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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.

Question

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.

7.8%
of US counties had no primary-care physician at all
Of about 3,143 US counties, 2022. This is the only county-denominated primary-care access figure HRSA publishes directly.

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.

0 25,000 50,000 75,000 100,000 13,500 86,000 Total (all physicians) 20,200 40,400 Primary care 10,100 19,900 Surgical specialties -3,700 5,500 Medical specialties -4,300 19,500 Other specialties Low estimate High estimate
⊞ data table⬇ CSV
Specialty groupLow estimateHigh estimate
Total (all physicians)1350086000
Primary care2020040400
Surgical specialties1010019900
Medical specialties-37005500
Other specialties-430019500

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.

0 62,500 125,000 187,500 250,000 Officially projected shortfall, 2036 (low) 13,500 Officially projected shortfall, 2036 (high) 86,000 To equalize access for underserved communities, 2021 (low) 117,100 To equalize access for underserved communities, 2021 (high) 202,800
⊞ data table⬇ CSV
EstimatePhysicians
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.

0 50 100 150 200 39.8 53.3 Primary care, 2012 (CDC) 51 80 Primary care, 2020 (USDA) 59.7 125.3 All physicians, 2010 to 2017 (JAMA) Rural Urban
⊞ data table⬇ CSV
MeasureRural per 100kUrban per 100k
Primary care, 2012 (CDC)39.853.3
Primary care, 2020 (USDA)5180
All physicians, 2010 to 2017 (JAMA)59.7125.3

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.

AK 369.9 ME 386.1 WA 288.4 ID 265.6 MT 304 ND 352 MN 349 WI 317.5 MI 332.8 NY 346.9 VT 349.4 NH 370.7 OR 290.8 NV 235.6 WY 269.1 SD 343.3 IA 283.3 IL 299.4 IN 285.5 OH 318.8 PA 324.5 NJ 245.6 MA 400.2 CA 238.7 UT 240.2 CO 305.2 NE 320.4 MO 296.9 KY 326.1 WV 351.6 VA 284 MD 312.3 CT 332.1 RI 379.4 AZ 268.2 NM 296.9 KS 308.6 AR 251.1 TN 319.1 NC 316.6 SC 276.1 DC 548.9 DE 352.6 OK 249.4 LA 274.6 MS 286.5 AL 250.1 GA 267.2 TX 225 FL 318.3 HI 283.2 0 550
⊞ data table⬇ CSV
StateProviders per 100,000
District of Columbia548.9
Massachusetts400.2
Maine386.1
Rhode Island379.4
New Hampshire370.7
Alaska369.9
Delaware352.6
North Dakota352
West Virginia351.6
Vermont349.4
Minnesota349
New York346.9
South Dakota343.3
Michigan332.8
Connecticut332.1
Kentucky326.1
Pennsylvania324.5
Nebraska320.4
Tennessee319.1
Ohio318.8
Florida318.3
Wisconsin317.5
North Carolina316.6
Maryland312.3
Kansas308.6
Colorado305.2
Montana304
Illinois299.4
Missouri296.9
New Mexico296.9
Oregon290.8
Washington288.4
Mississippi286.5
Indiana285.5
Virginia284
Iowa283.3
Hawaii283.2
South Carolina276.1
Louisiana274.6
Wyoming269.1
Arizona268.2
Georgia267.2
Idaho265.6
Arkansas251.1
Alabama250.1
Oklahoma249.4
New Jersey245.6
Utah240.2
California238.7
Nevada235.6
Texas225

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.

27.3%
of need is met inside mental-health shortage areas
137 million people live in designated areas, which need about 6,800 more psychiatrists.

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.

0.0% 25.0% 50.0% 75.0% 100.0% Primary care 9,003 shortage areas 47.4% Dental 7,951 shortage areas 33.6% Mental health 7,109 shortage areas 26.5% Need fully met
⊞ data table⬇ CSV
Shortage typePercent of need metShortage areasPractitioners needed
Primary care47.43900318541
Dental33.6795112760
Mental health26.5371097825

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.

0 5,000 10,000 15,000 20,000 Primary care physicians 18,541 Dentists 12,760 Mental-health providers 7,825
⊞ data table⬇ CSV
TypePractitioners needed
Primary care physicians18541
Dentists12760
Mental-health providers7825

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%.

