Supply of Primary Care Physicians Varies Widely by State

May 09, 2014

In a map of medical disparity, some states such as Massachusetts and Vermont had roughly twice as many office-based primary care physicians per 100,000 population than states such as Georgia and Texas in 2012, according to the statistical arm of the Centers for Disease Control and Prevention (CDC).

A report released Thursday by the CDC's National Center for Health Statistics (NCHS) also showed that the overall supply of primary care physicians per 100,000 population nationwide remained fairly constant between 2002 (46.7) and 2012 (46.1). In addition, the supply of office-based specialists in 2012 exceeded that for primary care by 1.4 to 1, a ratio that has held steady more or less since 2002.

The NCHS study defined a primary care physician as someone in family practice, general practice, internal medicine, geriatrics, and pediatrics. Excluded from the study were primary care physicians who work as hospitalists.

Four states — Massachusetts, Rhode Island, Vermont, and Washington — significantly topped the national average of primary care physicians per 100,000 population. The 6 states of Arkansas, Georgia, Mississippi, Nevada, New Mexico, and Texas were well below the norm.

State-by-State Feast and Famine for Primary Care in 2012

Leaders

State Primary Care Physicians per 100,000 Population
Vermont 66.8
Rhode Island 66.6
Massachusetts 65.7
Washington 59.6
National average 46.1

 

Laggards

State Primary Care Physicians per 100,000 Population
Arkansas 36.4
New Mexico 36.2
Nevada 33.9
Texas 33.6
Georgia 31.0
Mississippi 26.5
National Average 46.1

Source: National Center for Health Statistics, Centers for Disease Control and Prevention

The NCHS estimates of the supply of primary care physicians are derived from the agency's National Ambulatory Medical Care Survey (NAMCS) and a supplement introduced in 2008 called the NAMC Electronic Heath Records (EHR) Survey. Estimates for 2012 are based on a sample of some 10,000 office-based physicians in the NAMC EHR Survey.

Smaller sample sizes in some states introduced larger sampling errors, lead author Esther Hing told Medscape Medical News. As a result, some states that appeared to be either well or poorly stocked with primary care physicians per 100,000 — Hawaii at 93.7 and Indiana at 35.5 — turned out to be not significantly different from the national average, said Hing, an NCHS survey statistician.

Use of NPs, PAs in Primary Care Hasn't Changed Much

The NCHS study also found wide state-by-state variation in the percentage of primary care physicians who have a physician assistant (PA) or nurse practitioner (NP) in their practice. South Dakota led the pack with 89.6% of its primary care physicians using these clinicians. Five other states — Montana, Minnesota, Alaska, Massachusetts, and North Dakota — also exceeded the 80% mark, and 19 states overall were significantly higher than the national average of 53%. In contrast, only 34.8% of office-based primary care physicians in Georgia worked with a PA or NP. Georgia and Hawaii were the only 2 states deemed significantly below the national average.

The reliance on NPs and PAs appears to have only inched up since 2006, when the national average was 51.2%. 2006 was the first year in which NAMCS asked primary care physicians about NPs and PAs.

Primary care physicians in rural areas (65.5%) were more likely to work with NPs and PAs than their big-city counterparts (41.9%). Practice type was another variable, with 77.5% of physicians in multispecialty groups teaming with NPs and Pas, compared with 56.6% in single-specialty groups and 36.3% in solo practices and partnerships.

A copy of the NCHS report is available on the organization's Web site.

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