The empirical research documents a persistent shortage of Primary Care Physicians (PCPs) in US rural regions, as will limit the effectiveness of any effort to implement universal health coverage into the United States.

As a result, it constitutes a critical policy issue of immediate importance.

However, complexity has rendered repeated efforts to introduce a solution futile, belying an urgent need for an improved, conceptual understanding.

To support this critical objective, this study purposively adopts a rigorous methodology known as root cause analysis (RCA), as a first for the literature in this context.

Whereas the rural and metro PCP have been falsely interpreted as representing close substitutes, this comprehensive analysis reveals that the rural, shortage area PCP is a vocational commitment with unique, defining characteristics.

Fresh insights into a problem that has spanned several decades enable this study to introduce a comprehensive strategy - as based upon seven, evidenced-based policy approaches - that receives strong empirical support as a potential means of reversing the in transient trend.