Provider shortage
Why cannot we train our way out of the provider shortage?
Even where people are insured, providers can be scarce. AAMC projects a shortfall of 13,500 to 86,000 physicians by 2036, and the country's 9,003 primary-care shortage areas meet only 47% of their need. Provider density ranges from 400 per 100,000 people in Massachusetts to 225 in Texas.
The problem
The provider shortage is a system-capacity problem that cuts across hospitals, outpatient practices, nursing schools, and public workforce policy. A national headcount projection understates the issue because the shortage is distributed unevenly by specialty, geography, and training pipeline, with mental-health and rural markets carrying the greatest operational risk.
The recommendation
Manage workforce capacity as a multi-year supply chain. The recommended approach is to expand residency and clinical-training capacity where shortage designations are most severe, close nursing-faculty bottlenecks, and tie public funding to placement in underserved markets rather than simply increasing national headcount.
The gap
How large the projected shortfall is and where provider density is thinnest.
Projected physician shortfall by 2036, low and high estimate
AAMC reports the 25th to 75th percentile across 48 scenarios. Negative values are a projected surplus.
Read it this way Primary care and surgical specialties show a shortfall under both the low and high estimate, but medical and other specialties straddle zero, meaning the same methodology projects either a modest shortage or a modest surplus for those two groups depending on the scenario. As the caveat notes, press coverage usually leads with the 86,000 high-end total alone, when the report's actual finding is the full 13,500-to-86,000 range. Use this chart to locate the bottleneck in the workforce supply chain, projection, geography, specialty, or training capacity, and to test where targeted workforce investment should be sequenced first.
Caveat AAMC press materials and most coverage lead with the high end (up to 86,000), but the report's actual finding is a range from 13,500 to 86,000, and two specialty groups span from a shortage into a projected surplus depending on the scenario.
⊞ data table⬇ CSV
| Specialty group | Low estimate | High estimate |
|---|---|---|
| Total (all physicians) | 13500 | 86000 |
| Primary care | 20200 | 40400 |
| Surgical specialties | 10100 | 19900 |
| Medical specialties | -3700 | 5500 |
| Other specialties | -4300 | 19500 |
AAMC, The Complexities of Physician Supply and Demand: Projections From 2021 to 2036 · 2024 · source
Two ways to size the physician gap
The official 2036 shortfall counts unmet demand at current use patterns. The equity estimate counts physicians needed to give underserved communities equal access, measured for 2021.
Read it this way The equity-adjusted estimate, 117,100 to 202,800 physicians, dwarfs the officially projected 2036 shortfall of 13,500 to 86,000, showing true parity would require far more than the official shortfall implies. As the caveat states, the equity figure is a 2021 hypothetical and is not additive to the 2036 range, so don't sum the two. Use this chart to locate the bottleneck in the workforce supply chain, projection, geography, specialty, or training capacity, and to test where targeted workforce investment should be sequenced first.
Caveat The equity-adjusted figure (117,100 to 202,800) is a hypothetical demand estimate for 2021 and is not additive to the 2036 shortfall range.
⊞ data table⬇ CSV
| Estimate | Physicians |
|---|---|
| Officially projected shortfall, 2036 (low) | 13500 |
| Officially projected shortfall, 2036 (high) | 86000 |
| To equalize access for underserved communities, 2021 (low) | 117100 |
| To equalize access for underserved communities, 2021 (high) | 202800 |
AAMC, The Complexities of Physician Supply and Demand: Projections From 2021 to 2036 · 2024 · source
Rural areas have far fewer physicians per capita than urban areas
Physicians per 100,000 people, rural vs urban, across three source-year measures. Urban areas consistently have more.
Read it this way Urban physician density outpaces rural in all three measures, with the widest gap in the all-physician count (125.3 vs 59.7 per 100,000). As the caveat notes, the three rows use different provider definitions and years, so this is three separate snapshots of the same rural-urban pattern, not one consistent time series. Use this chart to locate the bottleneck in the workforce supply chain, projection, geography, specialty, or training capacity, and to test where targeted workforce investment should be sequenced first.
