Abstract
PURPOSE: To assess county-level and specialty-level age differences between urban and rural physicians. METHODS: We linked the 2008-2021 Medicare Data on Provider Practice and Specialty (MD-PPAS) dataset with the 2024 Doctors and Clinicians national downloadable file. We assessed specialty-level differences in the age of rural versus urban physicians using Rural-Urban Continuum Codes (RUCC) with four groups: urban (RUCC 1-3), large rural (RUCC 4-5), small rural (RUCC 6-7), and isolated rural (RUCC 8-9). We analyzed the relationship between rurality and physician age using choropleth graphs, spatial clustering, and univariable regression. FINDINGS: Our final cohort comprised 571,886 physicians. The mean ages of physicians were higher in rural counties (large rural: 53.1 years; small rural: 53.3 years; isolated rural: 53.5 years) than urban counties (52.5 years; p value <0.001). Some specialties including medical oncology, palliative care, and thoracic surgery showed particularly large age differences with older physicians in more rural areas. There were clusters of older physicians in the South and clusters of younger physicians in the Mountain West and Midwest. Rurality was strongly associated with clusters of older physicians (odds ratio [OR]: 3.8; 95% confidence interval [CI], 2.6-5.5), and the percentage of households with broadband internet subscription was strongly associated with clusters of younger physicians (OR: 2.6; 95% CI, 2.2-3.0). CONCLUSIONS: Rural physicians were older than urban physicians with certain specialties and regions demonstrating large age disparities. The aging of rural physicians could worsen existing urban-rural health care disparities. Initiatives focusing on recruiting and retaining rural physicians should target specific regions and specialties to ameliorate these inequities.