Where Residents Train Is Where They Stay — And That Has Consequences for Primary Care Access

If you direct a family medicine residency program, you already know that where you train physicians shapes where those physicians will practice. But a new analysis published in Health Affairs, Majority Of Family Physicians Still Choose To Practice In The State Where They Were Trained, quantifies that connection more clearly than ever, and offers a direct message to program directors: the work you do has lasting geographic consequences for primary care access across the country.

What the Data Show

Researchers analyzed 20,233 family physicians from 560 residency programs who graduated between 2007 and 2018. Their key finding: as of 2024, 62 percent of these physicians were still practicing in the same state where they completed residency, up from 57 percent a decade ago. Proximity was even more striking at the local level: more than half of graduates practice within 100 miles of their program, and nearly a quarter practice within just 5 miles.

Retention remains strong over time. While more recent graduates (2013–18) are practicing closer to their residency sites, the majority of graduates from earlier cohorts are still practicing relatively close to the residency program.

The Retention Paradox

Here’s where the data get complicated — and important. High physician retention doesn’t automatically solve physician shortages. Several states with strong in-state retention rates, including Texas, Louisiana, Mississippi, and Arkansas, continue to have low primary care physician capacity relative to their populations. In other words, keeping doctors in-state isn’t enough if the state isn’t producing enough doctors to begin with.

The researchers are clear on the implication: retention is not the problem in these states — production is. States like Wyoming, Missouri, and South Carolina, which have both low retention and low primary care capacity, face a compounding challenge: they’re not training enough physicians, and the ones they do train are leaving.

What This Means for Residency Program Directors

The authors argue that strategically increasing the number of residency positions in underserved states offers a scalable, evidence-based solution, particularly through programs with demonstrated high retention such as community-based residency programs, Teaching Health Center Graduate Medical Education programs, and HRSA-supported rural residencies, including rural track programs. These programs have expanded dramatically over the past decade, and evidence cited in the paper suggests their graduates are more likely to practice in rural and underserved areas.

The authors also note the role of professional and personal ties formed during training. Physicians develop strong professional networks, referral relationships, and familiarity with local health systems during residency. They and their families also develop personal and community ties that anchor them to the area, making staying near the training site a practical and attractive option for many graduates.

The Bottom Line

These findings reaffirm the impact of residency training location on the primary care workforce and point to the need for renewed federal and state efforts to align graduate medical education expansion with both need and demonstrated retention effectiveness. Despite strong geographic retention, targeted investment in training capacity remains essential to meeting growing primary care demand.

Topmiller M, Peterson LE, Bazemore AW, et al. Majority of family physicians still choose to practice in the state where they were trained. Health Affairs. 2026;45(3).