Physician shortage in rural areas of the US worsened since 2017

Loss of family physicians is greatest in Northeast

University of Rochester Medical Center

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

The national shortage of primary care physicians has been a concern for years, and a new study in the Annals of Family Medicine underscores how urgent the problem is and where the biggest pain point lies: in rural parts of the country that are seeing the largest population spikes in nearly a century.

By studying the location of practicing family physicians across the U.S. from 2017 to 2023, authors found a year-over-year decrease in family physicians practicing in rural areas, with a net loss of 11% nationwide over the 7 years studied. The greatest losses were in the Northeast and fewest in the West.  There were 11,847 rural family physicians in 2017 and 10,544 in 2023, a net loss of 1,303 (11%) for the country as a whole. The West lost 67 rural family physicians, the fewest on a percentage basis (3.2%); the Northeast lost 193, the most on a percentage basis (15.3%).

The findings were as surprising as they are alarming, according to lead author Colleen T. Fogarty, MD, professor and chair of the department of Family Medicine at the University of Rochester.

“The data reflect what we already experience and know about physician shortages, but the year-over-year numbers for rural areas were astonishing to me. The speed at which this has happened is remarkable and terrible,” said Fogarty.

The exodus of rural physicians is happening at a time when young adults in the 25-44 age group are moving to rural areas at the highest rate in nearly a century; two-thirds of the growth took place in smaller cities and rural counties since 2020. Powered by remote work opportunities and attracted to the amenities of country life, they are settling into rural areas but will find it increasingly difficult to access medical care.

Family physicians carry patient panels between 1,000 and 3,500 people, so the loss of even one in a community has a significant impact. When a physician leaves, their patients may turn to an already overburdened colleague still practicing in the community or travel farther to see a physician in another town.

There are several causes for the trend, Fogarty noted.

Family physicians in rural communities serve many roles, making them vulnerable to overwork and burnout that drives them to relocate or retire. In addition to adult medical care, they often provide emergency care and maternity care, including cesarean deliveries, as well as pediatric care.

“Fewer U.S. medical students are choosing family medicine as a specialty, and medical students from rural areas remain underrepresented compared with their non-rural peers. Over the years, international students choosing family medicine have offset the shortage, as they have become valuable and integral members of their rural communities, but current uncertainty around visa requirements for residents and practicing physicians adds another layer of concern about the family medicine workforce,” said Fogarty.

One encouraging trend from the study: the proportion of women family physicians has grown to almost equal that of men. Females represented 44% of family physicians in 2017 and the percentage steadily increased until 2023, when they represented 49.3%. In rural areas, as in the overall sample, the percentage of female practicing family physicians increased from 35.5% in 2017 to 41.8% in 2023.

But that trend, too, raises a challenge for recruiting doctors to a rural area.

“Does the rural community have what working mothers need? Healthy boundaries on work life are important; we need to get male and female family physicians the support they need so they are not working around the clock and diagnosing a medical issue while they’re at the cash register at the grocery store,” Fogarty added.

Reversing the trend will take time and resources. Advanced practice providers can ease the burden on rural physicians, and improved compensation packages may help recruitment and retention. 

Medical schools can also play a role, focusing on recruiting candidates from rural areas and developing rural health-specific curricula. Fogarty is leading a team to create a new rural residency training track at the University of Rochester School of Medicine & Dentistry Department of Family Medicine. Based on a national model, residents complete their first year of rotations in a city for the high volume, high acuity care that’s foundational, then spend their last two years of residency in a continuity practice in a rural community, and complete rotations working with local specialists.

“It’s an important initiative that we hope will make a difference,” said Fogarty. The first two candidates at Rochester will match in July 2027 and begin their rural training in July 2028.

Along with study co-authors Hoon Byun, DrPH at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, and Alison N. Huffstetler, MD, at Virginia Commonwealth University’s Department of Family Medicine, Fogarty used the American Medical Association Physician Masterfile to identify U.S. family physicians practicing outpatient care during 2017-2023 and where they were located.

