Independent physicians, practices disappearing from rural landscape

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If you are an independent physician in a rural area and it seems like you have fewer and fewer peers, you’re right.

Independent physicians in rural areas declined 43%, or 9,500 doctors, in the five-year period from January 2019 to January 2024, according to a new analysis commissioned by the Physicians Advocacy Institute (PAI), with data from Avalere.

The overall number of doctors is inching down, as is the number of independent medical practices, which saw a 42% drop, or 7,300 practices, for the same time period. Based on practice ownership type, health system and other corporate ownership levels increased during that time, according to the new study. The results could foreshadow not just doctors switching types of employment, but a larger issue of declining health care access in rural areas, according to PAI.

“Small, independent practices have been the cornerstone of medical care for many people in rural areas,” PAI CEO Kelly Kenney said in a news release about the study. “We’ve seen with rural hospitals that corporate acquisitions often lead to closures.

“We are concerned that this same profit-first approach will cause corporate owners to shutter rural practices that don’t produce high enough revenues, leaving patients without the access to care they need,” she said.

By the numbers

The PAI analysis included the following figures:

• Rural areas lost an estimated 2,500 physicians, dropping from approximately 52,600 in 2019 to 50,100 in 2024.
• Medical practices in rural areas decreased by 3,300, from 30,000 to 25,700.
• The share of independent rural physicians fell from 42% to 25%.
• Physicians employed by health systems grew from 48% to 58%.
• Corporate-owned physicians rose from 11% to 18%.
• The share of independent medical practices decreased from 58% to 38%.
• The share of corporate-owned practices grew from 11% to 23%.

“Overall, 75% of rural physicians were employed by health systems and corporate entities, and 61% of all rural medical practices were owned by non-physicians,” the report said.

The figures were based on IQVIA OneKey database, supplemented with provider ZIP codes and the U.S. Health Resources Administration’s Federal Office of Rural Health Policy crosswalk, according to PAI.

Additional analysis

The PAI study came out a day after the American College of Physicians (ACP) published “Improving Health and Health Care in Rural Communities: A Position Paper From the American College of Physicians,” a new position paper outlining problems and potential solutions for rural health care. ACP said doctors, educational institutions and policy makers all must collaborate on interventions to help. The solutions will include more physicians and educational programs to train them, better reimbursement, telehealth and greater opportunities for international medical graduates.