Blog: Surprising stats on rural clinician workforce

Here's an interesting statistic from the American Academy of Family Physicians: In areas where there are few physicians, there are still usually more doctors than nurse practitioners.

I was sent that stat and more after writing a blog post responding to the AAFP's and the American Medical Association's (PDF) insistence that in the drive toward team-based healthcare, physician leadership is an absolute requirement for any healthcare team.

While physicians have presented a unified front, they stand in isolation.

Nurse practitioners criticized the AAFP and called it "misdirected and out of step” on the issue. With a nod to the idea that the care-coordination-focused medical-home practice model is the new foundation of team-based care in the U.S., the NPs noted that none of the organizations that recognize practices as medical homes requires practices to be physician-led to earn the organization's seal of approval. (I had trouble believing that last part, so I called the National Committee for Quality Assurance, the Joint Commission and the Accreditation Association for Ambulatory Health Care, and they all confirmed it was true.)

So I piled on by talking about rural areas where doctors are few and far-between and sarcastically asked whether physicians would be willing to be subject to a draft in order to fill vacant physician leadership posts in the nation's hinterlands.

An AAFP spokeswoman responded with a polite but blunt rebuttal to my rant and educated me on my misperceptions of the rural workforce balance of physicians and nurse practitioners.

"Your concern that we cannot have physician-led teams in areas where there are no physicians is legitimate," her e-mail said. "However, it's not necessarily based on research data."

(Brace yourself: Here come a lot of numbers.)

The data, as presented in the publication Primary Care Workforce Facts and Stats No. 3 from HHS' Agency for Healthcare Research and Quality, indicate that in 2010 there were 85,611 primary-care doctors practicing in rural areas compared with 12,350 primary-care nurse practitioners.

To paint an even more specific picture, the AHRQ broke things down between large, small and "remote/frontier" rural regions for areas with populations between 10,000 and 50,000 people, 2,500 and 9,999 people, and fewer than 2,500 people, respectively.

Large rural areas house 10% of the U.S. population and had 50,114 primary-care doctors practicing in them, or 24% of the primary-care physician workforce (11.1% of family physicians, 6.7% of internists and 6.2% of pediatricians), and 6,119 primary-care nurse practitioners, or 11% of that workforce.

Small rural areas house 5% of the U.S. population and had 22,969 primary-care doctors, or 11.4% of the workforce (7.2% of the family physicians, 2.4% of the internists, and 1.8% of the pediatricians), and 4,005 primary-care nurse practitioners or 7.7% of the workforce.

And, in those aforementioned hinterlands (where 5% of the U.S. population dwells), there were 12,528 primary-care doctors, or 6% of the workforce (4.2% of family physicians, 1.1% of internists and 0.8% of the pediatricians), compared with 2,226 primary-care nurse practitioners, or 4.2% of the workforce.

Not to throw too many more numbers out there, but for the record, the AHRQ also noted that there were 30,402 primary-care physician assistants out there in 2010, and that about 4,743 of them were practicing in rural areas.

The AAFP scores some points for pointing out that, if care is being delivered at all in a remote area, it is most likely being done by a physician. So, my questions now become: What if there are still not enough doctors to provide the care needed in the nation's rural regions? Would remote communities still be allowed to field a healthcare team without the physician leader that physician associations demand?

Follow Andis Robeznieks on Twitter: @MHARobeznieks.



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