Distribution of U.S. physicians by medical specialty across levels of rurality

Objective:Disparities persist in healthcare access, quality and outcome between rural and urban areas. A shortage of healthcare providers in rural areas can lead to further deteriorating health outcomes since rural populations experience higher rates of chronic diseases.  The objective of this study is to identify medical specialty areas with the largest physician shortages by examining practice patterns for physicians at varied rurality levels.

Methods:Practicing locations and medical specialties of physicians were determined using data from the Centers for Medicare and Medicaid Services, National Practitioner Identifier (NPI) file. Based on standard U.S. Census classification scheme, locations were grouped by rurality into urban areas (population ≥ 500,000) and rural areas (population < 500,000). The latter was further divided into Large Town (population=10,000-499,999), Small Town (population=2,500-9,999), and Remote Village (population<2,500). Physician ratios per 100,000 population for 26 medical specialties in three categories (generalized, non-surgical specialized and surgical specialized areas) were compared across levels of rurality.  Disparities were measured by ratio of physician to population in urban areas over that in remote villages.

Results:Only nine percent of physicians practiced in rural America in 2013.  The physician ratios were inversely correlated with the level of rurality in all medical specialties except for family medicine in the generalized category. Physician ratios decrease across four rurality levels ranged from 140 in urban areas to 84 in large towns, 70 in small towns and 69 in remote villages for primary care specialties, from 56 to 35, 19 and 13 for surgical specialists, and from 85 to 42, 23 and 17 for non-surgical specialists. The largest disparities between urban areas and remote villages were seen among surgical specialists (colon and rectal surgery (21.0 times), neurological surgery (18.2 times), plastic surgery (11.7 times), transplant surgery (10.5 times) and thoracic surgery (9.1 times)); non-surgical specialists (medical genetics (13.0 times), anesthesiology (11.1 times) and pathology (10.6 times)); and generalists (pediatrics (5.6 times) and internal medicine (5.1 times)).

Conclusions: Physician supply is a crucial component of a complex healthcare system. Based on NPI data, a national physician registry, our findings indicate that disparities between urban and rural areas in physician supply were particularly severe in surgical specialized care and non-surgical specialized care, which result in poor access to care for Americans living in rural areas therefore enlarging disparities in health between urban and rural populations. Our conclusions will contribute to workforce planning efforts to address health equity in rural areas.