In a small clinic room in Sparta, Tennessee, Dr. Ty Webb moved his chair near his 70-year-old patient and encouraged her progress with weight loss and smoking. His wife, Janet Webb, a pharmacist and scribe, helped consolidate more than a dozen medication bottles and discard those no longer needed. When his patient shared fears about her new heart condition, he offered tissues and assured her that she would be able to navigate the necessary care.

“Stress is going to make you feel like you can’t keep anything straight,” Webb said. Turning to the many pill containers, he added, “We’ll try to simplify.”

Webb explained next steps and upcoming blood tests, before moving on to his next patient down the hall, counseling once again on cigarettes and commending improved blood sugar levels.

It’s a familiar routine, one he has fulfilled for nearly three decades as a family physician, often serving the same families he met when he first moved to the town of 5,000. But as his retirement and those of other family physicians draw nearer, he carries with him concerns and questions about what that will mean for the rural communities they serve.

“Finding physicians to do what I do and take my place — I’ve been looking for 15 years and can’t find somebody,” Webb, 59, said. “There is no one coming in to replace the doctors like me out there and we are five to seven years from retirement. There is about to be a really big problem.”

Webb is among a shrinking pool of family medicine doctors in rural Tennessee. Young family doctors must navigate a more complicated medical landscape for independent practice than in previous decades, and aspiring physicians are often drawn to higher salaries in more specialized fields or to positions in urban areas. That leaves many rural counties in Tennessee with a shortage of doctors.

The number of family physicians in rural areas in the South fell by 14% in the seven years through 2023, according to a recent Annals of Family Medicine study. Tennessee’s urban counties, including Davidson, Williamson and Knox, have ratios of fewer than 1,100 residents to one primary care physician, while nearly 30 rural counties have ratios that exceed 4,000 to one, according to 2022 data from the University of Wisconsin Population Health Institute.

Tennessee has ranked among the least healthy states for decades. About one in three Tennesseans live in rural areas, where life expectancy and incomes are lower and reliance on public health insurance and health risks are higher, according to a 2025 state report.

“We have a dearth of physicians practicing in areas of our state that need it most,” said Dave Chaney, executive director of the Tennessee Academy of Family Physicians. “When family doctors are in communities, people live longer, are healthier and the overall cost of care goes down.”

To help address these rural health care needs, Tennessee lawmakers, led by Republican state Sen. Rusty Crowe of Johnson City, approved a loan repayment program in 2023 to encourage family physicians to work in underserved areas. The Tennessee Academy of Family Physicians Foundation, which developed the program, began selecting recipients this year who will receive as much as $200,000 in loan repayment dollars during five-year commitments.

The new family physician loan repayment program is part of a broader focus in Tennessee to boost health care outcomes in rural parts of the state. Gov. Bill Lee launched a rural healthcare task force in 2022, and the state was awarded $207 million in federal funds in 2025 to be allocated through a five-year Rural Health Transformation Program.

‘DEGRADATION OF CARE’

For Webb, moving to a town heavy in Bluegrass music, grain silos and cattle farms felt like a natural step for him after completing his medical residency. Sparta, located 90 miles east of Nashville, was a departure from his years studying medicine in Memphis and growing up in Indianapolis, but he knew he could use his broad medical specializations in a smaller town, he said.

He joined a practice with three other family medicine doctors, delivered babies, offered psychiatric care, performed colonoscopies and did rounds at the local hospital. He and Janet raised three kids on a 50-acre farm, where they now host grandchildren and care for their three dogs. His home, his clinic, his grocery store, his kids’ schools, his church and city hall are all within a short drive.

“It’s fabulous. The cost of living is low, people are great,” Webb said. “It’s just the pace of life is different. I enjoy the smaller community.”

Most of Webb’s patients live in White County, but some drive from two or three counties away, having built relationships with him and his team that now consists of three nurse practitioners and a physician assistant. He no longer sees hospital patients, but at his Sparta clinic and at a smaller office in Spencer, his team sees about 12,000 patients and he works 12- to 14-hour days to fit them all in. His clinic gets multiple calls a day from people seeking to establish primary care, openings that do not exist.

