Availability of medical doctors favors metropolitan areas with low rates of self-employment

This is a line graph showing the average rate of U.S. doctors by county type from 1960 to 2017, broken out by metro and nonmetro status and high/low self-employment status.

To understand how the availability of health care for self-employed workers in metropolitan and nonmetropolitan areas has changed over time, researchers at USDA, Economic Research Service (ERS) examined the average rate of doctors with medical degrees (not with osteopathic degrees) per 10,000 people. In this chart, they focused on differences between metropolitan and nonmetropolitan counties with high and low rates of self-employment. The researchers found that between 1960 and 2017, doctors have been far more available in metropolitan counties with low self-employment rates than in other counties. They also found that doctors have been the least available in nonmetropolitan counties with high self-employment rates. The largest gap in doctor availability existed between these two groups: in 2017, there was an average of 23 doctors per 10,000 residents in low self-employment metropolitan counties versus 7 doctors in high self-employment nonmetropolitan counties. However, the average rates of doctors and trends in those rates have changed over time. Between 1970 and 2000, the average rate of doctors increased in both metropolitan and nonmetropolitan counties. But since 2000, the average rate of doctors started to decrease in nonmetropolitan counties. By 2017, the average rate of doctors in low self-employment nonmetropolitan counties fell below the rate in high self-employment metropolitan counties. Thus, people living in nonmetropolitan counties, particularly those with a higher proportion of self-employed workers, generally had less access to doctors. A version of this chart appears in the ERS publication Health Care Access Among Self-Employed Workers in Nonmetropolitan Counties, published May 2022.

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