States With the Biggest Discrepancies Between Urban and Rural Healthcare Access

The disparity in healthcare access between rural and urban areas varies significantly across the United States. The map above illustrates the primary care physician gap in each state, measuring the difference in healthcare access by comparing the number of people per primary care physician in rural and urban counties. The majority of states have hundreds more people per physician in their rural counties than in their urban counties, which means that physicians in urban counties generally have more manageable patient loads than their rural counterparts.

What This Means for Healthcare Access

A high gap indicates that rural residents have significantly fewer available PCPs and must compete with many patients for appointments. A high ratio of people per PCP can lead to challenges in accessing medical care, such as longer wait times and an increased need to travel long distances for care. It can also result in higher patient costs due to increased reliance on emergency care or specialist visits. Additionally, with fewer doctors available, patients have less choice in selecting a provider, often having to settle for whichever doctor has availability rather than choosing based on personal preferences.

National Averages:

• Urban Ratio: 1 primary care physician per 1,485 people
• Rural Ratio: 1 primary care physician per 1,961 people
• Physician Gap: 476 more people per primary care physician in rural areas than in urban areas
• Rural-to-Urban Access Gap: 39% more people per primary care physician in rural areasthan in urban areas

States With the Largest Gaps in Urban vs. Rural Healthcare Access

Some states exhibit extreme disparities in healthcare access between rural and urban areas:

• North Dakota has the largest discrepancy, with rural residents facing 2,079 more people per primary care physician than urban residents. This equates to a 352% greater burden for rural communities.
• Florida, Louisiana, and North Carolina also rank among the worst states for rural healthcare access, with rural residents facing at least 1,200 more people per primary care physician than those in urban areas.
• Mississippi and Alabama follow closely, where rural areas see nearly twice the patient load per primary care physician compared to urban regions.

States Where Rural Residents Have Better Access Than Urban Areas

Interestingly, in some states, rural areas have better access to primary care physicians than urban areas:

• Vermont leads the way, where rural residents have 21% better access than urban populations, with 295 fewer people per primary care physician in rural communities.
• Other states with stronger rural access include Nebraska, Iowa, Idaho, Wyoming, Kansas, New Hampshire, Missouri, New Jersey, and Alaska, where the physician-to-patient ratios in rural areas are lower than in urban regions.

• North Carolina has the largest rural physician deficit, requiring an estimated 642 additional primary care physicians to close the gap between rural and urban access. Rural residents in the state already face a 122% greater burden in accessing care, with an average of 2,228 people per physician in rural areas, compared to just 1,005 per primary care physician in urban regions.
• Michigan ranks second, with a physician deficit of 377, meaning hundreds of additional healthcare professionals would be needed to ensure equal access across the state.
• North Dakota, despite having the largest percentage gap in physician access (352%), has a total deficit of 372 primary care physicians needed to bring rural access in line with urban levels.
• Mississippi, Minnesota, and Texas also rank among the states with the most significant primary care physician shortages, requiring anywhere from 240 to 300 additional rural primary care physicians to match urban access.

Key Takeaways

The states with the highest primary care physician deficits are largely concentrated in the South and Midwest, where a combination of rural hospital closures, physician shortages, and economic factors make it harder for residents to access primary care. North Carolina, Michigan, and North Dakota stand out as the most affected, with hundreds of additional physicians needed to close the gap. Texas, ranked sixth, highlights the challenge in large states where rural populations are widely dispersed. These findings underscore the critical need for healthcare workforce development initiatives to bring more primary care professionals to underserved rural areas.

• Healthcare Workforce Shortages: Many rural areas struggle to attract and retain primary care physicians due to lower salaries, fewer professional development opportunities, and limited access to advanced medical facilities. States with extreme shortages, such as North Dakota and Mississippi, might not have enough incentives in place to keep medical professionals in rural communities.
• Population Density and Geography: In sparsely populated states, long travel distances between towns and medical facilities make it difficult for rural residents to access care. States like North Dakota, Montana, and Wyoming, where towns are spread out, face greater challenges in healthcare access compared to smaller states like Vermont or New Jersey, where rural areas may still be relatively close to urban centers.
• State-Level Healthcare Policies: Many states have implemented targeted programs to improve rural healthcare access, including loan forgiveness initiatives that incentivize medical professionals to work in underserved areas. Vermont and Nebraska, for example, have benefited from policies designed to attract and retain healthcare physicians in rural communities.

• Hospital & Clinic Closures: Rural hospitals have been closing at an alarming rate in the U.S., especially in Southern states like Mississippi, Alabama, and Louisiana. When hospitals and clinics shut down, rural residents must travel even farther to see a doctor, leading to worsening physician-to-patient ratios.
• Economic Disparities: Rural communities often have lower incomes and higher rates of uninsured residents, which can impact the financial viability of healthcare physicians. Physicians may be less likely to set up practices in areas where many patients are unable to afford care.

These factors, combined with state-specific trends in healthcare funding and workforce distribution, help explain why some states experience far greater rural-urban disparities than others.