Practice Activity of Physicians and Rural Location

Robert C. Bowman, M.D.

Major Points

Few medical schools or residency programs are in rural locations. Over 97% of medical students and residents are in urban locations.
Family medicine and general practice physicians distribute according to the US population with a greater percentage in rural locations followed by General Surgery, Medicine Pediatrics, and Orthopedics. The other main primary care specialties of Internal Medicine and Pediatrics have 10 - 11 % in rural areas when considering all types, but lower levels when considering those who deliver office-based care more reflective of actual primary care physician supply.

Source is AMA Masterfile, all active physicians (not inactive or residents)

Practice zip code (or other zip code if missing) is coded by RUCA

Practice Activity by Rural Location (practice zip code)

	Urban higher income	Urban Over 20% Pov	Rural higher income	Rural Over 20% Pov	All Over 20 % Pov	% Rural
administration	10898	19.9%	959	11.7%	19.2%	8.1%
hospital full-time	32265	15.5%	4612	15.6%	15.5%	12.5%
hospital resident	64602	23.5%	1889	26.8%	23.6%	2.8%
inactive	51591	10.5%	11158	12.8%	10.9%	17.8%
Locums	333	6.9%	87	9.2%	7.4%	20.7%
medical teaching	6819	29.7%	394	12.7%	28.8%	5.5%
not classified	21924	20.5%	1632	23.7%	20.7%	6.9%
office based	326860	14.9%	50424	15.7%	15.0%	13.4%
other	2474	12.7%	284	10.6%	12.5%	10.3%
research	9225	27.7%	295	9.2%	27.2%	3.1%
	526991	16.3%	71734	15.6%	16.2%	12.0%

Residents in training are located urban over 97% of the time.

Medical teaching is a rare practice activity in rural locations, but not in poverty zips Understanding Poverty and Physician Workforce

Rural vs urban not different in most categories except researchers, with fewer in rural zips.

Inactive docs tend to be located in rural areas, a reflection of retirement and an important area to understand in doing physician workforce.

It is entirely possible that many of the locums physicians are former rural physicians, representing a loss of continuity care for higher paid locums and emergency care. Efforts to graduate more hospitalists or to fund locums and ER work more may depleted continuity physicians from rural primary care practices.

% of active physicians in each self designated specialty located in rural areas. Again the total percentage drops when considering those who are in active office-based activities.

	Total	% Rural
GenPract	1883	29.5%
FamMed	14009	28.0%
GenSurg	3531	19.2%
MedPeds	260	17.4%
Ortho	2527	15.2%
Urology	997	13.8%
OBGyn	3570	13.0%
EarNoseThroat	936	12.9%
DiagRadio	1814	12.6%
Path	879	12.2%
Emerg Med	1950	12.1%
Ophth	1725	11.9%
Radiology	659	11.3%
Int Med	6817	10.8%
Pediatrics	3334	10.3%
GenPrevMed	82	10.1%
RadiationOnco	253	9.6%
OtherSpec	189	9.6%
Anesthesia	1952	9.4%
Psychiatry	1616	8.8%
Gastroent	598	8.8%
Pulmonary	304	8.5%
OccuMed	114	8.4%
Derm	655	8.4%
Neurology	531	8.2%
HemeOnc	97	8.1%
Cardiology	929	7.8%
Prev Med	256	7.4%
Child Psych	250	7.1%
NeuroSurg	218	6.8%
AllerImm	145	6.3%
Thoracic Surg	184	5.6%
Plastic Surg	227	5.0%

Other specialties at a lower number than 100 US physicians in rural areas or lower in %