Geographic Distribution of Family Physicians

American Board of Family Medicine (ABFM) Diplomates are found in all 50 states, multiple U.S. territories, and abroad in other countries. Using 2021 state-level population estimates from the U.S. Census Bureau¹¹, there are approximately 30 family physicians for every 100,000 persons in the United States. The most common state in which these physicians practice is California (12.0%) followed by Texas (7.6%), Florida (5.1%), Pennsylvania (4.1%), and New York and Illinois (3.9%). The map (Figure 7) demonstrates the ratio of family physicians per state population. Alaska has the highest number of ABFM Diplomates per 100,000 population at 65.9 while Connecticut and New Jersey have the lowest at 17.1 each.

TABLE 1. Family Physicians by Location

Rural Health

Family medicine serves an important role in improving health care access for rural populations due to its breadth in scope of practice. Previous research has found that family physicians are disproportionately represented in rural areas compared to primary care physicians in other specialties.¹² ABFM defines rural practice as existing in a county with a Rural-Urban Continuum Code (RUCC) of greater than 4 on the U.S. Department of Agriculture (USDA) 9-point scale.¹³ Using practice location data for family medicine Diplomates in U.S. states, 8.0% practice in a large rural city or town, 6.9% practice in a small isolated city or town, and 85.2% do not practice in a rural area.

Practice Location

The majority of family physicians provide direct outpatient care (93.6%). Outpatient medicine is defined as clinical work outside of a hospital setting, including ambulatory clinics, community practices, and home-based care. See Chapter 5 for more details on Diplomate practice sites.

Most family physicians reported providing continuity care (78.7%). Continuity care involves an ongoing relationship between the clinical care team and patient, forming a sustained partnership to address health care needs and whole-person health.¹⁴ By seeing the same physician over time, the patient and provider benefit from greater trust, improved communication, and partnered responsibility.¹⁵ Studies indicate a strong relationship between physician-level continuity and improved patient outcomes including reduction in ED visits, hospital admissions and readmissions, and per member per month cost.^{16, 17}

For those not in outpatient continuity care, the most popular alternative principal practice activities were urgent care (28.6%), emergency medicine (21.4%), and hospital medicine (20.2%). To further characterize physician practice types, we obtained questionnaire respondent data from early career family physicians who were practicing for three years since residency graduation (cohort from the ABFM Graduate Survey Report – see Methods Appendix). Compared to ABFM Diplomates who are later in their careers and maintain continuous certification, more early career Diplomates reported practicing direct patient care (98.5% vs. 93.6%). Furthermore, if they were not practicing outpatient continuity care, early career Diplomates reported a higher percentage practicing hospitalist medicine (46.9% vs. 20.2%). Interestingly, there was a lower percentage of early career Diplomates reporting emergency medicine, geriatrics, and urgent care practice compared to mid-or late career ABFM Diplomates.

TABLE 2. Reported Practice Type by Family Physicians