Primary Care and General Pediatrics

Rural America differs substantially from urban settings in healthcare access and culture.  Physicians, historically the ready source for rural settings throughout the 20th century are being complemented, and at times substituted, by physician assistants (PAs) and nurse practitioners (NPs) often the result of policies.    For the purposes of this study, we conducted spatial and statistical analysis on eighteen states that have varying length of existing Scope of Practice legislation to determine the impact the laws were having upon access to care.

 

When conducting workforce migration trend analysis for use in small area geographic analysis (e.g. county  or sub-county level), which is necessary to accurately gage rural versus urban impact, assessing the data initially at the individual provider practice location is required for accurately integrating with the geography of the rural definition used in the analysis.  This type of analysis allows for more accurate measurement of the shift in providers’ practice patterns in rural as a portion of the total change as oppose to the total change in rural as others have measured.

 

For the initial 18 states analyzed, from 2008 to 2015, total Physicians in Rural Areas increased by 4%, while total PA/NPs increased by only 3%.   While there were three states (Maine, Nebraska, and New Hampshire) that showed decreases in Physicians but increases in PAs/NPs in Rural Areas, in most cases where there was a decrease in Physicians practicing in Rural Areas there were decreases in PAs/NPs as well (Arizona, Iowa, Maryland, Nevada and Wyoming) .