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Primary care access problems still plague rural areas

Rural, predominantly White areas in Virginia face bigger primary care access issues, likely due to growing provider shortages in those areas.

Sara Heath
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Published: 28 May 2025

Virginia has a primary care access problem, with neighborhoods in rural parts of the Commonwealth having bigger issues accessing healthcare than those in predominantly Black and urban neighborhoods, according to new research in the Annals of Family Medicine.

Overall, only 56% of the census tracts in Virginia had adequate primary care provider access, defined as having enough providers to fulfill patient demand in that area, the researchers reported. Factors like marital status, educational attainment and English language proficiency were associated with poor primary care access, as were neighborhood and rurality.

These findings come as the medical industry stares down a mounting workforce problem. March 2024 figures from the Association of American Medical Colleges estimated that the United States would be short up to 86,000 physicians, both in specialty and primary care, by 2036.

"This is a serious public health concern because inadequate access to primary care results in increased numbers of hospitalizations and emergency department visits, decreased life expectancies, and greater health inequities for communities," the Annals researchers wrote in this most recent report.

The primary care provider shortage is going to affect some geographies more acutely than others. Using Virginia as a case study, the researchers found that primary care provider shortages can cause care access problems in some neighborhoods due to various characteristics.

Using the 2019 Virginia All-Payers Claims Database to identify primary care providers and the number of unique patients they see, the researchers were able to calculate primary care access by census tract.

Across the Commonwealth, 44% of census tracts did not have adequate primary care provider access, the researchers found. A number of social determinants of health (SDOH) were at play here, the researchers said.

The researchers looked at four categories of SDOH to assess their influence on primary care access.

Predisposing factors include characteristics that might put someone at risk for something, in this case living in a primary care desert. Enabling factors make it easier for an individual to change their behavior or environment. Meanwhile, need factors referred to things like health status. Structural factors included things like rurality.

Majority Black neighborhoods have better primary care access

Overall, structural factors had the biggest impact on primary care access, the report authors found. In particular, rural areas with a higher proportion of White people faced greater provider shortages and primary care access issues. Places with a greater proportion of Black people, which tended to be urban, had greater primary care access.

That might be a counterintuitive finding, the researchers acknowledged. Much of the data investigating the impacts of redlining has found that predominantly Black neighborhoods have less access to resources, including high-quality hospitals.

However, nationwide policymaking creating more safety-net facilities and federally qualified health centers in urban settings could be improving primary care access for Black people. This is promising, the researchers said, because it demonstrates that health policy has the power to better support populations.

Other factors at play could be the National Health Service Corps closing racial gaps in primary care access and the increase in Black medical school graduates who are more likely to practice in predominantly Black neighborhoods, the researchers posited.

Rural areas face PCP shortages

Conversely, the data showed a more pressing primary care access problem in rural settings. This finding echoes numerous other studies underscoring healthcare access challenges in rural geographies.

There are numerous explanations for rural workforce shortages.

For example, most providers practice where they have trained. Being that most medical schools are located in more populated urban settings, providers are more likely to then practice in those settings. Low pay, potential for geographic isolation and the burden of an older, sicker population might also drive providers away from practicing in rural settings.

Although geography was the biggest predictor of primary care access, a few other factors held influence. Marital status, lower educational attainment and limited English language proficiency were all linked to better care access.

Sara Heath has reported news related to patient engagement and health equity since 2015.

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