with the Daily Yonder.

“But I think we have to help people understand that there’s a quality of life in rural America… There are various ways people have proposed doing that. One of the most obvious is you get doctors and nurses from rural areas who have a motivation to go home or stay home.”

Wykoff is considered one of the nation’s experts on public and rural health, having previously spent his career working for the U.S. Food and Drug Administration (FDA) and the U.S. Department of Health and Human Services (HHS). He said another way is to provide those rural doctors and healthcare providers with the support they need to help their patients.

“It’s daunting for anyone to be in sort of solo practice, especially in a rural area,” he said. “I think through connections, whether it’s telemedicine or other support, we need to build a spoke-and-hub system so the [physicians] that are out in the more rural areas can communicate regularly with their counterparts and not have to struggle to get referrals and things like that. Some of it will come from making sure that rural hospitals and rural providers are paid a wage that can keep them going.”

In Washington, some Congress members are calling for the federal government to tackle the issue. Earlier this month, U.S. senators Roger Wicker, R-Mississippi, and Jackie Rosen, D-Nevada, introduced the Specialty Physicians Advancing Rural Care Act, or “SPARC,” that would create a student loan repayment program for specialist physicians and other healthcare specialists who practice in rural areas.

“The entire nation is dealing with a physician shortage, and rural communities in Mississippi have been particularly affected. Congress can help provide a solution,” Wicker said in a statement. “The SPARC Act would offer targeted incentives to medical professionals who choose to work in underserved towns and cities. I believe this bill will encourage providers to bring their services to areas that need them most.”

Dr. LouAnn Woodward, vice chancellor for health affairs and dean of the University of Mississippi Medical Center School of Medicine, said in a statement that the legislation would bring more qualified healthcare providers to rural communities and encourage more skilled physicians to establish specialty-medicine practices in rural areas.

Kenney, of the Physicians Advocacy Institute, said keeping independent physicians in rural communities requires changes in federal policies as well. Among those are ending the moratorium on physician-owned hospitals enacted after the Affordable Care Act.

Physician-owned hospitals can “provide care very cost-effectively, and the quality is high,” Kenney said. “We’ve been advocating to lift that moratorium and to start in rural areas.”

Other policies should address the discrepancies in payment for services rendered to make it easier for independent physicians to sustain their practices, she said. Payment policies within Medicare, Medicaid, and insurance favor larger organizations, she said, which puts smaller independent practices at a disadvantage. And that further pushes independent physicians to join larger groups, or to leave rural areas altogether.

“The bottom line is when there’s less competition, we have higher costs, and oftentimes, we have less access in places like rural America where, frankly, you’re just not making the profits that those corporations want to make,” she said.