Workforce shortages remain one of the most frequently cited challenges facing healthcare in Texas. Discussions often focus on producing more physicians, nurses, dentists, behavioral health professionals, and public health practitioners, and with a rapidly growing population, those investments matter.

Yet workforce shortages are often discussed as a statewide challenge, while they are experienced as a local one.

For decades, federal and state agencies have identified shortages of primary care, dental, and mental health professionals across Texas. Today, hundreds of Health Professional Shortage Area (HPSA) designations remain active across these disciplines, with many concentrated in our state’s rural and frontier communities. The persistence of these shortages raises an important question:

If Texas succeeds in training more healthcare professionals, what determines whether they practice where they are needed most?

Why do Workforce Shortages Persist?

Texas undoubtedly faces workforce shortages. However, the challenge is not simply one of supply. Many communities experience overlapping shortages in primary care, dental care, and behavioral health services. Rural Texans are often older, experience a higher burden of chronic disease, and travel farther for care, yet these same communities frequently face the greatest workforce challenges.

This suggests that Texas may be confronting not only a workforce supply challenge, but also a workforce distribution and retention challenge. The question is not simply whether healthcare professionals exist somewhere in the state, but whether communities can attract, support, and retain them over time.

What Determines Where Clinicians Choose to Practice?

Workforce decisions do not happen in a vacuum. Compensation, educational debt, lifestyle, professional support, administrative burden, advancement opportunities, and community connections all influence career choices.

This reality is particularly relevant as Texas seeks to strengthen primary care, oral health, behavioral health, and public health systems. If workforce shortages are concentrated in these fields, it is worth examining whether current financing, training, and professional incentives align with the workforce goals policymakers hope to achieve. Viewed through this lens, workforce outcomes are often less about individual decisions and more about the incentives and signals embedded within the healthcare system itself.

A useful question may not be:

“Why don’t more clinicians choose primary care or rural practice?”

Instead, it may be:

“What signals are our healthcare systems, policies, and incentives sending about what we value?”

Are We Recruiting People or Building Workforce Infrastructure?

Historically, workforce strategies have focused on recruitment.

Recruit a physician.

Recruit a nurse.

Recruit a dentist.

Offer a signing bonus.

These approaches remain important, but emerging workforce strategies are beginning to ask a different question:

How do we create the conditions that help healthcare professionals want to stay?

One notable aspect of Texas’ Rural Texas Strong Initiative 4 is that it moves beyond traditional recruitment strategies. Rather than focusing solely on attracting clinicians to underserved communities, the initiative emphasizes local education pathways, mentorship, training opportunities, workforce development, and retention.

Whether these approaches ultimately succeed remains to be seen. However, they reflect an emerging recognition that workforce challenges may be rooted not only in supply, but also in the infrastructure that supports workforce development over time. These investments may not produce immediate results, but they help create the conditions that influence where people choose to build their careers.

Furthermore, recruitment often receives the most attention. Yet retention may ultimately prove just as important. Housing, childcare, schools, broadband, professional support, and opportunities for spouses and families all influence whether healthcare professionals remain in a community. Workforce development, in this sense, is also community development. After all, healthcare professionals are not only clinicians. They are parents, spouses, neighbors, volunteers, and community members making decisions about where to build their lives.

What Questions Should Texas be Asking Next?

As Texas continues investing in healthcare workforce development, several questions may help inform future efforts:

• How do workforce incentives influence specialty selection, practice location, and long-term retention?
• What role should local education and training pathways play in workforce strategy?
• How can communities better support healthcare professionals beyond recruitment?

Through our statewide alignment efforts, a consistent theme emerges: workforce challenges rarely exist in isolation. They are often connected to financing, education, practice sustainability, community conditions, and local economic opportunities.

The future of workforce strategy may depend not only on how many healthcare professionals Texas produces, but also on the conditions that influence where they train, where they practice, and whether they stay.

Explore the Data

Workforce challenges vary significantly across Texas. Readers can explore county-level workforce, demographic, and community indicators through Texas Health Insights to better understand the unique conditions shaping workforce needs in your community.