More than 180 areas in the United States have been federally designated as primary care shortage areas for at least 40 years, according to an analysis of federal data from KFF Health News.
The stagnation holds even as the overall number of licensed U.S. physicians more than doubled from 1990 to 2022 to over 1 million, outpacing overall population growth, according to the Federation of State Medical Boards. There are more than 8,300 designated primary care shortage areas in the U.S.
The finding underlines the quality of physician and provider workforce data in the U.S., which is astoundingly inadequate. Even basic figures or estimates, such as national estimates of physician turnover, are not rigorously and systematically captured. It is unlikely for federal policy to realize its full potential in addressing physician or provider shortages without data showing where deficits are most critical.
Auburn Gresham on Chicago's far South Side has been designated as a shortage area since 1978. Livingston Parish, part of the Baton Rouge metropolitan area in Louisiana, has been named a shortage area since 1979, most recently with 22 full-time primary care physicians for nearly 140,000 people. In the heartland of Florida, Glades County has one full-time primary care physician for more than 12,000 people; it's been recognized as a shortage area since 1979. Some areas, like Indian Springs, Nev., or Slope County, N.D., have zero primary care physicians with shortage designations also dating back to the late 1970s.
"There's no government organization that's tracking: Who trained in what, where, and where are they now, and what are they practicing?" Alison Huffstetler, medical director of Washington, D.C.-based research group Robert Graham Center, told KFF. "If we don't know who is doing what kind of care — and where — then there is no way for us to equitably manage the patient-to-clinician ratio across every state."
The problems begin at the top. Funding and staffing vary greatly among the state health authorities responsible for identifying possible shortage areas and submitting them to the Health Resources and Services Administration, which then scores the extent of any shortages. Additionally, the physician-to-population ratio — the main metric for identifying shortage areas — is limited and does not account for other primary care professionals, like physician assistants and nurse practitioners.
Some sources quoted by KFF express doubt with the efficacy of the federal HPSA program, established in 1965 to draw providers to underserved areas, and more recent efforts like it to improve physician density in the long-term. Others say that even though designated shortage areas go back to 1984 or earlier for 180-plus areas, the state of affairs could be worse if not for the program.
Find the KFF report in full, with a map of the 180 areas in long-term shortage, here.