Nearly 40% of adults living in rural areas have turned to emergency departments for care that could have been handled in a primary care setting, pointing to persistent issues rural residents face when trying to access routine healthcare services, according to a Commonwealth Fund report published Nov. 17.
The report, “The State of Rural Primary Care in the United States,” draws from federal health workforce projections and data from the Commonwealth Fund’s 2023 International Health Policy Survey. It offers a comprehensive look at rural primary care gaps across the country, examining projected workforce shortages, geographic disparities in provider availability and highlights community-based care delivery models to address access issues.
Four takeaways from the report:
1. Supply‑and-demand mismatch: Nationally, primary care physician supply is expected to meet 73% of demand by 2037; in rural areas, that figure drops to 68%. As physician capacity lags, rural areas are increasingly relying on advanced practice providers. The supply of nurse practitioners in rural communities is expected to exceed demand by 2037 as they take on an expanded role in primary care. Nurse practitioner is the fastest-growing clinical role and the third-fastest growing occupation in the country overall. These providers are increasingly relied on to offset physician shortages and improve access in underserved areas.
2. The majority of rural counties face primary care workforce shortages: Around 92% of rural counties are federally designated as primary care Health Professional Shortage Areas, meaning they lack a sufficient number of providers relative to community needs. Overall, nearly 43 million people live in rural areas where there is an insufficient supply of primary care providers.
3. Access gaps drive rural patients toward higher-cost care: Limited provider availability continues to push rural residents toward higher-cost settings. Nearly 40% of rural adults reported using the emergency department for care that could have been handled in a primary care setting. Fewer than 30% said they can easily access after-hours primary care. Beyond provider shortages, additional barriers — such as transportation challenges and limited access to broadband internet — continue to limit rural residents’ ability to get timely care, according to the report.
4. Efforts to strengthen primary care delivery: The report outlines several efforts to strengthen rural primary care delivery, including broader use of community-based models such as rural health clinics and mobile health units that bring services directly to underserved areas.
It also highlights strategies to recruit and retain clinicians, such as expanding federal loan repayment programs such as the National Health Service Corps and rural training tracks during medical school to encourage long-term practice in rural communities. On the financial side, the report calls for rural-specific payment models to help stabilize primary care practices, which often face higher operating costs and lower patient volumes. Investments in broadband and digital infrastructure are also cited as critical to expanding access through telehealth.
