Independent primary care doctors see banding together as one way to remain solvent and keep their autonomy

Valley Medical Group joined an IPA to help regain its
financial footing. (New England Public Media photo)

As the number of primary care doctors in the U.S. continues to decrease, the number of independent primary care practices has also fallen. A practice in the Connecticut River Valley, Valley Medical Group, has sought to maintain its independence while boosting its bottom line by joining with other independent primary physicians, reports Karen Brown of New England Public Media.

Founded during the 1990s, Valley Medical Group has become one of the "largest independent practices in western Massachusetts," Brown writes. But the practice's patient volume and focus on quality family medical care haven't shielded it from the financial pitfalls of the American insurance payment system, which rewards specialists and physicians who perform procedures over primary care.

Valley Medical Group owners found themselves stuck in insurance contracts that didn't pay well or accurately. "In January, the practice laid off 40 employees — 10% of its 400-person staff — mostly in support positions," Brown writes. "Thousands of primary care practices, a key gateway to the medical system, are fighting to remain financially viable — and independent."

VMG doctors also wanted to avoid selling their practice to a hospital, which would likely take away some of their clinical autonomy. Instead, the group opted to join an Independent Physician Association. Brown explains, "Like a union, an IPA combines individual primary care offices, giving them power in numbers when negotiating contracts with Medicaid, Medicare, and private insurance companies."

While not all IPAs are equal -- some are owned by hospitals or private equity funds -- most help level the financial playing field for smaller practices. According to Brown, when independent practices band together, they can accept insurance contracts that pay them a per-patient allotment rather than billing for each visit or procedure.

Chris Kryder, CEO of Arches Medical IPA in Cambridge, Massachusetts, told Brown, "If we keep people out of the ER, keep them out of unnecessary hospitalizations, we save money for the system. . . And we create more income for the primary care providers, which is dreadfully needed."

Waves of American doctors and nurses leave their practices and head to Canada to avoid U.S. political climate

Often born and trained in the U.S., many nurses and doctors are leaving the U.S. for Canada.
(Graphic by Oona Zenda, KFF Health News)

At a time when Americans can least afford to lose medical professionals, many are leaving the U.S., citing the country's current political climate as their reason for leaving. In rural parts of the U.S., already facing a chronic shortage of medical care providers, the loss of any medical professionals makes accessing care more difficult.

"American nurses, doctors, and other health care workers moving to Canada, and specifically British Columbia, where more than 1,000 U.S.-trained nurses have been approved to work since April 2025," Brett Kelman of KFF Health News reports. 

Justin and Amy Miller from Wisconsin serve as one example. They are both nurses who were born in the U.S. and trained at American schools, but didn't want to stay in the U.S. because of policies and cuts by the Trump administration, Kelman explains. They moved their family of five to Canada, where they found new nursing jobs.

As the Trump administration systematically slashed "funding for public health, insurance, and medical research, many nurses have felt the draw of Canada’s progressive politics, friendly reputation, and universal health care system," Kelman reports.

For U.S.-trained nurses, Canada is rolling out the welcome wagon. "Ontario and British Columbia have streamlined the licensing process for American nurses since Trump returned to the White House," Kelman writes. British Columbia also launched a $5 million advertising campaign last year to recruit nurses from California, Oregon, and Washington state."

Doctors are leaving as well. "Michael, an emergency room doctor who was born, raised, and trained in the United States, packed up his family and got out," Kelman reports. KFF did not use his last name because he expressed concerns about reprisals if he returned to the U.S. 

Rural Canadians, who also struggle with accessing medical care, are also hoping to attract some American medical professionals. Doctors Manitoba, which "represents physicians in the rural province that struggles with one of Canada’s worst doctor shortages, launched a recruiting campaign after the election to capitalize on Trump and the rise of far-right politics in the U.S," Kelman writes. 

Report: Rural primary care physician shortages will persist for at least another 12 years

Graph by Celli Horstman and Arnav Shah, State of Rural Primary Care in the United States, Commonwealth Fund

Rural residents will continue to grapple with a shortage of primary care doctors for at least another 12 years, according to a report issued last week by the nonprofit Commonwealth Fund.

Using federal health workforce data, researchers concluded that "rural areas will continue to have only about two-thirds of the primary care physicians they need," reports Nada Hassanein for the Wisconsin Examiner. Report authors noted that the persistent shortage of primary care doctors leaves million of rural residents "with fewer options for routine and preventive care."