---

Journal

The Annals of Family Medicine

Subject of Research

People

Article Title

Family Physician Workforce Trends: The Toll on Rural Communities

Article Publication Date

24-Nov-2025

Study finds nationwide decline in rural family physicians

Family physician workforce trends: the toll on rural communities

American Academy of Family Physicians

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

Research Brief

Background: In this study, researchers used the American Medical Association Physician Masterfile to identify family physicians aged 65 years or younger in the U.S. actively practicing outpatient care from 2017 to 2023. Physicians’ office addresses were mapped to the U.S. Department of Agriculture’s Rural-Urban Continuum Codes to identify and describe family physicians in rural communities.

What This Study Found:

• There has been an 11% nationwide decline in rural family physicians from 2017 to 2023.

• The Northeast saw the greatest percentage loss (15.3%), while the West saw the least (3.2%).

• The proportion of female rural family physicians increased from 35.5% in 2017 to 41.8% in 2023. 

Implications: Despite decades of programs to develop the rural workforce, the study findings show an ongoing loss of rural practicing family physicians, which further exacerbates existing disparities rural communities face.  

Family Physician Workforce Trends: The Toll on Rural Communities

Colleen T. Fogarty, MD, MSc, et al

University of Rochester School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, New York

Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC

Pre-Embargo Link (temporary) 

---

Journal

The Annals of Family Medicine

Article Title

Study Finds Nationwide Decline in Rural Family Physicians

Article Publication Date

24-Nov-2025

 

Nontraditional benefits play key role in retaining the under-35 government health worker

Columbia University's Mailman School of Public Health

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

November 20, 2025-- Younger workers in governmental public health place significantly higher value on nontraditional benefits than their older counterparts, according to a new study from Columbia University Mailman School of Public Health. Flexible scheduling and remote-work policies were among the top motivators for younger employees choosing and remaining in public service. The findings are published in the Journal of Public Health Management and Practice.

“Public health workers age 35 or younger consistently show lower retention rates than older workers,” said Heather Krasna PhD, EdM, MS, associate dean of Career and Professional Development at Columbia Mailman School, and senior author. “Salaries matter, but because health departments often face limits on salary increases, offering nontraditional benefits may be an effective strategy to attract and retain younger staff.”

The research team analyzed data from the 2024 Public Health Workforce Interests and Needs Survey (PH WINS), developed by the Beaumont Foundation and the Association of State and Territorial Health Officials. Responses from permanent, full-time health department employees were divided into two groups—those 35 and younger and those over 35—to compare how each valued nontraditional benefits, reasons for staying and, for younger workers, motivators for initially entering governmental public health. The two groups were similar in gender composition.

Younger workers were significantly more likely to cite nontraditional benefits as important reasons for staying with their organization:

• Flexibility: 38 percent of workers 35 and under vs. 31.5 percent of older workers
• Remote-work policies: 25 percent vs. 20 percent
• Training opportunities: 23 percent vs. 17 percent

Despite modest gains in younger representation in earlier years—26 percent of staff were younger than 40 in 2014 compared with 29 percent in 2017—retention has remained a persistent challenge. For example, workers under age 30 accounted for just 6 percent of the workforce between 2014 and 2017 but 13 percent of all departures. Turnover is costly, especially among skilled staff.

“The state and local governmental health department workforce has undergone dramatic shifts in recent years,” said Krasna. “The COVID-19 pandemic and long-standing recruitment and retention challenges—especially among younger staff—have further strained the system.”

Key drivers of retention for younger professionals include job satisfaction, meaningful work, recognition, supervisor support, workplace culture, work-life balance, remote-work options, and access to childcare.