Caveat The three rows use different provider definitions and years and are not a single time series.
⊞ data table⬇ CSV
| Measure | Rural per 100k | Urban per 100k |
|---|---|---|
| Primary care, 2012 (CDC) | 39.8 | 53.3 |
| Primary care, 2020 (USDA) | 51 | 80 |
| All physicians, 2010 to 2017 (JAMA) | 59.7 | 125.3 |
CDC/NCHS (2012), USDA ERS (2020), JAMA Network Open (2010 to 2017) · 2021 · source
Primary-care providers per 100,000 people by state (2025)
Broad measure: primary-care physicians plus nurse practitioners and physician assistants. Higher is better. National average is 291.4.
Read it this way States shaded darkest, below the 291.4 national benchmark, like Texas at 225.0 and California at 238.7, have thinner primary-care coverage than the rest of the country, while DC (548.9) and Massachusetts (400.2) lead. This counts physicians, nurse practitioners, and physician assistants together, so it can mask a shortage in one of those three roles even in a state that looks adequately staffed overall. Use this chart to locate the bottleneck in the workforce supply chain, projection, geography, specialty, or training capacity, and to test where targeted workforce investment should be sequenced first.
⊞ data table⬇ CSV
| State | Providers per 100,000 |
|---|---|
| District of Columbia | 548.9 |
| Massachusetts | 400.2 |
| Maine | 386.1 |
| Rhode Island | 379.4 |
| New Hampshire | 370.7 |
| Alaska | 369.9 |
| Delaware | 352.6 |
| North Dakota | 352 |
| West Virginia | 351.6 |
| Vermont | 349.4 |
| Minnesota | 349 |
| New York | 346.9 |
| South Dakota | 343.3 |
| Michigan | 332.8 |
| Connecticut | 332.1 |
| Kentucky | 326.1 |
| Pennsylvania | 324.5 |
| Nebraska | 320.4 |
| Tennessee | 319.1 |
| Ohio | 318.8 |
| Florida | 318.3 |
| Wisconsin | 317.5 |
| North Carolina | 316.6 |
| Maryland | 312.3 |
| Kansas | 308.6 |
| Colorado | 305.2 |
| Montana | 304 |
| Illinois | 299.4 |
| Missouri | 296.9 |
| New Mexico | 296.9 |
| Oregon | 290.8 |
| Washington | 288.4 |
| Mississippi | 286.5 |
| Indiana | 285.5 |
| Virginia | 284 |
| Iowa | 283.3 |
| Hawaii | 283.2 |
| South Carolina | 276.1 |
| Louisiana | 274.6 |
| Wyoming | 269.1 |
| Arizona | 268.2 |
| Georgia | 267.2 |
| Idaho | 265.6 |
| Arkansas | 251.1 |
| Alabama | 250.1 |
| Oklahoma | 249.4 |
| New Jersey | 245.6 |
| Utah | 240.2 |
| California | 238.7 |
| Nevada | 235.6 |
| Texas | 225 |
America's Health Rankings, Primary Care Providers (CMS NPPES) · 2025 · source
The unmet need
How much need goes unmet even inside designated shortage areas, and how far behind mental-health access lags.
Percent of need met inside designated shortage areas (2026)
HRSA Health Professional Shortage Areas. The gap to 100% is the unmet need within already-designated areas.
Read it this way Every bar falls far short of the 100% reference line, and mental health lags furthest at 26.53% met, roughly half of primary care's 47.43%. This is need met only inside areas already designated as shortage areas, so it doesn't capture unmet need in places that haven't been formally designated. Use this chart to locate the bottleneck in the workforce supply chain, projection, geography, specialty, or training capacity, and to test where targeted workforce investment should be sequenced first.
⊞ data table⬇ CSV
| Shortage type | Percent of need met | Shortage areas | Practitioners needed |
|---|---|---|---|
| Primary care | 47.43 | 9003 | 18541 |
| Dental | 33.6 | 7951 | 12760 |
| Mental health | 26.53 | 7109 | 7825 |
HRSA Bureau of Health Workforce, Designated HPSA Quarterly Summary, Q3 FY2026 · 2026 · source
Practitioners needed to erase every shortage designation
Additional practitioners needed to lift every designated shortage area to full need-met, by type (HRSA, 2026).
