Rural Primary Care Physician Workforce Trends and the Affordable Care Act
Presenter Biography
Jordan C Gemelas is an MD/MPH dual degree student with a focus on Epidemiology and Biostatistics. He received his Bachelor of Science degree with honors from the University of Washington School of Public Health. He was born and raised in rural Oregon and is interested in rural health disparities, social determinants of health, and primary care innovation.
Institution
OHSU
Program/Major
Epidemiology and Biostatistics
Degree
MD/MPH
Presentation Type
Poster
Start Date
4-7-2020 3:10 PM
End Date
4-7-2020 3:15 PM
Persistent Identifier
https://archives.pdx.edu/ds/psu/33761
Keywords
Rural Primary Care
Abstract
Purpose: Index of Relative Rurality (IRR) captures multiple indicators of healthcare access but is underrepresented in the primary care literature. This research investigates trends in the ratio of physicians-per-population in US counties with respect to IRR and change since the Affordable Care Act was passed.
Methods: In this ecologic study, annual ratio of primary care physicians per 100,000 population in US counties was computed for 2010 to 2017 (N=25,104). IRR assigned in 2010 placed counties on a rural-urban continuum without the use of a threshold. Primary outcomes were associations of IRR and year with physician ratio and annual change in physician ratio. Multivariable regression models were used to detect associations. A priori hypothesis was that highly rural counties did not lose physicians at a faster rate than less rural counties since 2010. Secondary analysis ranked states with leading growth rates in order to identify possible exemplary policies as targets for future research.
Results: IRR and year were independently inversely associated with ratio of primary care physicians per 100,000 and annual growth in physician ratio. Highly rural states demonstrated marked variation in annual growth.
Conclusions: Rural counties continue to lose primary care physicians per capita more rapidly than more urban counties, and the rate of loss is worsening gradually with time. This study finds no evidence for significant improvement in the primary care physician shortage, highlighting the urgent need for policy innovation to avert a workforce crisis in the coming decades.
Rural Primary Care Physician Workforce Trends and the Affordable Care Act
Purpose: Index of Relative Rurality (IRR) captures multiple indicators of healthcare access but is underrepresented in the primary care literature. This research investigates trends in the ratio of physicians-per-population in US counties with respect to IRR and change since the Affordable Care Act was passed.
Methods: In this ecologic study, annual ratio of primary care physicians per 100,000 population in US counties was computed for 2010 to 2017 (N=25,104). IRR assigned in 2010 placed counties on a rural-urban continuum without the use of a threshold. Primary outcomes were associations of IRR and year with physician ratio and annual change in physician ratio. Multivariable regression models were used to detect associations. A priori hypothesis was that highly rural counties did not lose physicians at a faster rate than less rural counties since 2010. Secondary analysis ranked states with leading growth rates in order to identify possible exemplary policies as targets for future research.
Results: IRR and year were independently inversely associated with ratio of primary care physicians per 100,000 and annual growth in physician ratio. Highly rural states demonstrated marked variation in annual growth.
Conclusions: Rural counties continue to lose primary care physicians per capita more rapidly than more urban counties, and the rate of loss is worsening gradually with time. This study finds no evidence for significant improvement in the primary care physician shortage, highlighting the urgent need for policy innovation to avert a workforce crisis in the coming decades.