Specialty care access is growing more strained across the U.S. — and nowhere is that more visible than in rural America, where a shrinking physician workforce, hospital closures and transportation barriers are colliding at once.
Here are 10 things to know, according to a July 23 AAMCNews feature examining the crisis through the lens of one West Virginia clinic.
1. The shortage is already large — and getting worse. Workforce data, including from the AAMC, project a shortage of up to 140,000 physicians in the next decade. The Health Resources and Services Administration, or HRSA, projects a shortfall of almost 70,000 primary care physicians by 2036, and an equal shortage of specialists.
2. Population growth, not just aging, is driving it. The U.S. population has grown almost 20%, or roughly 58 million people, since 2000. “Most people are aware of the aging population, but they don’t necessarily understand how much the population as a whole is growing,” says Michael Dill, director of workforce studies at the AAMC. “The population of the United States is projected to double in my lifetime. That’s a lot more people, and they need a lot more physicians.”
3. More than 11,200 Americans turn 65 every day. By 2030, about 1 in 5 Americans will be 65 or older, according to U.S. Census data — a demographic shift that increases demand for the specialty care older adults use most.
4. Rural America carries the heaviest burden. About 65.5 million people live in rural areas, and roughly 20% of rural residents were 65 or older in 2022, according to HRSA. Rural residents also have higher rates of heart disease, cancer, respiratory disease, diabetes and dementia — all conditions that require specialty care.
5. Rural hospital closures have thinned access further. More than 195 rural hospitals have closed since January 2005, according to the Cecil G. Sheps Center for Health Services Research. Some survivors have converted to primary care clinics that no longer offer inpatient or specialty care.
6. Wait times are longest where the need is greatest. Wait times to see a specialist in 12 major metropolitan areas average 31 days, up 48% since 2004, according to AMN Healthcare — and wait times in rural areas are even greater.
7. Transportation is as big a barrier as physician supply. “We have patients all the time who have told us it’s too hard to get here,” says Melanie Ward, MD, a WVU Medicine neurologist. “A lot of our patients don’t have a car, or they have a car but they don’t have gas money, or they have a car and they have gas money, but they can’t drive and they don’t have somebody to drive them.”
8. Coverage losses are compounding the access gap. At least 4 million Americans have dropped off ACA marketplaces since premiums spiked in January 2026, and millions more are expected to lose Medicaid coverage as the One Big Beautiful Bill Act of 2025 takes full effect. Limited broadband access also blunts telehealth as a workaround in many rural areas.
9. One health system’s answer: bring specialists to patients. WVU Medicine opened an outpatient clinic in Glenville, W.Va. — population about 1,100 — in 2022. Specialists in neurology, cardiology, substance use disorder, pediatrics and mental health now travel there monthly; the clinic served more than 350 patients across nine counties and logged 2,623 visits in 2025. “If not for the clinic, where would those people go?” says John Brick, MD, who founded it.
10. The long-term fix is bottlenecked by training time and funding. Becoming a fully licensed physician takes nine to 15 years of post-secondary education, and Medicare’s support for graduate medical education — which helps fund about 120,000 residency slots — has been essentially frozen since 1997. The AAMC backs the bipartisan Resident Physician Shortage Reduction Act, which would add 14,000 Medicare-funded GME positions over seven years; expanding the role of nurse practitioners and physician assistants is another proposed near-term lever.
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