Read it this way More primary-care physicians are needed (18,541) than dentists or mental-health providers alone to erase every current shortage designation. This is the practitioner count needed to close existing designated gaps, a different measure from the AAMC's 2036 projected shortfall shown elsewhere in this tab, so the two figures shouldn't be added together. Use this chart to locate the bottleneck in the workforce supply chain, projection, geography, specialty, or training capacity, and to test where targeted workforce investment should be sequenced first.
⊞ data table⬇ CSV
| Type | Practitioners needed |
|---|---|
| Primary care physicians | 18541 |
| Dentists | 12760 |
| Mental-health providers | 7825 |
HRSA Bureau of Health Workforce, Designated HPSA Quarterly Summary, Q3 FY2026 · 2026 · source
People per psychiatrist: five best vs five worst states
A larger number means fewer psychiatrists per person. Five best states shown against five worst.
Read it this way Idaho residents share a psychiatrist among roughly 9.5 times as many people as DC residents do (13,709 vs 1,442 per psychiatrist), showing the psychiatrist shortage is far more geographically uneven than a national average would suggest. As the caveat notes, this covers only 10 states from secondary sources citing HRSA data that can disagree by 5 to 20%, so treat exact figures as approximate. Use this chart to locate the bottleneck in the workforce supply chain, projection, geography, specialty, or training capacity, and to test where targeted workforce investment should be sequenced first.
Caveat Psychiatrist-only counts are estimated from secondary sources citing HRSA (2024) and cover only 10 states. Sources disagree by 5 to 20%.
⊞ data table⬇ CSV
| State | People per psychiatrist |
|---|---|
| District of Columbia | 1442 |
| Massachusetts | 2543 |
| Vermont | 2691 |
| New York | 2913 |
| Connecticut | 2935 |
| Nevada | 9471 |
| Indiana | 9766 |
| Montana | 9803 |
| Mississippi | 10586 |
| Idaho | 13709 |
Psychiatrist Shortage by State (citing HRSA data as of December 2024) · 2024 · source
Why it persists
The supply-side reason the shortage does not self-correct: a nursing pipeline throttled by a faculty pay gap.
Why qualified nursing applicants get turned away
Reasons US nursing programs give for rejecting qualified applicants (AACN faculty-vacancy survey).
Read it this way Faculty shortage alone accounts for 64% of why qualified nursing applicants get turned away, nearly five times the next largest reason, insufficient clinical sites at 14%. This shows why programs reject qualified applicants, not how many total qualified applicants apply each year. Use this chart to locate the bottleneck in the workforce supply chain, projection, geography, specialty, or training capacity, and to test where targeted workforce investment should be sequenced first.
⊞ data table⬇ CSV
| Reason | Share (%) |
|---|---|
| Faculty shortage | 64 |
| Insufficient clinical sites | 14 |
| Classroom or lab space | 9 |
| Insufficient preceptors | 8 |
| Budget cuts | 5 |
American Association of Colleges of Nursing, 2023 to 2024 Enrollment and Graduations · 2024 · source
Qualified nursing applicants turned away each year, 2014 to 2023
Qualified applicants turned away from US nursing programs. The peak was about 91,938 in 2021, easing to 65,766 in 2023.
Read it this way Turned-away applicants climbed to a peak of 91,938 in 2021 before easing to 65,766 by 2023, so the bottleneck has loosened somewhat but remains above the 2014 to 2017 baseline of roughly 56,000 to 69,000. This shows applicants rejected, a proxy for the size of the faculty-capacity constraint, not the total number of students who wanted to enroll. Use this chart to locate the bottleneck in the workforce supply chain, projection, geography, specialty, or training capacity, and to test where targeted workforce investment should be sequenced first.
