November 12, 2025
3 min read
Key takeaways:
- Rural areas have about 15% fewer PCPs per capita.
- But rural clinicians provided more comprehensive care vs. urban clinicians.
- More investments are needed to sustain rural primary care.
Rural primary care is typically more comprehensive than urban primary care despite having fewer clinicians, according to a new report from the Primary Care Collaborative and Robert Graham Center.
“This report demonstrates that strengthening rural primary care can improve health — and keep communities alive economically and socially,” Primary Care Collaborative (PCC) President and CEO Ann Greiner, MCP, said in a press release.
PCC’s evidence report analyzed urban and rural primary care trends — including spending, comprehensiveness and workforce — and five case studies describing rural primary care, while providing several policy recommendations.
Report findings
According to the report, rural areas still have around 15% fewer PCPs per capita despite growth in physician associates and nurse practitioners.
The report also showed the consequences of unsustainability in rural health, as the loss of just one rural family clinician may raise health spending by over $1,300 per patient annually, or $5,200 for a family of four.
But rural PCPs — and nurse practitioners and physician associates “albeit to a smaller degree” — were more comprehensive in their care vs. their urban peers, PCC noted.
For example, rural clinicians were likelier to perform endoscopies and minor skin procedures, whereas those practicing in federally qualified health centers were more likely to provide behavioral health services like addressing social determinants of health and treating substance use disorders.
Overall, the mean comprehensiveness of rural PCPs from 2016 to 2022 was 5.16 as defined by the Berenson-Eggers Type of Service classification system, compared with 4.51 for urban PCPs.
“They’re able to do that through team-based care and a very comprehensive primary care model,” Greiner said during a press briefing.
PCC found that spending on both rural and primary care “disturbingly” fell from 2018 to 2022. During that time, the national share of rural primary care spending to total medical spending declined from 5.5 to 4.6 among those enrolled in employer-sponsored plans and from 7.3 to 6.7 among those enrolled in traditional Medicare.
The case studies showed that comprehensive primary care builds trust with patients, though workforce development and retention require continued investment, academic partnerships, scholarships, and rural and nontraditional training pathways.
Policy recommendations
The PCC and Robert Graham Center recommended that policymakers:
- immediately raise investment in proven programs that sustain rural primary care;
- measure primary care spending regularly and establish benchmarks and targets for increasing investment;
- refrain from reducing primary care reimbursement rates across states;
- ensure that resources and programs meant for rural care support training;
- ensure that value-based purchasing models are “rural friendly” and consider the characteristics of rural primary care; and
- put comprehensive, whole-person care at the foundation of rural health transformation when beginning initiatives funded by the Rural Health Transformation Program.
“We do feel like states are beginning to get the message that for them to have an appreciation of what they are doing to keep their population healthy, they need to understand what they’re spending on primary care,” Greiner said during the briefing.
She added that spending will become more critical to track “as states are faced with what do they do as federal dollars for Medicaid start to be more constrained.”
“We do not think that states should move forward to further cut primary care. We already are struggling with a rural population that has higher prevalence of chronic diseases and who doesn’t have the same life expectancy as those in urban and suburban communities,” Greiner said. “These measures are going to be really important … we want all states to be reporting on primary care.”
Sources/Disclosures
Source:
Press Briefing
References:
Disclosures:
Healio could not determine relevant financial disclosures at the time of publication.
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