Post‐ACA Trends in the US Primary Care Physician Shortage with Index of Relative Rurality

Purpose Index of Relative Rurality (IRR) captures multiple indicators of health care access but is underrepresented in the primary care literature. This research investigates trends in primary care physician supply in US counties with respect to IRR and time since the Affordable Care Act (ACA) was p...

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Bibliographic Details
Published in:The Journal of rural health 2021-09, Vol.37 (4), p.700-704
Main Author: Gemelas, Jordan C.
Format: Article
Language:English
Subjects:
Clinical outcomes
Counties
Growth rate
Health care
Health care access
health disparities
Health services
health services research
Health status
health workforce
Indexes
Physicians
Primary care
Regression analysis
Regression models
Rural areas
Rural communities
Rural urban continuum
Rurality
States
Trends
Workforce
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Summary:Purpose Index of Relative Rurality (IRR) captures multiple indicators of health care access but is underrepresented in the primary care literature. This research investigates trends in primary care physician supply in US counties with respect to IRR and time since the Affordable Care Act (ACA) was passed. Methods In this ecologic study, annual ratio of primary care physicians per 100,000 population in US counties was computed for 2010‐2017 (3,138 counties over 8 years, 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. The a priori hypothesis was that neither rurality nor year was associated with physician ratio or annual growth. Results IRR and year were independently inversely associated with the ratio of primary care physicians per 100,000 and annual growth in physician ratio. A post‐hoc analysis of highly rural US states revealed positive median growth rates in some areas. Conclusions Despite significant policies in the ACA designed to address the maldistribution of the US primary care physician workforce, more funding and further innovative reforms are urgently necessary to avert a rural workforce crisis in the coming decades. IRR may be a useful continuous, threshold‐free metric of rurality in future health services research.
ISSN:0890-765X
1748-0361
DOI:10.1111/jrh.12506