09/16/2025
I have seen dramatic decreases in physician availability in my 24 years of practice and the overall trend continues that way. That’s why I’m over the moon to have added two new young physicians to our group. Drs. Smith and Heiner have just finished their rigorous training and are ready to manage a wide variety of medical issues across the spectrum of our community. If you are interested in establishing care with either of them call (417) 667-6015.
Rural America has been losing doctors and medical practices at an alarming pace, and Arizona is feeling the pressure.
A new study from Avalere, a health policy consulting firm, and the Physicians Advocacy Institute, a nonprofit focused on physician advocacy, shows just how stark the national trend has become — and how closely it mirrors the challenges faced in Arizona’s small towns and tribal communities.
Between January 1, 2019 and January 24, 2024, rural communities across the U.S. lost 2,500 physicians and saw nearly 3,300 medical practices shut their doors, according to the Avalere and PAI report. That equates to an 11 percent reduction in the number of practices overall, leaving patients with fewer points of access for care. The steepest decline came among independent doctors. In just five years, the number of independent physicians practicing in rural America dropped by 43 percent. Many sold their practices or retired, while others were absorbed into hospital systems, insurance-owned clinics, or private equity-backed companies.
The study warns that this shift could reshape rural health care delivery for decades to come. “Small, independent practices have been the cornerstone of medical care for many people in rural areas,” said PAI CEO Kelly Kenney in a statement. “We are concerned that profit-first owners will shutter rural practices that don’t produce high enough revenues, leaving patients without the access to care they need.”
Arizona’s own rural landscape underscores those concerns. The Arizona Center for Rural Health reports that all 15 counties in the state are designated as primary-care shortage areas under federal guidelines. To meet current needs, the state would require nearly 500 additional full-time primary-care physicians. Arizona ranks 42nd nationally for active primary-care doctors, with just 80.2 physicians per 100,000 residents compared to the U.S. average of 94.4. When counting all medical specialties, Arizona ranks 32nd, underscoring a broader provider gap. Those shortages are most acute in counties like Navajo, Apache, and Gila, where patients often must travel hours to reach specialists or wait weeks for a primary-care appointment.
“These numbers don’t surprise us,” said Dr. Dan Derksen, director of the Arizona Center for Rural Health at the University of Arizona. “We’ve been tracking these shortages for years, and the Avalere/PAI study puts national numbers behind what rural Arizonans experience every day.”
The impact is particularly severe for Arizona’s tribal nations. Federal data shows persistent primary-care shortages in areas serving the Navajo Nation, Hopi, White Mountain Apache, San Carlos Apache, and Tohono O’odham communities. Many of these populations already face higher burdens of chronic disease and poverty, making reliable access to local care even more vital. For residents in towns like Springerville or St. Johns, even a routine checkup can require a 90-minute drive — a burden compounded when specialty care or follow-up visits are required. Transportation challenges, weather, and limited broadband access for telehealth all add layers of difficulty.
Experts point to several overlapping reasons for the decline in rural physicians and independent practices. Lower reimbursement rates from Medicare, Medicaid, and commercial insurers make it difficult for small practices to stay afloat. Rural doctors often shoulder heavier patient loads and longer hours, with fewer colleagues to share call schedules. Many are nearing retirement age, with fewer young doctors willing to relocate to small towns. Meanwhile, hospitals, health systems, and corporate entities have aggressively purchased practices, seeking market share and leverage with insurers. The Avalere/PAI study found corporate ownership of rural practices nearly doubled between 2019 and 2024.
“The economics just don’t work for a lot of small practices,” said Kenney. “That’s why we’re seeing this mass shift to employment under larger systems.” For rural Arizonans, these closures translate into longer waits and longer drives. Patients in eastern Arizona have reported traveling two hours for a cardiology appointment or waiting three months for a mental-health consult. Emergency care is also strained, with smaller hospitals sometimes unable to keep full-time specialists on staff.
“When a local practice closes, it’s not just an inconvenience — it’s a community crisis,” said Michelle Thomas, a nurse practitioner in Holbrook. “We lose continuity of care, and our patients feel abandoned. That’s when people delay seeking help, and small problems become emergencies.”
Health experts stress that solutions will require coordinated action. Potential measures include loan repayment programs, tax credits, and higher reimbursement rates to attract more doctors to underserved areas. Reducing administrative burdens and offering grants for technology and staff could help small clinics survive. Broadband investment and telemedicine reimbursement parity could bridge some gaps, though connectivity remains a challenge in remote areas. Training medical residents in rural hospitals has also been shown to increase the odds those doctors will remain in rural communities after graduation.
Arizona has made some moves in this direction, including funding for rural graduate medical education and telehealth expansion during the pandemic. But health advocates say more will be needed as the state’s population continues to grow. For now, the Avalere and PAI findings serve as both a snapshot and a warning. If rural communities continue to lose physicians at the current pace, patients will face even steeper barriers to care.
“The data tells us what rural families already know: access to a trusted local doctor is slipping away,” said Derksen. “We need to treat this as a public health priority, not just a workforce issue.”
