Disclosures: Machado reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
January 22, 2021
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PCP density decreasing in rural US counties

Disclosures: Machado reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Rural counties in the United States have a lower density of primary care physicians compared with urban counties, and the PCP workforce is decreasing in half of these counties, according to research published in JAMA Network Open.

“Our results indicate there is a decreasing density of primary care physicians in rural counties, which combined with low and stagnant density of medical specialties is likely to lead to decreased access to health care among rural populations, which already carry a higher burden of disease,” Sara R. Machado, PhD, a fellow in the department of health policy at London School of Economics and Political Science, London, told Healio Primary Care.

Rural counties where primary care density decreased
Reference: Machado SR, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2020.33994.

Machado and colleagues conducted a cross-sectional study using data from the AMA Physician Masterfile to identify the number of nonfederal physicians in each U.S. county, and whether they were PCPs, medical specialists, surgical specialists or other specialists.

The researchers measured physician density per 100,000 persons each year from 2010 through 2017.

A total of 3,142 U.S. counties were evaluated in the study. Of those, 436 were large metropolitan counties, 730 were small or medium metropolitan counties and 1,976 were rural counties.

Photo of Sara Machado
Sara R. Machado

Machado and colleagues determined that during the study period, the median density of physicians was higher in urban counties, with 125.3 (IQR; 62.5-255) per 100,000 persons in large metropolitan counties, 124.3 (IQR; 50.4-215.7) per 100,000 persons in small to medium metropolitan counties, and 59.7 (IQR; 32.0-101.1) per 100,000 persons in rural counties.

Overall physician density increased by a mean 1.5 physicians per 100,000 persons from 2010 to 2017. However, the researchers found that this varied between different types of counties, with a mean increase of 10 (37.9) physicians per 100,000 persons in large metropolitan counties and 8.8 (46.2) physicians per 100,000 persons in small or medium metropolitan counties. In contrast, rural counties experienced a mean decrease of 3.1 (35.5) physicians per 100,000 persons.

Additionally, from 2010 to 2017, the PCP density decreased in 43.3% of large metropolitan counties, in 41.8% of small to medium metropolitan counties and in 50.3% of rural counties.

The researchers noted that the aging rural physician workforce may be linked to rising physician shortages and “is expected to further be associated with decreased physician density in these areas.”

Machado said that another possible reason for decreasing physician density in rural areas is “the current incentive structure, which has directly or indirectly led to the consolidation of the physician workforce in larger physician groups and health care systems, many of them based in urban locations.”

Whether the COVID-19 pandemic will further reduce the density of PCPs in rural counties is unknown, Machado said, adding that it may improve the density of PCPs in these communities.

“If there is a greater focus on remote appointments, combined with the reorganization of office work which may lead people to opt for living in less metropolitan areas, it may actually be a driver for greater physician density in rural communities,” she said.