What Is a Health Desert — And Who Lives in One?
- Robert Han
- Jun 8
- 3 min read
92 million Americans live in areas designated as primary care shortage zones. Understanding what that means—and why it keeps getting worse—is essential to understanding why healthcare workforce equity matters.
A health desert is not a metaphor. It is a documented geographic reality: a place where the ratio of patients to providers is so high, and the barriers to care so significant, that the population is functionally without reliable access to healthcare.
The federal government calls them Health Professional Shortage Areas (HPSAs). As of January 2026, approximately 92 million Americans live in one.
What a shortage area actually looks like
The government designates an area as a primary care HPSA when the patient-to-provider ratio exceeds 3,500:1. That means one primary care physician — or nurse practitioner, or physician assistant — responsible for 3,500 or more patients. The national average for a well-functioning primary care practice is roughly 1,500 patients per provider.
In the most underserved areas, the ratio can be far worse. And the provider that exists is often not a physician at all — it is an APRN or PA providing care at the outer limits of their scope, covering an entire county, seeing patients for conditions that would be referred to specialists in a well-resourced zip code.
HPSA type | Designated shortage areas (2025) | Population affected |
|---|---|---|
Primary care | 7,500+ | 92 million Americans |
Mental health | 6,500+ | 158 million Americans |
Dental care | 7,000+ | 65 million Americans |
Rural HPSAs | Majority of designations | Disproportionately rural, Indigenous, low-income |
The geography of who goes without
Health deserts are not randomly distributed. They cluster in predictable places: rural communities, tribal lands, low-income urban neighborhoods, and communities of color. The factors that make a community economically vulnerable are, in most cases, the same factors that make it medically vulnerable.
Rural counties that have lost hospital services in the last decade — more than 180 rural hospitals have closed since 2005
Urban neighborhoods where insurance coverage is lowest and provider reimbursement rates make practice economically unviable
Tribal nations, where Indian Health Service funding has chronically fallen short of population need
Agricultural communities with high immigrant populations, where language access and documentation status create additional barriers
Who fills the gap — and what happens when they can't
Advanced practice registered nurses, physician assistants, and community health workers are the primary care infrastructure in health deserts. They are not filling in for absent physicians — they are the system. When APRN training becomes harder to fund, when PA programs lose students to financial barriers, the communities that depend on these providers bear the direct clinical cost.
What does that look like in practice? Emergency rooms become primary care. Preventable conditions become hospitalizations. Chronic diseases go unmanaged. Maternal mortality — already a crisis in the United States compared to peer nations — gets worse in the places it is already worst.
A connected crisis The communities most affected by health deserts are also the communities that produce the fewest healthcare professionals — not because of lack of motivation, but because of lack of access to the training pipeline. Investing in students from these communities is not charity. It is infrastructure repair. |
What the research says about who stays
Decades of research on healthcare workforce distribution have reached a consistent finding: providers who grew up in underserved communities are significantly more likely to return to practice in them. Medical students from rural backgrounds are more likely to practice in rural areas. Students from low-income urban backgrounds are more likely to work in safety-net settings. Bilingual providers practice in bilingual communities.
This is the strategic case for diversity in the healthcare training pipeline — not just equity, but effectiveness. If the goal is to get providers into the communities where they are most needed, the most reliable predictor is where those providers came from.
What it will take
Sustained scholarship and financial support for students from underrepresented backgrounds pursuing primary care and APRN roles
Loan forgiveness programs that meaningfully incentivize practice in HPSAs — and policy changes that preserve rather than erode those programs
Pipeline programs that identify and support students from shortage areas early in their educational journey
Federal and state investment in community health worker training and integration into primary care teams
The map of health deserts in America is not inevitable. It is the result of decades of underinvestment in the communities and the students best positioned to change it. That is a policy choice — and it can be a different one.
Comments