The Unequal Distribution of Primary Care Physicians

The current concentration of physicians in urban and suburban areas means most states and primary care service areas currently have shortages.

The entire country may be facing a primary care physician shortage, but the situation is much direr in rural areas.

The Robert Graham Center published a one-page policy paper on the unequal distribution of the primary care workforce in the United States. According to data from the Agency for Healthcare Research and Quality (AHRQ), the concentration of physicians in urban and suburban areas means most states and primary care service areas currently have shortages.

In the country there are 80 primary care physicians per 100,000 people. In urban areas, the ratio is slightly more favorable with 84 primary care physicians per 100,000 people. However, in rural areas the ratio is much worse: just 68 per 100,000 people.

“Unlike many Western nations, the United States does not manage or actively regulate the number, type, or geographic distribution of its health workforce,” wrote the policy paper’s authors Stephen M Petterson, PhD; Robert L. Phillips, Jr., MD, MSPH; Andrew W. Bazemore, MD, MPH; and Gerald T. Koinis, BA. “As a result, health care professionals choose how and where to work.”

The numbers aren’t any more favorable for nurse practitioners (NPs) or physician assistants (PAs) practicing in primary care. According to AHRQ data, 72.1% of NPs and 75.1% of PAs are in urban areas; 7.7% of NPs and 11.6% of PAs in large rural areas; 7.7% of NPs and 6.9% of PAs in small rural areas; and 9.1% of NPs and 6.3% of PAs in isolated rural areas.

The distribution of NPs and PAs is slightly better than the numbers for physicians. General internal medicine physicians have the worst distribution percentages: 89.8% are in urban areas, 6.7% in large rural, 2.4% in small rural and just 1.1% in isolated rural.

Among all physicians in all specialties, 91% are located in urban areas and less than 1% are in isolated rural areas of the country.

Of course, the ever-present concern is that access to primary care will be even more significant when millions more Americans are newly insured under health care reform law.

“New incentives and policies for distributing primary care physicians to areas of greatest need, as well as a larger absolute number of these physicians will be needed to ensure access for the newly insured,” the authors wrote.