Rural health, primary care and the importance of workforce

According to the Agency for Healthcare Research and Quality (AHRQ; 2011), in 2010, there were approximately 209,000 practicing primary care physicians in the United States. AHRQ reported that of the 624,434 physicians delivering direct patient care only less than one-third are working in primary care. When one considers that approximately 52% of the time Americans made an office-based medical visit it was to primary care, it becomes easy to understand why the desperate need to increase the primary care workforce is a top priority in healthcare. There are simply not enough primary care physicians to meet the needs of the American public. As the largest platform of healthcare delivery, primary care is an essential cornerstone of U.S. healthcare (and as seen below).

However, when we begin discussing the importance of primary care and the primary care workforce, it becomes apparent that there are certain disparities in where providers practice (rural vs. urban). While there is an overall need to expand the primary care workforce in general, in some rural areas, one primary care provider may be all a community has to help take care of their healthcare needs.

From an excellent position paper on rural healthcare and primary care:

“Family physicians comprise just under 15 percent of the U.S. outpatient physician work force, yet they perform 23 percent of the visits that Americans make to their physicians each year. In rural areas, an even greater proportion, about 42 percent, of these visits are to family physician offices. Possessing a broad range of skills, family physicians provide comprehensive and irreplaceable care to small rural communities.  A 2001 study from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care indicated that, if family physicians were removed from the 1,548 rural U.S. counties that are not Primary Care Health Personnel Shortage Areas (PCHPSAs), 67.8 percent of those counties would become PCHPSAs. On the other hand, removing all general internists would make only 2.1 percent of the counties PCHPSAs, and only 0.5 percent would become PCHPSAs without pediatricians or without ob/gyns.”

The above data simply shows that the vast majority of healthcare providers in rural communities are family physicians, and without these family docs in place, there would be considerable “holes” where no healthcare services were provided.

From a Future of Family Medicine blog post:

“20% of Americans or approximately 60 million people live in rural America. Those who live in rural communities are older, poorer and have more chronic diseases than the typical city dweller. The problem: few doctors choose to practice in rural America. And the doctors who are out there are getting older themselves and are close to retirement.”

Healthcare reform paid a significant amount of attention to expanding coverage for individuals who previously had no health coverage. In some rural areas, being able to have access to insurance means that you are now more likely to be seen than before. But what happens when there is no one there to see you? What happens where there is no workforce to address your healthcare needs? While the same can be said for urban areas too, the need is more apparent in our rural communities.

The point of this post is twofold:

1) We must continue to work on expanding our primary care workforce; and,

2) We must work towards better distributing the primary care workforce we currently have.

Communities of all shapes and sizes will continue to rely on primary care as the first point of contact in the healthcare system. We must acknowledge this and work towards supporting policies that strengthen primary care and foster building up and better distributing the workforce.

Other countries have done this – why can’t we?