- The number of primary care physicians increased significantly from 2009 to 2017, though growth was more pronounced in urban rather than rural areas, according to a JAMA Network Open study published Wednesday.
- In urban counties, the density of primary care physicians increased 20.8% from 2009 to 2017. For rural counties, it increased by 14.3%.
- Rural clinician shortages may be associated with the widening gap in population health outcomes between rural and urban residents that policy and intervention efforts could help fix, the study's authors wrote.
While more physicians are practicing primary care today than roughly 10 years ago, they're setting up shop in large urban areas — more so than the underserved, rural communities who need them most, the study noted.
More than 30% of residents in rural communities live in federally designated health professional shortage areas, and 82% of rural counties are classified as medically underserved regions, according to the study.
For rural patients that often means longer travel times and other barriers to care access, especially when seeking preventative services or managing chronic conditions.
Researchers looked at 3,143 U.S. counties based on the national rural-urban classification scheme used by the National Center for Health Statistics at the Centers for Disease Control and Prevention.
Analyzing trends in the distribution of primary care clinicians at the county-level from 2009 to 2017, they found that rural-urban disparities are increasing in the U.S.
Primary care providers include internists, family physicians and general practitioners, as well as non-physician clinicians including nurse practitioners and physician assistants.
From 2009 to 2017, the density of nurse practitioners working in urban counties increased by 93.6%. In rural counties, it increased by 90%.
The density of physicians' assistants working in urban counties also increased by 64.9% during the study's period, while in rural counties, it increased by 49.3%.
Non-physician clinicians, such as nurse practitioners and physician assistants, are increasingly accepted by patients, the authors note. But practice regulations that vary by state mean some regions could lag behind in using that workforce.
In order to close the gaps, some policy changes are needed, such as geographically based adjustments in Medicare payments or programs that encourage clinical practice in rural areas, according to the study's authors.
In states that expanded Medicaid, hospitals were more likely to have improved financial health and a lower likelihood of closure, particularly in rural areas where there were typically high rates of uninsured people prior to expansion, according to a previous study in Health Affairs.
"The extensive availability of Medicaid coverage provides the needed linkages and payment infrastructure for primary care clinicians to serve patients in need of care but with limited resources," the JAMA Network Open study authors wrote.
The expansion of telemedicine also shows some potential for improving access and mitigating health disparities due to rural clinician shortages.