An analysis of nationwide health professional accessibility data suggests that the primary care workforce is unequally distributed across the nation, with internal medicine physicians, family medicine physicians, and nurse practitioners each displaying a unique pattern for their spatial accessibility. The research, recently published in the journal PLoS One, was supported by the National Center for Complementary and Integrative Health (NCCIH).
The researchers used a combination of provider location, medical claims, and U.S. Census data as well as state-of-the-art geospatial methods to perform a national study of health provider accessibility. They used the National Plan and Provider Enumeration System along with Medicare claims to identify providers actively caring for patients in 2014.
Researchers found that spatial accessibility was not equally distributed across geographic areas among all of the provider types examined (provider categories included primary care physicians—internists and family physicians—specialists, nurse practitioners, and chiropractors):
- Accessibility of internists most resembled that of specialists, with higher accessibility in urban locations and often in areas with a medical school. Accessibility of nurse practitioners most resembled that of family physicians, with higher accessibility in rural areas.
- Higher accessibility of family physicians was concentrated in the upper Midwest.
- Internists and specialists were more accessible by patients in the Northeast.
- For nurse practitioners, spatial accessibility was lowest in the West and uniform across the Midwest, South, and Northeast regions.
- Among chiropractors, high spatial accessibility was seen in the Midwest, with relatively lower spatial accessibility in the South and West regions.
In light of these findings, the researchers suggest that future programs and policies intended to address maldistribution of the primary care workforce may need to be individualized according to provider type, target population, and geographic location. Additional research is needed to explore the factors that influence geographic patterns of spatial accessibility and the interaction between primary care provider groups.
- Naylor KB, Tootoo J, Yakusheva O, et al. Geographic variation in spatial accessibility of U.S. healthcare providers. PLoS One. 2019;14(4):e0215016.