As the U.S. population continues to grow — and age — demand for health care services is expected to increase. Along with demographic changes, the number of Americans with health insurance has also increased considerably in recent years — another factor in the growing demand for health care services. As a result, the number of physicians needed in the United States will likely continue to rise.
However, while the number of doctors per capita has been indeed increasing nationwide, in a number of areas across the country, this pattern does not hold. Based on data from the U.S. Department of Health and Human Services, 24/7 Wall St. reviewed the metro areas shedding primary care physicians the fastest.
The Bureau of Labor Statistics projects employment levels of physicians and surgeons to increase by 14%, considerably faster than average. From 2010 through 2013, the number of primary care physicians per 100,000 Americans increased by 3.7%. Yet, there are close to 100 metro areas where the number of primary care physicians per 100,000 people declined over that period. Of these areas, seven report declines of more than 10%.
In each of these seven U.S. cities there are also fewer doctors per capita than there are across the country as a whole. In most cases, this was true even before the loss of doctors. Fewer doctors per capita in a given area means primary care physicians are often strained with more patient visits in a single day. Such a work environment is stressful, and doctors often leave such areas in favor of more urban areas with a larger medical establishments.
Simple supply economic factors also play a role in where doctors decide to work. In an interview with 24/7 Wall St. Martin Kohli, chief regional economist with the Bureau of Labor Statistics, explained that doctors’ “expected income is probably related in part to the expected income of their customers — poorer people probably can’t spend as much money on medical care as richer people.” Median household income in four of seven cities losing the most doctors is below the national median income. In Morristown, Tennessee, for example, a city that has suffered a 10.8% drop in the number of primary care physicians per capita, the typical household earns only $39,822 a year, one of the lowest median incomes in the country.
Doctors are drawn to areas with strong demand for health services. For example, because the elderly need more medical care, areas with older populations tend to have more doctors per capita. “The growth of the elderly population is one of the things that drives growth in health care in general, and in the offices of physicians in particular,” Kohli said.
The age of a given population is one of the factors that influences where doctors choose to practice, and some of the cities losing the most doctors are especially young. Midland, Texas, and Jacksonville, North Carolina are two of the youngest cities in the country, with less than 10% of the population 65 or older. The number of primary care physicians per capita dropped by over 14% in each of those two cities between 2010 and 2013.
Due to the number of factors that can affect the number of doctors per capita in a given area, including aging population, economic prosperity, physician productivity, and scientific advances in treatment technology, it is difficult to determine the consequences of declining numbers of doctors. According to the U.S. Department of Health and Human Services, while an area can certainly be underserved by its health system, there is no clear optimal doctor to population ratio.
To identify the cities running out of doctors, 24/7 Wall St. reviewed the number of primary care physicians per 100,000 metro area residents in 2010, 2011, and 2013, and ranked them based on the percentage change from 2010 through 2014. Data came from the Area Health Resources Files published by the U.S. Department of Health and Human Services.
These are the cities running out of doctors.