“We can’t accommodate that. We’re full,” Webb said.

Other rural Tennessee doctors describe similar demands. Dr. Katherine Hall, 47, is a family physician in Athens, Tennessee, often with a two-month waiting period for new patients. She tries not to turn people away, but that makes it more difficult to see her existing patients when they are sick. On a typical morning, she has fed her horses and made hospital rounds before her clinic opens at 8 a.m.

“It is really hard to be available for acute needs when I’m spending all my time catching up and managing the refills and the labs and the other management of patients,” she said. “I see 24 to 27 in a day. You can’t really squeeze more in than that.”

Dr. Wm. Ryan Bartz, 47, who works in Selmer in West Tennessee, has a full clinic for 10 hours on weekdays, sees acute care patients and makes regular house calls. He has been compensated or thanked with plates of cookies, fresh chicken eggs and beef donations, even soup deliveries when he has been sick.

“I love my job,” he said. “It’s not a clock-in, clock-out job.”

As an independent physician, Webb believes he is better positioned to care for patients than those working at hospitals, where longevity is also uncertain. Seventeen hospitals have closed in rural parts of Tennessee since 2012, and as of 2022, more than 20 rural hospitals were at risk of closure, according to annual state health reports.

But, being an independent family medicine doctor comes with its own bureaucratic and billing challenges, and Webb said he understands why young doctors are often discouraged from following course. Many seek more defined hours, which is hard to make work financially and to meet patients’ needs in a rural private practice, he said. Dealing with insurers reluctant to cover costs is increasingly adding to his workload, along with keeping up with ever-evolving regulations. Webb is less certain that he will be working into his 70s, as he had long envisioned.

“I love medicine. I would keep doing this for a very long time,” he said. “The problem is the bureaucracy of medicine, and it’s killing me.”

More than half of non-metro doctors in Tennessee were older than 65 in 2022, compared to a third in metro areas, according to data from Rural Health Information Hub, illustrating the upcoming pressures on rural communities. Meanwhile, Tennessee lost 42% of independent physicians in rural areas in the five years through 2024, according to a Physicians Advocacy Institute report.

A further reduced physician presence in rural areas in the coming years will mean patients with less access to comprehensive, preventative care, Webb forecast. Patients will have to rely more on nurse practitioners and physician assistants, who are knowledgeable and skilled but whose training is meant to accompany doctors’ roles, he said. Patients will also likely turn more to urgent care clinics or to emergency centers farther away when heart disease, blood pressure or other issues reach crisis levels, adding more costs to the system and to patients.

“It’s going to be a degradation of care,” Webb said.

FINANCIAL PRESSURES

For many in their residency, their looming medical school debt forces them to seek more lucrative specialties or positions in urban areas that include more patients relying on private insurers. Medical students graduating in 2025 with education debt owed on average more than $220,000, according to the Association of American Medical Colleges.

“The financial fear is real,” Webb said, adding car payments, house payments and childcare costs to the tally. “Their entire life has been put on hold until they can start work, and they are starting that way behind the eight ball financially.”

The state’s new loan program helps alleviate at least the medical school debt pressures, which is significant, and Webb said he is hopeful it can draw more candidates to his practice and others facing similar staffing needs.

“There is still a hurdle there, but it is a much more achievable hurdle to overcome,” he said. “That’s going to be helpful.”

The Tennessee family physician group’s foundation awarded five recipients in April out of about 300 Tennessee family medicine resident doctors training at a dozen programs across the state. The annual cost to the state is forecast to reach $520,000.

While other existing loan repayment programs in the state target rural health practitioners more generally, the new initiative only goes toward family medicine doctors. The family medicine program also requires a longer time commitment and a greater repayment level, with the hope that doctors will develop stronger ties to the community and will be more likely to stay beyond the five-year period. Even placing two or three doctors through the loan repayment program can make a meaningful difference, Chaney said.

“No other type of doctor is equipped to go into one of these rural areas and provide the type of comprehensive care that these communities need,” he said. “Let’s invest in primary care on the front end, let’s keep people well, improve public health status and, in the long run, reduce overall costs.”

Read more at TennesseeLookout.com.