0 5,000 10,000 15,000 20,000 District of Columbia 1,442 Massachusetts 2,543 Vermont 2,691 New York 2,913 Connecticut 2,935 Nevada 9,471 Indiana 9,766 Montana 9,803 Mississippi 10,586 Idaho 13,709
⊞ data table⬇ CSV
StatePeople per psychiatrist
District of Columbia1442
Massachusetts2543
Vermont2691
New York2913
Connecticut2935
Nevada9471
Indiana9766
Montana9803
Mississippi10586
Idaho13709

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.

64% faculty shortage Faculty shortage 64% · 64% Insufficient clinical sites 14% · 14% Classroom or lab space 9% · 9% Insufficient preceptors 8% · 8% Budget cuts 5% · 5%
⊞ data table⬇ CSV
ReasonShare (%)
Faculty shortage64
Insufficient clinical sites14
Classroom or lab space9
Insufficient preceptors8
Budget cuts5

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.

0 25,000 50,000 75,000 100,000 201420162018202020222023 Turned away
⊞ data table⬇ CSV
YearQualified applicants turned away
201468938
201568936
201664067
201756000
201880407
201980521
202080407
202191938
202278191
202365766

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.

$0 $50,000 $100,000 $150,000 $200,000 Median nurse practitioner (clinical) $124,680 Median associate-professor nurse faculty $87,325
⊞ data table⬇ CSV
RoleMedian salary (USD)
Median nurse practitioner (clinical)124680
Median associate-professor nurse faculty87325

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 count

Each tile is a state. Pick a state in the Scope control above to drill into its counties.

AK 71.9 ME 73.2 WA 56.1 ID 37.1 MT 45.4 ND 39.6 MN 58.4 WI 55.5 MI 42.4 NY 53.6 VT 84.4 NH 79.8 OR 66 NV 41.7 WY 60.6 SD 40.3 IA 35.8 IL 38.6 IN 42 OH 39.2 PA 50.2 NJ 62.7 MA 84.5 CA 62.6 UT 38 CO 54 NE 47 MO 26.6 KY 36.5 WV 38.2 VA 51.6 MD 61.4 CT RI 97.5 AZ 46.3 NM 44.7 KS 47 AR 41.2 TN 37.5 NC 47.5 SC 45.4 DC 129.1 DE 55 OK 25.1 LA 42.3 MS 33.8 AL 38.9 GA 38.1 TX 32.8 FL 43.9 HI 62.9 better than benchmark worse

HRSA Area Health Resources File · 2023 · source

Registered nurses per 100k

County · direct count

Each tile is a state. Pick a state in the Scope control above to drill into its counties.

AK 231.3 ME 428.3 WA 246 ID 215.7 MT 348.6 ND 331.9 MN 226.2 WI 217.8 MI 287 NY 359.6 VT 334.5 NH 490.6 OR 261 NV 207.3 WY 352.4 SD 336.2 IA 352.9 IL 280.1 IN 214.4 OH 279.4 PA 314.1 NJ 327.4 MA 307.6 CA 240.8 UT 214.5 CO 242.4 NE 335.3 MO 239.9 KY 282.7 WV 356.4 VA 336.3 MD 332.8 CT RI 183.2 AZ 326.5 NM 208.5 KS 399.4 AR 214.2 TN 193 NC 274.2 SC 238.2 DC 868.8 DE 422.3 OK 215.8 LA 256.7 MS 288.2 AL 242.4 GA 243.6 TX 190 FL 260.6 HI 224.5 better than benchmark worse

HRSA Area Health Resources File · 2023 · source

Hospital beds per 1,000

County · direct count

Each tile is a state. Pick a state in the Scope control above to drill into its counties.

AK 1.9 ME 2.4 WA 2.2 ID 2.2 MT 6.4 ND 6 MN 3.6 WI 1.8 MI 2.3 NY 2.9 VT 1.7 NH 2.2 OR 1.5 NV 2.4 WY 4.5 SD 5.2 IA 2.6 IL 2.1 IN 2 OH 2 PA 3.2 NJ 2.7 MA 2.7 CA 2.2 UT 1.8 CO 3.3 NE 3.6 MO 1.9 KY 2.3 WV 2.9 VA 3.2 MD 2.1 CT RI 1.5 AZ 1.8 NM 1.7 KS 7.4 AR 2.3 TN 1.8 NC 1.8 SC 1.8 DC 6 DE 2.4 OK 2.5 LA 3.3 MS 3.9 AL 2.8 GA 2.6 TX 2.2 FL 2.3 HI 1.9 better than benchmark worse

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