“Because salary increases and broader workplace-culture reforms can be slow, innovative benefits may offer a more immediate tool for improving retention,” Krasna added. “Our study reinforces a growing body of evidence that nontraditional benefits—such as schedule flexibility, remote work, and professional development opportunities—play a substantial role in job satisfaction and are especially influential for younger public health workers.”

“For health departments unable to rapidly boost salaries, options like flex time, professional-development funding, or childcare support could meaningfully encourage younger staff to stay.”

Sarika Karra of Columbia Public Health is a co-author.

The study was supported by the Centers for Disease Control and Prevention and the Health Resources and Services Administration, grants U81HP47167 and UR2HP4737.1.

 

---

DOI

10.1097/PHH.0000000000002234 

Article Title

The Role of Nontraditional Benefits in Recruitment and Retention for Public Health Workers Age 35 and Under

Most homemade dog diets lack nutrients, Texas A&M study finds

New research from the Dog Aging Project reveals that only 6% of homemade dog food recipes meet essential nutritional requirements.

Texas A&M University

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

Over the last two decades, homemade diets have seen a rise in popularity among dog owners. However, new research from the Dog Aging Project (DAP) reveals that most homemade diets are missing important nutrients that dogs need to lead healthy lives.

In the study, published in the American Journal of Veterinary Research, the team assessed the nutritional completeness of 1,726 homemade diets based on ingredients and preparation methods provided by dog owners.

“We found that only 6% of homemade diets had the potential to be nutritionally complete,” said Dr. Janice O’Brien, a doctoral researcher at the Virginia-Maryland College of Veterinary Medicine at Virginia Tech. “Since our study didn’t include exact ingredient amounts, it’s possible that a smaller percentage than 6% were nutritionally complete.”

Diet information was gathered from open-ended survey responses from owners participating in the DAP, a collaborative initiative led by the Texas A&M College of Veterinary Medicine and Biomedical Sciences (VMBS) and other institutions that studies the effects of aging and what makes a healthy canine life.

Through the DAP, owners of the more than 50,000 dogs from all backgrounds enrolled in the study complete surveys, including on diets. For this study, the diet information was entered into an online tool called Balance It that helps owners create nutritionally complete homemade diets for their pets.

“Balance It is compliant with both the United States Food and Drug Administration and the Association of American Feed Control Officials’ recommendations for canine nutrition,” O’Brien said. “By entering the list of ingredients in each recipe into Balance It, we determined if there were nutrients missing.”

The importance of a complete meal

Based on the results of the study, dog owners should be aware that choosing to prepare a pet’s meals at home comes with responsibility, according to Dr. Katie Tolbert, a board-certified veterinary nutritionist, small animal internist, and associate professor in VMBS’ Department of Small Animal Clinical Sciences.

“There is a temptation for a lot of dog owners to go off script when preparing meals at home,” said Tolbert, who also is one of the study’s authors. “If you decide to formulate your dog’s food at home, be sure to work with a board-certified veterinary nutritionist and stick to the diet exactly as prescribed. Nothing is considered a ‘filler’ that you can leave out.”

For example, substituting different types of oil can change the nutritional completeness of the diet, and something as simple as a calcium supplement — a common addition in homemade dog food recipes — can cause serious problems if omitted.

“If your dog’s calcium and phosphate levels get out of balance, they can develop bone health problems, including a condition nicknamed ‘rubber jaw’ where the bone starts to become soft, like cartilage,” Tolbert said. “It can also cause problems in the kidneys.”

For dogs with existing illnesses, the stakes of good nutrition are even higher.

“Dogs that are not already in good health can have exacerbated symptoms if they do not receive a balanced diet that is specifically formulated to treat their disease,” Tolbert said.

Tolbert also recommends avoiding adding ingredients that are not safe for dogs, like whole bones or grapes.

“Grapes can be toxic to dogs,” she said. “Whole bones, on the other hand, are risky because dogs can end up with sharp pieces of bone in their stomach.”