The report's release came just days after the window closed for hospitals to apply for a share of the $50 billion federal Rural Health Transformation Program administered by the Centers for Medicare & Medicaid Services. Hassanein writes, "Some states want to use the federal money to expand their rural residency programs, as physicians who complete their residencies in rural areas are more likely to practice in one."

Nearly all of the more than 40 million rural Americans live in areas with primary care physician shortages, according to the report. "Forty-five percent of rural counties had five or fewer primary care doctors in 2023," Hassanein adds. "Roughly 200 rural counties lacked one altogether."

The report found that doctor shortages in rural areas vary by region. Hassanein writes, "States in the South had 3,411 patients per physician, whereas states in the Northeast had 1,979 residents per physician."

Although rural areas will continue to lack enough primary care physicians, some of the gap will be filled by rural nurse practitioners. Hassanein adds, "Nurse practitioners are the fastest-growing type of clinician in the U.S., regardless of geography, the report authors wrote."

Rural hospitals tap into high schools to meet ongoing staffing challenges

Ballad Health is one of several rural-serving 
hospitals training high school students.

Ballad Health is a rural hospital system in Tennessee that, like many rural hospitals, spends millions of dollars a year paying traveling nurses to cover staffing shortages. To address its recruitment woes, Ballad is working with area high schools to train its next generation of medical care workers, reports Te-Ping Chen of The Wall Street Journal. 

Ballad's high school training academy includes students from "five northeast Tennessee school districts," Chen writes, "The first batch of 200 students will graduate in 2029, with their licensed practical nurse credentials and be eligible to work right away at Ballad, earning $23 an hour." 

Building and implementing a medical training academy for high school students is time-intensive and expensive, so Ballad Health partnered with Bloomberg Philanthropies, which "last year announced it was pumping $250 million into 10 programs in states including Tennessee, Texas and North Carolina to create a high school-to-healthcare pipeline," Chen explains. 

Ballad isn't alone in its staffing struggles, and as the baby boomer generation ages, demand for medical care staffing is expected to grow. Chen reports, "Human resources advisory firm Mercer projects a deficit of 100,000 healthcare workers by 2028."

Since 2006, Baystate Health system, which serves rural populations in western Massachusetts, has invested in a "high-school career program for jobs such as respiratory therapist and sterile processing technician," Chen adds. "Many participants have gone on to pursue additional training, and more than 900 have ended up working for Baystate in the past decade."

Two million rural Americans live in 'dead zones' that lack health care providers and reliable internet service

'Dead zone' counties have three things in common: They lack access to high-speed and reliable internet, primary care providers, and behavioral health specialists. (KFF Health News graphic)

In U.S. communities that lack both medical care providers and dependable internet service, residents tend to "live sicker and die younger than others in America," report Sarah Jane Tribble and Holly K. Hacker for KFF Health News. KFF Health News calls regions that lack both services “dead zones.” Roughly 2.7 million Americans live in dead zones, and the vast majority of those zones are rural.

"In 2023, 83% of residents in non-metropolitan, or rural, counties had access to broadband, compared to over 90% of metropolitan residents," reports Sarah Melotte of The Daily Yonder. Out of the 2.7 million Americans who live in dead zones, "two million, or 70% of them, are from rural counties. That means the rate at which rural residents live in these shortage areas is five times higher than the urban rate."

In some cases, communities leverage broadband service and telehealth care to fill in for a lack of providers; but the absence of both options leaves millions disadvantaged. "Compared with those in other regions, patients across the rural South, Appalachia, and remote West are most often unable to make a video call to their doctor or log into their patient portals," KFF reports. "Both are essential ways to participate in the U.S. medical system."

Without reliable high-speed internet, it's hard to attract and keep medical providers in more remote parts of the country. At the same time, poor connectivity means telehealth care isn't an option. "Connectivity dead zones persist in American life despite at least $115 billion lawmakers have thrown toward fixing the inequities," Tribble and Hacker explain. "Federal broadband efforts are fragmented and overlapping, with more than 133 funding programs administered by 15 agencies, according to a 2023 federal report."

The contrast between "the digital haves and have-nots" is stark. "The KFF Health News analysis found that counties with the highest rates of internet access and health care providers correlated with higher life expectancy, less chronic disease, and key lifestyle factors such as higher incomes and education levels," KFF reports. In many rural counties, the lack of reliable high-speed internet access leads to the opposite, where residents tend to live unhealthier, poorer and shorter lives."