Arizona's rural areas, primary-care needs hit hardest by doctor shortage

Arizona urgently needs doctors who provide basic and routine care — and that’s likely to increase dramatically over the next decade as the state’s population continues to grow and an increasing number of physicians reach retirement age.

For low-income residents and those living in rural areas, the outlook is especially dire.

Nearly 3 million Arizona residents live where there’s limited access to primary care doctors, said Dr. G. Richard Olds, a national expert on the physician workforce and president of St. George’s University medical school.

This, coupled with about one-third of the state’s doctors being over age 60, means there needs to be at least 1,000 more primary care doctors in Arizona by 2030 to keep up with residents’ needs.

These findings are reflected in the Association of American Medical Colleges’ recent report. It shows that, nationally, the highest number of physicians per capita is concentrated in the northeast while states in the south and west tend to have lower ratios. This includes both medical doctors and doctors of osteopathy.

The data shows an average of 287 physicians with active licenses per 100,000 residents nationally in 2020, ranging from a high of 466 doctors per 100,000 residents in Massachusetts to 196 per 100,000 in Idaho. Arizona is ranked 31st with 252.

But just because a physician has an active license doesn’t mean direct patient care is part of that physician’s job.

When it comes to doctors providing direct care — instead of conducting research, for example, or doing administrative work — Arizona averages even lower, with about 230 doctors per 100,000 residents.

And for primary care physicians actually seeing patients, Arizona ranks 40th, with only 74 doctors per 100,000 residents.

“Arizona has a significant shortage of physicians, really, from top to bottom,” said Dr. Daniel Derksen, a professor of public health in the Mel and Enid Zuckerman College of Public Health at the University of Arizona.

Arizona meets just 37% of its primary care provider need, as more than 650 additional full-time primary-care doctors are needed, Derksen and Bryna Koch, a UA doctoral student in public health policy and management, found in their research.

The problem is compounded by the fact that Arizona is the fourth-fastest growing state in the nation, Derksen said, and Phoenix is the fastest-growing large city nationwide.

Using 2019 state licensure data, Derksen and Koch found there to be 16,947 active physicians statewide compared to the Association of American Medical Colleges’ finding of 18,343.

The UA researchers found the ratio of doctors providing care to patients in Arizona to be similar, however: 236 doctors per 100,000 residents compared to the AAMC finding of 231 per 100,000.

An additional challenge for Arizona is that federal funding for postgraduate medical training, commonly called residency spots, was capped in 1997 and there are not enough subsidized residency positions here now, Derksen said. As a result, many Arizona medical school graduates leave the state for their residency and then don’t come back.

Arizona’s situation is similar to what’s happening in California, Olds said, explaining that there’s a surplus of doctors in the cities and a serious deficit in rural areas.

“Some areas of Los Angeles have twice as many doctors as they need,” he said. One of the key answers, he said, is to recruit prospective doctors from underserved areas.

“You have to find a way to find more people who are born and raised in the physician shortage areas,” he said. The work needs to be done in those high schools and colleges, to get them excited to go into medicine, he said.

Derksen agrees, and wants to see more diversity in the state’s medical programs.

“When we focus on the physician workforce, certainly the percentage of (minority doctors and students) does not reflect the diversity of the population in the state of Arizona,” he said. “We’ve made some progress on that front, but much more needs to be done.”

Other findings in the AAMC report:

Female physicians make up 36.7% of the nation’s active physicians;

About 33.7% of the nation’s physicians are aged 60 and older while only about 16.3% are under 40;

About one-quarter, or 24.7%, of active physicians in 2020 were international medical graduates, meaning they graduated from a medical school outside the United States, Puerto Rico, or Canada;

There were 92,670 students enrolled to become medical doctors in 2020-21 and 31,663 enrolled to become doctors of osteopathy in 2019-20 for a combined increase of 30.2% since 2010-11.