Rural-Urban Primary Care Workforce Disparities on the Rise

A new study published in JAMA Network Open illustrates urban-rural primary care workforce disparities, demonstrating that while both rural and urban areas have seen an increase in primary care clinicians in recent years, the density of providers in urban areas remains higher than in rural areas.

Historically, there has been a primary care physician shortage in rural areas associated with longer travel distance to access care. The researchers noted that 82 percent of rural counties are classified as medically underserved, according to research from the National Academies of Sciences, Engineering and Medicine.

Access to primary care clinicians is necessary for improving population health and quality of care. Healthcare professionals have been aware of the rural-urban access to care disparity for many years and incentives have been put in place to attract primary care physicians to rural areas.

However, little research has been done to analyze potential changes in the primary care physician distribution over the past decade. Realizing the lack of new data on this significant access to care issue, researchers analyzed trends in the county-level distribution of primary care clinicians from 2009 to 2017.

The cross-sectional study of 3,143 US counties, 37 percent of which were urban and 63 percent of which were rural, used county-level data to investigate the density of primary care clinicians. The study defined primary care clinicians as including primary care physicians as well as advance practice providers like physician assistants and nurse practitioners.

Overall, primary care clinician density increased significantly in both rural and urban counties from 2009 to 2017. However, the study revealed that the significant geographic disparities in the density of clinicians between urban and rural areas widened during the study period. The density increase of primary care clinicians was more pronounced in urban counties than in rural counties.

The number of primary care clinicians per 3,500 people increased by approximately 17 percent in urban counties with a median density of 2.26 in 2009 and a median density of 2.66 in 2017. For rural communities, there was approximately a 12 percent increase in the number of primary care clinicians with a 2009 median density of 2.04 and a 2017 median density of 2.29.

The researchers broke down the trends of primary care clinician density by kind of clinician. In rural counties, the average annual percentage change (APC) of the mean density of primary care physicians was 1.7 percent, compared to 2.4 percent in urban counties. Similarly, the APC of the mean density of physician assistants in rural counties was 5.14 percent in comparison to the APC of 6.42 percent in urban communities.

These findings show that although primary care clinicians have been incentivized to work in rural areas in recent years, urban areas are still seeing a greater rate of growth when it comes to the density of clinicians within a particular county. Lack of an adequate number of clinicians is a major barrier preventing individuals living in rural and underserved areas from accessing the coordinated and integrated care they need to lead healthy lives.

The researchers also adjusted the data for county-level sociodemographic variables and the rural-urban disparities continued to be substantiated.

For instance, a positive linear correlation was found between the number of primary care clinicians per 3,500 people and median household income quintile categories. In other words, there were more primary care clinicians in areas with higher average household income.

These findings can help influence policy changes to provide more equal access to care for rural counties. For example, the researchers suggested that geographically based adjustments in Medicare payment could help reduce the disparities. Additionally, programs that encourage clinicians to practice in rural areas may be needed in order to close the gaps of access to care.

The expansion of telemedicine may also improve access to care for rural residents, allowing them to receive care where they are.