Rural areas continue to be hit hard by primary care physician shortage

By Aine Cryts

Americans living in the most rural areas of the country continue to lack access to primary care clinicians, with nurse practitioners far more likely to serve these areas, according a recent study published in Medical Care. In states that haven't expanded Medicaid access, residents experience even greater challenges accessing primary care within their geographic area.

"The most rural areas of the country averaged nearly 357 uninsured people per primary care clinician compared to only 133 uninsured people per clinician in large urban areas," wrote lead study author John Graves, Ph.D., a healthcare economist at Vanderbilt University, in a study announcement.  

Researchers found that while physicians were more likely to provide primary care than nurse practitioners or physician assistants, most physicians were likely to practice in urban areas. Nurse practitioners were relatively more likely to deliver care in rural areas, according to researchers.

In a related finding, an individual state's scope-of-practice laws--which limit the responsibilities of nurse practitioners and physician assistants--seemed to have a negative impact on rural residents' access to primary care.

In 17 states that didn't restrict the responsibilities of nurse practitioners, 62 percent of the state's residents had high geographic accessibility to a primary care provider; whereas, in the 21 states that fully restricted the care provided by nurse practitioners, access to primary care decreased considerably, Peter Buerhaus, Ph.D., a study co-author and a professor of nursing at Montana State University, said in the study announcement.

One effort to increase access to healthcare in rural areas is University of Missouri School of Medicine's Community Integration Program, which invites third-year medical students completing clinical clerkships at rural sites to solve a healthcare problem in a rural area. Such programs can drive interest in rural practice among students, according to a study published in Medical Teacher.

Developed in 2006, the medical school's Community Integration Program encourages students to provide care in rural settings after graduation. Fifty-three percent of the medical school's rural track students have taken part in the program and reveal that their participation led to a better understanding of their role as healthcare providers in a rural setting, helped them feel close to the communities they served and they were more likely to get involved in community service activities in the future, according to an announcement from the university.

To learn more:
- check out the Medical Care study abstract
- read the study announcement
- view the Medical Teacher study abstract and study announcement