This document discusses physician and healthcare provider distribution across rural and urban areas in the United States. It finds that rural areas tend to have significantly fewer physicians, nurse practitioners, physician assistants, and certified nurse midwives per capita compared to urban areas. Several states and local areas are estimated to have shortages of primary care providers. Expanding primary care workforce and funding, increasing training opportunities, and maximizing the productivity of nurse practitioners and physician assistants are proposed to help address rural healthcare access issues.

1. The Rural Health Professional Workforce Stephen Petterson, PhD Robert Graham Center

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

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

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

11. PC Physician Shortage by Level of Rurality: Virginia

13. Scope of Practice

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