Primary Care Shortage Hits 3.8M Virginians

Yeah, I knowthis doesn't sound like the most thrilling thing to talk about over coffee. But stick with me.

We're not just discussing distant policy debates or hospital boardroom meetings. This is about what happens when your kid runs a fever at 2 a.m. Or when your dad, who's been ignoring that chest tightness for weeks, finally says, "Maybe I should get it checked." And then you callonly to find out the nearest doctor isn't taking new patients. For months.

That's the reality for nearly 3.8 million Virginiansalmost half the stateliving in neighborhoods where primary care is stretched too thin. These areas, called Health Professional Shortage Areas (HPSAs), aren't just rural backroads you fly over on a plane. They're Roanoke suburbs, Appalachian hollows, Hampton Roads neighborhoods, and corners of Northern Virginia where communities of color and low-income families get left behind.

So yeah. It's not just a statistic. It's real people. And in a lot of ways, our primary care system is quietly cracking under pressure.

How Bad Is It?

Let's start with a simple question: What even is a "primary care HPSA"?

It's a designation given by the Health Resources and Services Administration (HRSA) to areas with too few primary care providers, high poverty, or a large elderly population. As of mid-2024, there are over 7,500 such areas nationwide, affecting roughly 75 million peopleand Virginia's right in the thick of it.

A recent study from Virginia Commonwealth University found that 44% of Virginia's census tracts fall into this underserved category. That's not a small gap. That's almost half the state.

But here's the twist: If you look at Virginia's overall doctor-to-patient ratio84.6 primary care physicians per 100,000 peopleit's actually slightly better than the national average (83.8). Sounds okay, right?

Not so fast.

That number hides a brutal truth: access is wildly uneven. In cities like Richmond or Arlington, you might have a dozen clinics to choose from. But drive a couple hours southwest, and you'll hit counties like Buchanan, Dickenson, or Lee, where it's not unusual to have one primary care provider for tens of thousands of people.

County	Primary Care Providers per 100K	HPSA Designated?
Buchanan	19	Yes
Dickenson	12	Yes
Lee	21	Yes
Arlington	172	No
Fairfax	148	No

This isn't just a rural versus urban thingit's a people thing. And the people who suffer most? The elderly, the uninsured, Black and Latino communities, and those with chronic conditions like diabetes or heart disease.

Nation in Crisis

Virginia's struggle is part of a much bigger picture. Across the U.S., we're heading toward a healthcare cliff.

According to HRSA's 2024 State of the Primary Care Workforce report, we're on track to be short 87,150 full-time primary care physicians by 2037. That's like losing every single PCP in California, Texas, and Floridacombined.

Family medicine will be hit hardestprojected to be short over 43,000 doctors. Internal medicine? Almost 29,000. And geriatricsalready a tiny fieldis projected to fall thousands short for a population that's aging faster than ever.

Why is the gap growing so fast?

Well, picture this: By 2060, one in every four Americans will be 65 or older. More older adults means more chronic conditions, more medications, more appointments. And primary care is the backbone of managing all that.

But here's the catch: primary care isn't scaling. We're not training enough docs. We're not keeping the ones we have. And we're certainly not paying them enough to stick around.

Why Don't More Doctors Choose This Path?

Let me ask you something: If you spent a decade in school and training, racking up hundreds of thousands in debt, would you pick a job that pays half as much as some of your peers?

That's the reality for many aspiring family doctors.

According to Medscape's 2024 data, the median salary for a family medicine physician is $272,000. Sounds gooduntil you compare it to orthopedic surgeons, who make $558,000, or dermatologists at $493,000.

Nurse practitioners in primary care aren't doing much better. The average is around $100,820, while specialty NPs in areas like anesthesia or dermatology can make tens of thousands more. Physician assistants in primary care average about $115,000lower than their peers in surgery or emergency medicine.

But it's not just about money.

You know what one doctor told me in an interview? "We're doing the job of three specialists and getting paid like a glorified intern."

Primary care today is more than checkups and flu shots. Docs are now first responders for mental health crises, substance use disorders, women's health, and chronic disease management. All while drowning in paperwork, prior authorizations, and electronic medical records that feel like they were built by someone who's never treated a patient.

No wonder 51% of family doctors report burnoutone of the highest rates among all specialties. The job isn't just demanding. For too many, it feels unsustainable.

Rural Areas Pay the Price

Nowhere is this shortage felt more deeply than in rural America.

About 66.5% of all primary care HPSAs are located in rural areas. In Virginia, that means places like Lee County, the Northern Neck, and Central Appalachiabeautiful communities with deep roots, but crumbling healthcare access.

And get this: over 7% of U.S. counties have zero primary care physicians. None. Nada. If you live there and need care, you drive. Or you go without.

Telehealth has helpeddon't get me wrong. But for older folks, low-income patients, or those without reliable internet, a Zoom call isn't a fix. You can't do a physical exam over video. You can't draw blood. You can't build trust in a 15-minute screen pop.

