Specialty providers consistently outnumber primary care providers on a state-by-state basis, says new data from the Centers for Disease Control (CDC), but the number of PCPs has held relatively steady over the decade between 2002 and 2012 despite anecdotal evidence that PCPs are a dying breed. While the national average currently stands at 46.1 providers per 100,000 patients, Mississippi only has 26.5 while Vermont boasts 66.8 providers.
The states with the highest number of PCPs were Massachusetts, Rhode Island, Vermont, and Washington, while Arkansas, Georgia, Mississippi, Nevada, New Mexico, and Texas sat well below the national average. In 2012, 53% of PCPs practiced in conjunction with physician assistants or nurse practitioners. Georgia was the only state with significantly fewer PAs or NPs than the average nationally.
“Physician assistants and nurse practitioners are more prevalent in rural and underserved areas, which have fewer primary care physicians,” the report notes. “State variation in the availability of physician assistants or nurse practitioners in primary care physician practices may also depend on the presence of integrated health care delivery systems, such as group health maintenance organizations, which include physician assistants and nurse practitioners more often than other physician practices.”
PAs and NPs are much more common in rural areas, where there are fewer PCPs, the study found. While PCPs decreased from 53.3 in metropolitan areas to 39.8 in rural locations, the number of PCPs practicing with assistant professionals increased from 41.9% in centralized areas to 65.5% in rural locations.
Primary care physicians who worked within multispecialty groups were also more likely than solo or partner practitioners to use NPs and PAs as part of their care teams. Seventy-seven percent of multispecialty practitioners had non-physician clinicians on staff as compared to just 36.3% of smaller providers.
“Our study found that physicians in multispecialty group practices had physician assistants or nurse practitioners in their practices more often than did single-specialty group practices or small (solo or partner) practices,” the report concludes. “Other factors, such as state variation in scope-of-practice laws for physician assistants and nurse practitioners and insurance payment policies, also affect the availability of physician assistants and nurse practitioners in physician practices.”