New study reveals COVID-19’s toll on new physicians and rural health care access

Boston, MA – A new study led by the Harvard Pilgrim Health Care Institute reveals the impact of the COVID-19 pandemic on new physicians, highlighting significant shifts in their job market perceptions, compensation trends, and practice location choices.

Findings were published on March 11 in Medical Care.

Physician shortages, especially in rural areas, limit access to health care and lead to poor health outcomes. The COVID-19 pandemic worsened these shortages by causing burnout, early retirements, and increased workforce turnover.

Understanding labor dynamics such as practice preferences, compensation, and incentives is critical for addressing long-term workforce distribution and health care access challenges. While previous research has explored how the pandemic affected existing physicians, the pandemic’s impact on new physicians entering the workforce has been underexplored.

“We found that the COVID-19 pandemic was associated with concerning changes in new physician job market outcomes, especially substantial reductions in new physicians’ likelihood of entering rural practice and compensation,” said Tarun Ramesh, research fellow at the Harvard Pilgrim Health Care Institute and lead author of the study. “Homing in on the pandemic’s exacerbation of existing disparities draws attention to broader challenges in retaining healthcare talents and the need to ensure equitable access to care.”

The study used data from 31,925 medical residents and fellows participating in the 2010-2022 Survey of Residents Completing Training in New York. Researchers compared outcomes between pre-pandemic (2010–2019) and pandemic (2021–2022) periods, using a series of interrupted time series analyses, controlling for participants’ socio-demographic characteristics.

Key findings:

• Dramatic drop in new physicians entering rural practice: The percentage of new physicians entering rural practice dropped dramatically from 3.4% pre-pandemic to 0.62% during the pandemic, reversing pre-pandemic gains.
• Reduced compensation: Average base salaries decreased by $23,569 on average. The likelihood of receiving additional incentives fell significantly by 2.92%, and salary satisfaction dropped significantly by 2.4%.
• Job market perception: While the likelihood of receiving job offers increased slightly during the pandemic (88.18% vs. 86.60%), perceptions of the job market outlook declined significantly 55.77% vs. 44.13%) without a significant change in accepting a job offer from pre- to during the pandemic.
• Increased subgroup disparities: New primary care physicians experienced larger declines in rural practice rates and compensation compared to non-primary care physicians. Noncitizen international medical graduates faced the largest salary reductions, highlighting vulnerabilities in this group.

Urgent Policy Priorities The study underscores the need for urgent policy interventions to address rural physician shortages and improve compensation structures for new physicians. Recommendations include expanding financial incentives (e.g., loan forgiveness, bonuses) for rural practice, supporting primary care practices financially, and strengthening protections for noncitizen IMGs to ensure equitable compensation and reduce exploitation risks.

The work builds on the authors’ growing portfolio of evidence highlighting growing disparities in the healthcare workforce and potential solutions to mitigate these disparities. “This most recent study shows that while the demand for new physicians remained high during the pandemic, financial pressures on hospitals and practices limited physician compensation and incentives, creating a challenging environment for new physicians entering the workforce,” added senior author Hao Yu, Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute. “Our findings underscore the need for federal and state-level strategies to stabilize physician compensation and enhance rural healthcare access.”

About the Harvard Pilgrim Health Care Institute’s Department of Population Medicine
The Harvard Pilgrim Health Care Institute's Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Created in 1992, it is the first appointing medical school department in the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems, and public health agencies. Follow us on Bluesky, X, and LinkedIn.