⊞ data table⬇ CSV
| Year | Qualified applicants turned away |
|---|---|
| 2014 | 68938 |
| 2015 | 68936 |
| 2016 | 64067 |
| 2017 | 56000 |
| 2018 | 80407 |
| 2019 | 80521 |
| 2020 | 80407 |
| 2021 | 91938 |
| 2022 | 78191 |
| 2023 | 65766 |
American Association of Colleges of Nursing, 2023 to 2024 Enrollment and Graduations · 2024 · source
Nurse faculty earn 30% less than clinical nurse practitioners
Median salary. Nurse faculty earn about $37,355 (30%) less than clinical nurse practitioners, which starves the teaching pipeline (AACN, 2023).
Read it this way Nurse faculty earn about $37,355 less than clinical nurse practitioners doing comparable-level work, a pay gap the note ties directly to why programs can't hire enough faculty to admit more of the qualified applicants shown in the chart beside it. This is one salary comparison, so it can't quantify how much closing the gap would actually shrink the faculty shortage. Use this chart to locate the bottleneck in the workforce supply chain, projection, geography, specialty, or training capacity, and to test where targeted workforce investment should be sequenced first.
⊞ data table⬇ CSV
| Role | Median salary (USD) |
|---|---|
| Median nurse practitioner (clinical) | 124680 |
| Median associate-professor nurse faculty | 87325 |
American Association of Colleges of Nursing, Salaries of Nursing Faculty · 2023 · source
Geography
The same question, state by state and then county by county. Pick a state in the filter above to drill into its counties.
Primary-care physicians per 100k
County · direct countEach tile is a state. Pick a state in the Scope control above to drill into its counties.
HRSA Area Health Resources File · 2023 · source
Registered nurses per 100k
County · direct countEach tile is a state. Pick a state in the Scope control above to drill into its counties.
HRSA Area Health Resources File · 2023 · source
Hospital beds per 1,000
County · direct countEach tile is a state. Pick a state in the Scope control above to drill into its counties.
HRSA Area Health Resources File · 2023 · source
Why this matters
AAMC's own range, 13,500 to 86,000 physicians by 2036, spans from a modest shortfall to a severe one, and its low end assumes continued residency-slot growth, a lever policymakers control through Medicare GME funding. The problem compounds on the nursing side: 64% of qualified nursing-school applicants are turned away specifically because of a faculty shortage, and nurse faculty earn about $37,355 less than clinical nurse practitioners, which starves the pipeline that could relieve primary-care strain. Leadership should care because the equity-adjusted estimate, 117,100 to 202,800 physicians needed for 2021 parity, shows the underserved gap is several times larger than the official 2036 projection alone suggests.
Recommended actions
- Target GME residency-slot expansion as the primary lever, since it is the mechanism AAMC ties to its low-end shortfall estimate.
- Prioritize mental-health shortage areas for new provider placement, since they meet only 27.3% of need versus 47.4% for primary care.
- Pilot nurse-faculty pay parity in a small number of states to test whether closing the $37,355 gap measurably raises nursing-program capacity.
- Monitor the rural-urban physician density gap (59.7 vs 125.3 per 100,000) as the geographic KPI deciding whether GME expansion reaches underserved counties, not just adds total supply.
- Treat the 117,100-to-202,800 equity-adjusted estimate as a ceiling for ambition, not a current-year target, since it is a 2021 hypothetical and not additive to the 2036 range.
The recommendation
Therefore, manage workforce capacity as a multi-year supply chain. The recommended approach is to expand residency and clinical-training capacity where shortage designations are most severe, close nursing-faculty bottlenecks, and tie public funding to placement in underserved markets rather than simply increasing national headcount.
Demographic slice geography (county) only, HRSA and AAMC sources carry no direct patient race or income field.
Sources
- AAMC, The Complexities of Physician Supply and Demand: Projections From 2021 to 2036 · 2024
- HRSA Bureau of Health Workforce, Designated HPSA Quarterly Summary, Q3 FY2026 · 2026
- America's Health Rankings, Primary Care Providers (CMS NPPES) · 2025
- American Association of Colleges of Nursing, Enrollment and Graduations and Faculty Salary data · 2024
- KFF State Health Facts, Mental Health Care HPSAs (HRSA source data) · 2025