Bringing nutritional completeness home

For owners interested in feeding their dogs a homemade meal, the first step is to talk with your local veterinarian about your pet’s specific dietary needs. Then, work with a board-certified veterinary nutritionist to create a healthy diet tailored to your pet.

Board certification ensures that the nutritionist has received advanced training from an accredited program.

If you plan to keep your dog on a homemade diet long-term, Tolbert recommends sending a sample to a food testing laboratory to make sure that the diet is the same in practice as it is on paper.

“It can be helpful to know exactly what is in the food you’re feeding your pet to make sure the recipe is as precise as possible,” Tolbert said.

By Courtney Price, Texas A&M University College of Veterinary Medicine and Biomedical Sciences

---

Journal

American Journal of Veterinary Research

DOI

10.2460/ajvr.25.06.0216 

Method of Research

Survey

Subject of Research

Animals

Article Title

Findings from the Dog Aging Project: home-prepared diets for companion dogs feature diverse ingredients, and few are nutritionally complete

 

From shiloh shepherds to chihuahuas, study finds that the majority of modern dogs have detectable wolf ancestry

Newly discovered post-domestication gene flow from wolves has shaped the characteristics and evolution of dogs

American Museum of Natural History

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

New research led by scientists at the American Museum of Natural History and the Smithsonian’s National Museum of Natural History reveals that the majority of dogs living today have low but detectable levels of post-domestication wolf ancestry that has likely shaped characteristics including body size, sense of smell, and personality traits. The study, published today in Proceedings of the National Academy of Sciences, suggests that this newly uncovered gene flow may help give unique advantages to dogs’ survival in diverse human environments. Among their findings: post-domestication wolf ancestry exists in a wide range of dog breeds, from large Shiloh shepherds to the tiny chihuahua.

“Modern dogs, especially pet dogs, can seem so removed from wolves, which are often demonized,” said the study’s lead author Audrey Lin, a Gerstner Postdoctoral Scholar in Bioinformatics and Computational Biology at the American Museum of Natural History. “But there are some characteristics that may have come from wolves that we greatly value in dogs today and that we choose to keep in their lineage. This is a study about dogs, but in a lot of ways, it’s telling us about wolves.”

Dogs evolved from an extinct population of gray wolves under human influences during the late Pleistocene, about 20,000 years ago. Although wolves and dogs live in the same geographic regions and can produce fertile offspring, hybridization is rare. And with few exceptions of intentionally crossbred wolves and dogs, there is little evidence of gene flow between the groups after dog domestication separated their gene pools.

“Prior to this study, the leading science seemed to suggest that in order for a dog to be a dog, there can’t be very much wolf DNA present, if any,” Lin said. “But we found if you look very closely in modern dog genomes, wolf is there. This suggests that dog genomes can “tolerate” wolf DNA up to an unknown level and still remain the dogs we know and love.”

The researchers explored historical dog-wolf gene flow using more than 2,700 published genomes from the National Center for Biotechnology Information and the European Nucleotide Archive of wolves, breed dogs, village dogs, and other canids spanning the late Pleistocene to the present. They found that almost two-thirds of breed dogs have wolf ancestry within their nuclear genome from crossbreeding that occurred around 1,000 generations ago. In addition, all of the genomes analyzed from village dogs—free-roaming dogs that live in or near human settlements—carry detectable wolf ancestry.

Czechoslovakian and Saarloos wolfdogs, which were purposefully bred through hybridization with wolves, had the highest levels of wolf ancestry, between 23-40 percent of their genomes. Among breed dogs, the most “wolfy” were the great Anglo-French tricolour hound (between 4.7 and 5.7 percent wolf ancestry) and the Shiloh shepherd (2.7 percent wolf ancestry). While the Shiloh shepherd originated from breeding efforts with wolfdogs or other recent dog–wolf hybrids to create healthier, more family-friendly shepherd dogs in the US, the origin of the extensive wolf ancestry in Great Anglo-French tricolour hounds—the most common hound in modern France—is unknown and unexpected. The Tamaskan, a “wolfalike” breed that originated in the UK in the 1980s from selecting huskies, malamutes, and other breeds with the goal of producing a wolf-like appearance, has about 3.7 percent wolf ancestry.

