Assessing Primary Care Health Workforce Shortage in Rural and Frontier America

Purpose: This study examines the geographic distribution of primary care health workforce across rurality in Primary Care Service Areas (PCSAs). The aim is to identify areas of real shortages and surplus of primary care health workforce across rural America.

Data Sources and Study Design: We used 2007 physician workforce and Medicare utilization data from the PCSA Project to identify optimal health workforce density for rural America and compared it to estimated shortage / surplus of primary care health workforce at provider to population bench marks of 1:1092, 1:1500, 1:2000, and 1:3000. Rurality of PCSAs was determined from Rural Urban Commuting Areas (RUCA) codes using majority rule based on population.

Results: Preliminary analysis showed that different optimal provider to population ratios might exist for urban and rural areas. It also showed a severe mal-distribution of primary care workforce across the nation: rural areas contain roughly 19% of population with only 14% of primary care physicians. Using the moderate bench mark of 1:1500 ratio, we found that 8,967 (or 27%) additional primary care physicians are needed for rural America. This number would be 20,290 (or 60%) additional primary care physicians to reach the 1:1092 ratio for all rural PCSAs.

Implications: The findings suggest that the shortages amidst surplus is still the most significant characteristics of the current geographic distribution of primary care physicians across rural and frontier America. Rural areas traditionally have difficulties with attraction and retention of health care professionals. Better policy remediation to ease the maldistribution of health workforce across the nation is needed.