Enter the Unsung Heroes

So if doctors are stretched thin, who's stepping in?

Nurse practitioners and physician assistants.

In 2022, there were over 270,000 NPs and nearly 28,000 PAs working in primary care. And here's the beautiful part: about half of them say they're interested in practicing in rural or underserved areas.

In Southwest Virginia, many clinics are now led by NPs. They deliver prenatal care, manage diabetes, treat depression, and stabilize minor emergencies. And they do it well.

Organizations like the American Association of Nurse Practitioners (AANP) and the National Commission on Certification of Physician Assistants (NCCPA) have found that in states where NPs have full practice authoritymeaning they don't need physician oversightaccess improves dramatically.

Virginia is exploring this model. And it could be a game-changer.

Why This Matters to You

You might be thinking: "But I'm healthy. Why should I care?"

Because primary care isn't just for when you're sick. It's the reason you stay healthy.

There's a powerful study from JAMA in 2019 that found something profound: for every 10 additional primary care doctors per 100,000 people, life expectancy goes up by 51.5 days.

Let that sink in. More access to a doctor you know and trustand you live months longer.

And yet, the U.S. ranks 32nd in life expectancy among OECD countries, despite spending more on healthcare than any other nation. Why? A broken primary care system.

Your regular doctor does more than prescribe meds. They catch diabetes before it blinds you. They notice depression before it turns into isolation. One study found that 39% of preventive gynecological visits for women under 45 happen in primary care offices. Another showed a 49% increase in mental health concerns discussed in PCP visits between 2006 and 2018.

In rural areas, many primary care providers are the only game in town. They deliver babies. Treat opioid addiction. Suture wounds. They're not just doctorsthey're lifelines.

Can We Fix This?

Okay. I won't sugarcoat it. This is a big, systemic problem.

Butgood newswe're not helpless.

Here are some real, working solutions:

First: Train doctors who want to stay. Schools like the University of Washington's WWAMI program (serving Washington, Wyoming, Alaska, Montana, Idaho) actively recruit students from rural areas. Turns out, if you grow up in a small town, you're more likely to return to one. Simple, right? But powerful.

Second: Shorten the path. Medical school is long and expensive. The University of California, Davis launched a 3-year Primary Care Accelerated Track. They've already seen family medicine match rates jump from 12% to 18%. That doesn't sound like muchuntil you realize these are 18% more people choosing a path we desperately need.

Third: Let NPs and PAs do their jobs. In states with full practice authority, patients get faster, cheaper, and just-as-good care. Virginia should join them.

And fourthand maybe most importantfix the job itself. It's not enough to train more people if we're burning them out.

That means hiring scribes to take charting off doctors' plates. Paying primary care fairly through Medicare and Medicaid. Building team-based care models so one person isn't carrying the whole load.

Some schools are already getting this right. The Long Island School of Medicinedespite being tuition-free, like NYUsends two-thirds of its grads into primary care. Why? Because they shape the culture from day one: mentorship, early clinical exposure, community focus.

It's not magic. It's intention.

What Can You Do?

So what does this mean for you?

If you're struggling to find a doctor, you're not alone. And help is out there.

Try HRSA's Find a Health Center tool to locate a nearby Federally Qualified Health Center (FQHC). These clinics serve everyone, regardless of insurance, and many are staffed by NPs or PAs who provide excellent caresometimes with same-week availability.

Telehealth platforms that partner with local clinics can also be a bridge. And heydon't rule out a nurse practitioner or PA just because they don't have "MD" after their name. In many ways, they're more accessible, and just as capable for routine and chronic care.

And if you're angry about this? Good. Use that energy.

Support bills that expand loan forgiveness for rural providers. Push for full practice authority for NPs in Virginia. Call your state delegate and ask, "What's your plan for fixing the primary care shortage?"

Share your story. Because healthcare policy isn't about politicsit's about people. And yours matters.

We Can Do Better

Let's be honest: this is frustrating. It's unfair. It's broken.

But it's also fixable.

We're not talking about moon-shot technology or billion-dollar investments. We're talking about valuing the people who keep us healthy. Paying them fairly. Letting them do their jobs without drowning in admin chaos. Training doctors who care about communities, not just careers.

The future of healthcare isn't fancy hospitals or new drugsit's a trusted face in your neighborhood clinic. Someone who knows your name. Your history. Your worries.

That's what primary care is supposed to be. That's what it can be.

So if you've ever waited months for an appointment if you've driven an hour just to get a prescription refilled if you've wondered, "Does anyone see me?"I hear you.

You're not alone. And you're not powerless.

Together, we can build a system that worksnot for profits, but for people.

Because everyone deserves care that's close, kind, and within reach.

Have you struggled to find a primary care doctor? Share your story below. Your voice might just help spark change.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.