The physician shortage in the United States is most severe in primary care, rural communities, and a handful of high-demand specialties. By 2036, the country faces a projected shortfall of 13,500 to 86,000 physicians overall, with primary care bearing the heaviest burden. The gaps aren’t evenly distributed: where you live, what kind of doctor you need, and how old you are all shape whether you’ll feel the squeeze.
Primary Care Carries the Largest Deficit
Primary care is where the shortage hits hardest, both now and in future projections. The Association of American Medical Colleges estimates a shortfall of 20,200 to 40,400 primary care physicians by 2036. The federal Health Resources and Services Administration paints an even steeper picture, projecting a deficit of 70,610 primary care physicians by 2038.
Within primary care, the gaps break down unevenly. Family medicine accounts for the single largest piece, with a projected shortfall of roughly 39,060 physicians. General internal medicine follows at 20,660, then pediatrics at 9,320. Geriatrics, despite serving the fastest-growing segment of the population, faces a shortfall of about 1,570 physicians. That last number may look small, but the geriatric workforce was already tiny to begin with, so even a modest deficit translates to millions of older adults without access to specialized aging care.
Rural Areas Face the Steepest Access Gaps
Geography is one of the strongest predictors of whether you can see a doctor. Rural areas account for about 63% of all primary medical shortage designations tracked by HRSA. By 2038, nonmetro areas are projected to experience a 39% shortage of primary care physicians, meaning these communities will have barely six out of every ten primary care doctors they actually need.
The reasons are straightforward. Rural practices typically offer lower salaries, fewer professional development opportunities, and greater isolation. Physicians trained in urban academic medical centers tend to stay in or near cities. The result is a self-reinforcing cycle: fewer doctors in rural areas means heavier workloads for those who remain, which makes the positions even harder to fill.
Specialist Wait Times Signal Growing Strain
The shortage isn’t confined to primary care. Certain specialties already show clear bottlenecks. Patients seeking appointments in dermatology, cardiology, pulmonology, psychiatry, and neurology are four to five times more likely to wait longer than three weeks compared to fields like ear, nose, and throat medicine. Gastroenterology and rheumatology also consistently show waits exceeding three weeks.
These delays aren’t just inconvenient. In cardiology, a month-long wait can mean unmanaged chest pain or uncontrolled blood pressure. In psychiatry, it can mean weeks without medication adjustments during a crisis. Long specialist wait times also push more patients back to primary care offices that are already stretched thin, compounding the problem at both ends.
An Aging Population Is Driving Demand Upward
The shortage isn’t only about too few doctors. It’s also about rapidly rising demand. The share of the U.S. population aged 65 and older is projected to climb from 17% in 2022 to 23% by 2050. In raw numbers, that’s a jump from 58 million to 82 million older Americans. The population over 85 is expected to nearly triple, growing from 6.5 million to 17.3 million over the same period.
Older adults visit doctors about 20% more frequently than younger adults and are hospitalized at three times the rate. Every year that the older population grows, the healthcare system needs more physicians just to maintain current levels of access. By 2030, one in five U.S. residents will be retirement age. That demographic shift alone would strain the system even if the physician supply were holding steady, which it is not.
Residency Funding Caps Limit New Doctors
The pipeline for new physicians has a hard ceiling baked into federal law. Medicare payments to teaching hospitals for residency training are capped by the number of residents each hospital is authorized to train. Medical schools have expanded enrollment over the past two decades, but residency slots haven’t kept pace. You can’t practice medicine without completing a residency, so unused medical school graduates effectively hit a wall.
Congress took a modest step in 2021, authorizing 1,000 new Medicare-funded residency positions to be distributed to qualifying hospitals. That helps, but it’s a fraction of what projections suggest is needed. The bottleneck at the residency level is a major reason the physician workforce is growing at just 3% over the next decade, while nurse practitioners are projected to grow at 46% and physician assistants at 28%. Those advanced practice clinicians are absorbing some of the demand, particularly in primary care and rural settings, but they aren’t a one-to-one replacement for physicians in complex or procedural care.
The Workforce Doesn’t Reflect the Population
The physician workforce also has a diversity gap that compounds access problems for underserved communities. In 2023, 56.3% of active physicians identified as White and 19.3% as Asian. Hispanic or Latino physicians made up just 6.5% of the workforce, despite Hispanic Americans representing roughly 19% of the U.S. population. Black or African American physicians accounted for 5.2%, compared to about 13% of the general population. American Indian or Alaska Native physicians represented just 0.3%.
This matters because research consistently shows that patients from underrepresented groups are more likely to seek care, follow through on treatment, and report better communication when their physician shares their racial or ethnic background. Communities with the fewest physicians also tend to be the most racially and ethnically diverse, creating overlapping layers of disadvantage. The shortage, in other words, doesn’t land equally. It hits hardest in the places that were already underserved.