Rural areas in the United States are quickly losing independent physicians and medical practices as corporate influence in health care grows, according to new PAI and Avalere research. Building upon previous analysis of national physician employment and practice ownership data, this new report provides a closer look at the physician practice landscape and health care corporatization in rural America.

Key Findings

Between January 1, 2019, and January 1, 2024:

• Rural areas lost nearly 2,500 physicians. This represents a loss of 5% of all practicing physicians in rural areas.
• Nearly 3,300 rural medical practices closed. People in rural areas had access to 11% fewer medical practices overall as of January 2024.
• The number of independent physicians fell sharply, declining 43%. Just 12,467 independent physicians remained in rural areas at the start of 2024, compared to 21,956 in 2019.
• More than 40% of independent medical practices closed or were acquired by hospitals, health systems and other corporate entities like health insurer-affiliated owners and private equity groups.
• Corporate employment of physicians and ownership of medical practices surged. Corporate entities nearly doubled ownership of practices in rural areas and employed 57% more physicians compared to 2019.
• Hospitals’ and health systems’ influence in rural health care grew. The number of physicians employed by these organizations increased 15%, and the number of practices they owned increased 11%.
• A majority of physicians and medical practices were employed or owned by non-physicians. Three quarters (76%) of physicians are employed by hospitals, health systems or corporate entities, and 61% of all rural medical practices were owned by non-physicians.