The researchers found several patterns among the data: wolf ancestry is higher among larger dogs and in those bred for certain types of work, including Arctic sled dogs, “pariah” breeds, and hunting dogs. Terriers, gundogs, and scent hounds have the least wolf ancestry, on average. While some large guardian dogs have high wolf ancestry, others, like the Neapolitan mastiff, bullmastiff, and the St. Bernard, have no detectable wolf ancestry. Wolf ancestry is also found in a wide range of dog breeds outside of these correlations, including in the tiny chihuahua, which has about 0.2 percent wolf ancestry.  

“This completely makes sense to anyone who owns a chihuahua,” Lin said. “And what we’ve found is that this is the norm—most dogs are a little bit wolfy.”

The research team also compared how often personality terms are used by kennel clubs to describe dog breeds with the highest and lowest levels of wolf ancestry. The descriptor most associated with low wolf-ancestry breeds was “friendly,” followed by “eager to please,” “easy to train,” “courageous,” “lively,” and “affectionate.” In contrast, high wolf-ancestry dogs are more often described as “suspicious of strangers,” as well as “independent,” “dignified,” “alert,” “loyal,” “reserved,” and “territorial.” Other descriptors, including “intelligent,” “obedient,” “good with children,” “dedicated,” “calm,” and “cheerful” occurred with similar frequency in both groups of dogs. The team stressed that these traits are biased assessments of breeds’ behaviors, and it is not known if wolf genes are directly responsible for these characteristics, but this finding opens paths for future research in dog behavioral science.

In addition, the study uncovered important adaptations that dogs have accessed through wolves, including: enriched wolf ancestry at olfactory receptor genes in village dogs, who depend on the ability to sniff out human food waste; and the distribution of a Tibetan wolf-like gene that helps Tibetan mastiffs tolerate low oxygen conditions in the Tibetan Plateau and the Himalayas.

“Dogs are our buddies, but apparently wolves have been a big part of shaping them into the companions we know and love today,” said study co-author Logan Kistler, curator of archaeobotany and archaeogenomics at the National Museum of Natural History. “Through the years, dogs have had to solve all kinds of evolutionary problems that come with living with humans, whether it’s surviving at high altitude, searching for their next meal as they freely roam a village, or protecting the herd, and it seems like they use wolf genes as part of a toolkit to continue their evolutionary success story.”

Other study authors include Regina Fairbanks, from the University of California, Davis; Jose Barba-Montoya, from the American Museum of Natural History; and Hsiao-Lei Liu, from the National Museum of Natural History and University of Stockholm.

 

ABOUT THE AMERICAN MUSEUM OF NATURAL HISTORY (AMNH)

The American Museum of Natural History in New York City, founded in 1869 with a dual mission of scientific research and science education, is one of the world’s preeminent scientific, educational, and cultural institutions. The Museum encompasses more than 40 permanent exhibition halls, galleries for temporary exhibitions, the Rose Center for Earth and Space including the Hayden Planetarium, and the Richard Gilder Center for Science, Education, and Innovation. The Museum’s scientists draw on a world-class permanent collection of more than 30 million specimens and objects, some of which are billions of years old, and on one of the largest natural history libraries in the world. Through its Richard Gilder Graduate School, the Museum offers two of the only free-standing, degree-granting programs of their kind at any U.S. museum: the Ph.D. program in Comparative Biology and the Master of Arts in Teaching (MAT) Earth Science residency program. Visit amnh.org for more information.

---

Journal

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2421768122 

Article Title

A legacy of genetic entanglement with wolves shapes modern dogs