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Abstract Investigating spatial accessibility of township to medical resources in provincial China is critical for policymakers to plan a more effective distribution of medical resources. However, accessibility of township to medical resources in provincial China has not been well studied. Accessibility of townships to hospitals in urban areas was calculated by Enhanced Two-step Floating Catchment Area (E2SFCA) by different age and urbanizing groups. Cold and hot spot analysis was used to recognize medical-shortage townships. The results showed that average percent of 65 + and 0–14 age groups in townships with below-average accessibility were 11.55% and 20.38%, higher than those in townships with above-average accessibility by 2 and 3.8 percentage points significantly, and when urbanization level fell from above 0.7 to 0.3–0.7 or below 0.3, accessibility declined by 27.39% or 51.32% significantly. There were 34 physiological medical-shortage townships with both significantly low accessibility and high percent of 65 + or 0–14 age group, and 13 economic medical-shortage townships with both significantly low accessibility and urbanization level. According to the results, spatial accessibility of children on the provincial or county boundaries in northern Anhui and elders and rural population in mountainous western and southern Anhui needed more attention from policymakers.