The Rural Health Professional Workforce Stephen Petterson, PhD Robert Graham Center
 
Physician Distribution across Rural-Urban Spectrum 424,773  45,388  72,180  10,525  80,239  301,621,157 Total FP: Family P...
 
 
 
 
Data Source:  National Provider Identifier (NPI), November 2008 4,669 61,250 90,031 301,621,157 Total 0.43% 1.32% 1.17% 1....
 
PCSA and State Level Capacity of Primary Care Workforce State analysis includes DC and PR. 1,674 438 10,101 6,125 #Excess ...
PC Physician Shortage by Level of Rurality: Virginia
 
Scope of Practice
Rural Scope of Practice Rural comprehensiveness reduces eligibility for proposed Medicare bonuses (MedPAC and reform bills...
 
 
Conclusion <ul><li>A mix of current options: </li></ul><ul><li>Expansion of Primary Care Workforce </li></ul><ul><li>Unloc...
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  • ------------------------------------------------------------------------------------- -&gt; rural_pcsa = 1 Variable | Obs Mean Std. Dev. Min Max -------------+-------------------------------------------------------- r_surpl~1500 | 2659 28819.32 0 28819.32 28819.32 r_short~1500 | 2659 -25347.98 0 -25347.98 -25347.98 -------------------------------------------------------------------------------------- -&gt; rural_pcsa = 2 Variable | Obs Mean Std. Dev. Min Max -------------+-------------------------------------------------------- r_surpl~1500 | 1115 1382.791 0 1382.791 1382.791 r_short~1500 | 1115 -6307.558 0 -6307.558 -6307.558 -------------------------------------------------------------------------------------- -&gt; rural_pcsa = 3 Variable | Obs Mean Std. Dev. Min Max -------------+-------------------------------------------------------- r_surpl~1500 | 1343 655.7963 0 655.7963 655.7963 r_short~1500 | 1343 -4468.389 0 -4468.389 -4468.389 -------------------------------------------------------------------------------------- -&gt; rural_pcsa = 4 Variable | Obs Mean Std. Dev. Min Max -------------+-------------------------------------------------------- r_surpl~1500 | 1202 334.6782 0 334.6782 334.6782 r_short~1500 | 1202 -2248.703 0 -2248.703 -2248.703 -------------------------------------------------------------------------------------- -&gt; rural_pcsa = 5 Variable | Obs Mean Std. Dev. Min Max -------------+-------------------------------------------------------- r_surpl~1500 | 218 54.63 0 54.63 54.63 r_short~1500 | 218 -296.3222 0 -296.3222 -296.3222 ------------------------------------------------------------------------------------- -&gt; rural_pcsa = 1 Variable | Obs Mean Std. Dev. Min Max -------------+-------------------------------------------------------- r_surpl~1500 | 2659 28819.32 0 28819.32 28819.32 r_short~1500 | 2659 -25347.98 0 -25347.98 -25347.98 -------------------------------------------------------------------------------------- -&gt; rural_pcsa = 2 Variable | Obs Mean Std. Dev. Min Max -------------+-------------------------------------------------------- r_surpl~1500 | 1115 1382.791 0 1382.791 1382.791 r_short~1500 | 1115 -6307.558 0 -6307.558 -6307.558 -------------------------------------------------------------------------------------- -&gt; rural_pcsa = 3 Variable | Obs Mean Std. Dev. Min Max -------------+-------------------------------------------------------- r_surpl~1500 | 1343 655.7963 0 655.7963 655.7963 r_short~1500 | 1343 -4468.389 0 -4468.389 -4468.389 -------------------------------------------------------------------------------------- -&gt; rural_pcsa = 4 Variable | Obs Mean Std. Dev. Min Max -------------+-------------------------------------------------------- r_surpl~1500 | 1202 334.6782 0 334.6782 334.6782 r_short~1500 | 1202 -2248.703 0 -2248.703 -2248.703 -------------------------------------------------------------------------------------- -&gt; rural_pcsa = 5 Variable | Obs Mean Std. Dev. Min Max -------------+-------------------------------------------------------- r_surpl~1500 | 218 54.63 0 54.63 54.63 r_short~1500 | 218 -296.3222 0 -296.3222 -296.3222
  • Petterson2

    1. 1. The Rural Health Professional Workforce Stephen Petterson, PhD Robert Graham Center
    2. 3. Physician Distribution across Rural-Urban Spectrum 424,773 45,388 72,180 10,525 80,239 301,621,157 Total FP: Family Physician, IM: General Internal Medicine, PD: Pediatrician. Data Source: American Medical Association Master File, July 2009; Census Population Estimate, 2007. 0.1% 0.1% 0.2% 0.8% 0.6% 1.6% Rural frontier 0.5% 0.5% 0.8% 3.4% 3.1% 2.5% Isolated small rural 1.8% 1.8% 2.4% 6.8% 7.4% 5.3% Small rural 6.4% 6.1% 6.6% 8.3% 11.1% 9.6% Large rural 88.1% 88.2% 87.4% 65.9% 75.5% 80.5% Urban Other PD IM GP FP Population RUCA
    3. 8. Data Source: National Provider Identifier (NPI), November 2008 4,669 61,250 90,031 301,621,157 Total 0.43% 1.32% 1.17% 1.56% Rural frontier 1.20% 1.47% 1.44% 2.54% Isolated small rural 3.34% 3.99% 4.13% 5.26% Small rural 8.31% 8.89% 8.77% 9.60% Large rural 86.72% 84.33% 84.50% 80.54% Urban CNM NP PA Population RUCA Table 3: Distribution of Physician Assistants, Nurse Practitioners and Certified Nurse Midwives Across Rural Urban Spectrum
    4. 10. PCSA and State Level Capacity of Primary Care Workforce State analysis includes DC and PR. 1,674 438 10,101 6,125 #Excess Physicians/Providers 7 3 29 25 # States with “surpluses” -76,811 -69,627 -20,527 -13,915 #Physicians/Providers Needed 45 49 23 27 # States with “shortages” State Analysis 20,789 14,495 38,220 30,529 #Excess Physicians/Providers 919 708 1750 1,487 # PCSAs with “surpluses” -94,237 -82,681 -48,355 -38,642 #Physicians/Providers Needed 5,587 5,798 4,756 5,019 #PCSA with shortages PCSA Analysis 938:1 1154:1 1169:1 1500:1 Benchmark Providers Physicians Providers Physicians “ Optimal” Ratio National Average
    5. 11. PC Physician Shortage by Level of Rurality: Virginia
    6. 13. Scope of Practice
    7. 14. Rural Scope of Practice Rural comprehensiveness reduces eligibility for proposed Medicare bonuses (MedPAC and reform bills) 76.7 54.3 Isolated/Frontier 72.8 49.1 Small Rural 69.5 46.6 Large Rural 78.7 62.9 Urban Post-adjustment Meet 50% Threshold Family Medicine meeting 50% “Primary Care” Threshold
    8. 17. Conclusion <ul><li>A mix of current options: </li></ul><ul><li>Expansion of Primary Care Workforce </li></ul><ul><li>Unlock link between GME $ and residencies: teaching health centers </li></ul><ul><li>- Additional Funding for NHSC, CHCs and RHCs: A proven cost effective delivery mechanism for primary care </li></ul><ul><li>Creative use of NPs/PAs: Maximize productivity within each professions’ scope of practice </li></ul><ul><li>Fast track Medical Home and ACO demonstrations </li></ul>

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