Nebraska's non-physician providers: Gap-fillers in primary care?

Background: Non-physician providers (NPs & PAs) have been traditionally used in primary care as gap fillers to address shortages of primary care physicians. Studies have indicated that non-physician providers are more likely than physicians to serve rural and underserved populations (Strickland et al, 1998; Everett et al, 2009). In Nebraska, empirical assessment of their role in filling gaps in primary care provision is limited. Much of the literature on shortage areas focus on simple professional to population ratios. This study however, places emphasis on assessing whether non-physician providers are meeting a need for primary care in Nebraska's counties. Methods: Using regression modeling we examined the relationships between the ratio of non-physicians to population in Nebraska's counties and measures of need (Wang & Luo, 2005) for primary care services. Findings: We found a negative association between the non-physician to population ratio and the percentage of the population with a high need for primary care services (i.e. total population under 5 years, women between age 15 and 44 and seniors over 65 years old) (p <0.05). However, counties with higher rates of poverty (p<0.05) as well as those with better self-reported population health status (p<0.001) were found to have a higher proportion of non-physician providers. Conclusion: Our findings suggest that Nebraska's non-physician providers may not be practicing in areas with a higher need for primary care services. Recruitment and retention policies for non-physician providers should focus more on meeting the needs of populations with a higher need for primary care.