Access to healthcare is one of the most important factors influencing public health outcomes. Yet for millions of Americans living in rural communities, finding a physician, psychologist, specialist, or other healthcare professional remains a significant challenge. A recent study examining healthcare workforce distribution across the United States highlights a concerning reality: nonmetropolitan areas continue to have substantially fewer healthcare workers relative to their population size than metropolitan regions.
The findings shed light on long-standing healthcare disparities and help explain why rural populations often experience barriers to care, delayed treatment, and poorer health outcomes compared with urban residents.
Researchers analyzed data from the American Community Survey Public Use Microdata Sample covering the years 2019 through 2023. The study focused on patient-facing healthcare occupations and compared workforce availability in metropolitan and nonmetropolitan areas across the country.
The results showed a striking imbalance. Although nearly 14 percent of the U.S. population lives in nonmetropolitan areas, only about 8 percent of the healthcare workforce works in those communities. This means rural regions have significantly fewer healthcare professionals available to serve residents.
When adjusted for population size, nonmetropolitan areas had approximately 44 percent fewer healthcare workers per 10,000 residents than metropolitan areas. This disparity was observed across every healthcare occupation examined in the study.
The workforce shortage is not distributed evenly across occupations. Some professions showed especially large gaps between urban and rural areas.
Psychologists experienced the largest disparity. Rural communities had only about one-quarter as many psychologists per capita compared with metropolitan regions. This shortage can have major implications for mental health access, particularly as demand for behavioral health services continues to rise nationwide.
Physicians also showed a significant gap. Rural areas had less than one-third the physician workforce rate found in metropolitan areas. Surgeons, dentists, pharmacists, and physician assistants were similarly underrepresented outside urban centers.
These findings suggest that residents in rural communities may face greater challenges when seeking specialized care, preventive services, and mental health treatment.
Healthcare workforce shortages can affect nearly every aspect of patient care. When communities have fewer healthcare professionals, patients may need to travel longer distances for appointments, experience extended wait times, or postpone care altogether.
These barriers can contribute to:
Research has consistently shown that rural populations experience higher rates of certain chronic conditions and mortality. Limited access to healthcare professionals may be one factor contributing to these outcomes.
One of the most notable findings from the study was that occupations requiring extensive education and specialized training tended to show the largest urban-rural differences.
For example, physicians were far less represented in nonmetropolitan areas than advanced practice nurses. Similarly, physical therapists showed larger disparities than physical therapist assistants.
Several factors may contribute to this trend:
Urban areas often provide access to larger hospitals, academic medical centers, research opportunities, and specialized practices. These environments can be attractive to highly trained professionals seeking career advancement.
Many healthcare professionals complete training in metropolitan regions and choose to remain there after graduation. This can create a pipeline effect that concentrates talent in urban settings.
Income potential, patient volume, and professional networking opportunities may be greater in metropolitan areas, influencing workforce distribution decisions.
Personal factors such as educational opportunities for children, employment options for spouses, and access to cultural amenities may also influence where healthcare professionals choose to practice.
While shortages were widespread, some healthcare occupations demonstrated smaller disparities between metropolitan and nonmetropolitan areas.
Nursing assistants, physical therapist assistants, and occupational therapy assistants showed comparatively narrower gaps. In some sensitivity analyses conducted by researchers, certain support roles even appeared more prevalent in rural areas.
This suggests that while workforce shortages affect many healthcare professions, the severity varies depending on training requirements, workforce pipelines, and healthcare delivery models.
Addressing healthcare workforce shortages in rural America will likely require a combination of policy initiatives, educational programs, and innovative care models.
Potential solutions include:
Studies have shown that healthcare professionals are more likely to practice in rural communities if they train there. Expanding rural residency and clinical training opportunities could help strengthen local workforce pipelines.
Loan repayment programs, scholarships, and incentive packages can encourage healthcare professionals to work in underserved areas.
Virtual healthcare services can help bridge access gaps, particularly for mental health care and specialist consultations.
Nurse practitioners, physician assistants, and other advanced practice providers can help improve healthcare access in areas where physician shortages are severe.
Strengthening rural hospitals, clinics, and community health centers may improve recruitment and retention of healthcare professionals.
The study provides one of the most comprehensive recent assessments of healthcare workforce distribution across the United States. Its findings reinforce concerns about healthcare access in rural communities and highlight the need for targeted workforce development strategies.
While the research does not determine the exact causes of workforce disparities, it clearly demonstrates that significant differences persist across nearly every patient-facing healthcare profession.
As healthcare systems continue to evolve, policymakers and healthcare leaders will need to focus on creating sustainable solutions that improve access to care for nonmetropolitan populations. Without meaningful intervention, workforce shortages could continue to widen existing health disparities between urban and rural communities.
The healthcare workforce remains heavily concentrated in metropolitan areas. Rural communities face fewer healthcare professionals across all major patient-facing occupations, with the largest shortages occurring among psychologists, physicians, and other highly trained clinical specialists. Improving healthcare access in nonmetropolitan areas will require long-term investment in workforce development, training, recruitment, and innovative care delivery approaches.
Burus, T., & Semprini, J. (2026). A Cross-Sectional Assessment of Differences in the U.S. Health Care Workforce by Urbanicity, 2019 to 2023. Annals of Internal Medicine. DOI: 10.7326/ANNALS-26-00239.
This blog post is an independently rewritten summary intended for educational and informational purposes only. It does not reproduce the original research article and should not be considered medical, legal, or policy advice. Readers seeking detailed methodology, statistical analysis, or clinical interpretation should consult the original publication.
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