Washington, D.C. (November 12, 2025) – A new report from the Primary Care Collaborative (PCC) released today finds that even as clinician shortages persist, rural practices manage a wider range of patient needs than urban practices, including chronic disease and behavioral health while providing or referring patients to community based services.
The PCC’s 2025 Evidence Report, Closing the Distance in Rural Primary Care: Evidence, Stories and Solutions, delves into the growing risks facing rural primary care in America and how policymakers can act now to sustain it.
The PCC report — completed in partnership with the AAFP Graham Center and with support from the ABFM Foundation — reveals that, despite growth in nurse practitioners (NPs) and physician associates (PAs), rural areas still have roughly 15% fewer primary care clinicians per capita. The loss of just one rural family physician can increase health spending by more than $1,300 per patient each year, or $5,200 for a family of four.
“Rural primary care clinicians are doing more with less as they strive to deliver whole-person care in the face of workforce shortages, policy uncertainty and financial strain,” said Ann Greiner, President and CEO of the PCC. “This report demonstrates that strengthening rural primary care can improve health — and keep communities alive economically and socially.”
These pressures come as federal policy changes enacted by H.R. 1 threaten to widen geographic disparities, reducing Medicaid coverage for up to 10 million Americans and cutting nearly $1 trillion in funding over the next decade. Although the bill included a new $50 billion Rural Health Transformation Program (RHTP), that investment will not offset the projected losses.
With state RHTP proposals now submitted, PCC’s report calls for the Administration to select proposals that strengthen primary care as the central foundation for rural health.
Case studies from across Texas, Oklahoma, New Mexico, Virginia and Idaho illustrate how community-driven innovation can preserve access and rebuild trust.
- In Texas, Waco Family Medicine sustains access for 75,000 patients through integrated behavioral health and pharmacy services, supported by the 340B program.
- In Oklahoma, Reliant Direct Primary Care restores clinician autonomy through subscription-based care that strengthens relationships and accountability.
- In New Mexico, Cross Arrow Medical keeps an entire county healthy–providing comprehensive care in the face of looming Medicaid cuts—led by two nurse practitioners.
- In Virginia’s Smyth County, local hospitals and schools are partnering to train nurses and recruit physicians through community-based pathways.
- And in Idaho, Full Circle Health’s teaching health center is building the next generation of rural clinicians through integrated residency training and strong partnerships with local hospitals.
The findings of Closing the Distance in Rural Primary Care show that consistent investment in primary care yields both better outcomes and lower costs. With the passage of H.R. 1 and its sweeping Medicaid changes, PCC implores states to implement responses to these policy changes plans that strengthen comprehensive primary care. Such actions will be critical to protect patient access and affordability.
The PCC urges policymakers to strengthen rural health clinics and federally qualified health centers, implement hybrid payment models, reauthorize and expand the Teaching Health Center and National Health Service Corps programs and provide stronger oversight to ensure new federal rural health funding truly reaches rural communities.
The 2025 Evidence Report underscores that primary care is a necessary infrastructure for survival of rural communities. The full report and executive summary are available here.
About the AAFP Robert Graham Center
The AAFP’s Robert Graham Center aims to improve individual and population healthcare delivery through the generation or synthesis of evidence that brings a family medicine and primary care perspective to health policy deliberations from the local to international levels. The information and opinions contained in research from the AAFP’s Robert Graham Center do not necessarily reflect the views or policies of the American Academy of Family Physicians.
Learn more: graham-center.org
About the ABFM Foundation
The ABFM Foundation advances the mission of ABFM through activities focused on education, training, and research for the family medicine specialty. Recent initiatives include the identification and evaluation of quality metrics that capture the contributions of family medicine; support for Family Medicine for America’s Health; establishment of a fellowship for international family physician educators to study best practices in family medicine education; development and assessment of the Preparing the Personal Physician for Practice and Length of Training initiatives; creation of a national collaborative to improve medical student onboarding and engagement of family medicine preceptors; the Strengthening Outcomes and Assessments in Residencies (SOAR) initiative in partnership with the Association of Family Medicine Residency Directors; support for the Advancing Innovation in Residency Education (AIRE) initiative of the Accreditation Council for Graduate Medical Education; and various leadership development initiatives. Since July 1, 2018, the ABFM Foundation has also housed the Center for Professionalism & Value in Health Care.