Robert C. Bowman, M.D.
Using PA data from http://depts.washington.edu/uwrhrc/uploads/CHWSWP105.pdf and FPGP data (including osteopathic FPs) from the 2005 OfficeMax version of the AMA Masterfile, the following comparisons can be made regarding rural distributions by state.
Low levels across the board suggest poor support for either PA or FP regarding rural distributions. In some cases distributional training demonstrates advantages, as in Washington State and the MEDEX program. States such as Nebraska demonstrate similar levels across the board indicating a balanced emphasis of distribution. Comparisons of both PA and FPGP to population can also be interesting. Either PAs or FPs should be distributing close to the rural population distribution of the state, if not, some questions should be asked about the policies for the whole state. The numbers of PAs and PAs were also very comparable for the all PA group in 2000 and this 1987 - 1999 group of family physicians, even without percentages.
Yellow cells have 10% greater PA distribution than FPGP. Gray cells have 10% greater distribution for FPGP. PA distributions on the left, FPGP in the middle, and the rural distributions of population by RUCA 2.0 are on the right
| PA | PA1 | PA2 | PA3 | PA4 | FPGP | FP1 | FP2 | FP3 | FP4 | Pop 2 | Pop 3 | Pop 4 | |
| Number | Urban | Large Rural | Small Rural | Isolated Rural | Number | Urban | Large Rural | Small Rural | Isolated Rural | Large Rural | Small Rural | Isolated | |
| AK | 253 | 44.3% | 21.3% | 20.2% | 14.2% | 181 | 59.7% | 12.2% | 19.9% | 8.3% | 22.6% | 15.3% | 11.9% |
| AL | 269 | 85.9% | 6.7% | 4.5% | 3.0% | 559 | 70.5% | 13.6% | 10.7% | 5.2% | 13.7% | 12.0% | 5.9% |
| AR | 56 | 64.3% | 16.1% | 14.3% | 5.4% | 528 | 58.7% | 21.0% | 17.0% | 3.2% | 27.8% | 23.2% | 10.6% |
| AZ | 726 | 76.2% | 12.5% | 8.1% | 3.2% | 739 | 81.6% | 6.6% | 9.7% | 2.0% | 10.4% | 6.0% | 2.6% |
| CA | 3,895 | 92.6% | 3.8% | 2.6% | 1.0% | 4031 | 93.0% | 4.6% | 1.4% | 1.0% | 3.0% | 1.8% | 0.5% |
| CO | 913 | 86.4% | 1.9% | 7.1% | 4.6% | 884 | 78.8% | 6.8% | 9.7% | 4.6% | 2.0% | 7.8% | 5.0% |
| CT | 779 | 97.6% | 1.2% | 0.6% | 0.6% | 235 | 91.1% | 6.8% | 0.0% | 2.1% | 2.7% | 1.5% | 2.2% |
| DC | 185 | 100.0% | 102 | 100.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | |||
| DE | 94 | 93.6% | 6.4% | 137 | 80.3% | 14.6% | 5.1% | 0.0% | 0.0% | 20.4% | 0.6% | ||
| FL | 2,111 | 92.3% | 2.2% | 4.0% | 1.5% | 1873 | 94.8% | 2.8% | 1.9% | 0.6% | 2.2% | 3.9% | 1.7% |
| GA | 1,313 | 77.6% | 13.7% | 5.6% | 3.0% | 1068 | 77.6% | 9.9% | 8.8% | 3.7% | 14.6% | 11.4% | 4.4% |
| HI | 93 | 69.9% | 20.4% | 5.4% | 4.3% | 172 | 63.4% | 29.1% | 4.7% | 2.9% | 18.3% | 4.0% | 5.8% |
| IA | 499 | 50.1% | 12.8% | 21.0% | 16.0% | 674 | 57.1% | 13.6% | 22.3% | 7.0% | 14.5% | 19.2% | 19.1% |
| ID | 212 | 53.8% | 23.1% | 13.7% | 9.4% | 263 | 63.1% | 12.5% | 16.7% | 7.6% | 30.6% | 14.5% | 11.3% |
| IL | 909 | 75.8% | 12.0% | 8.6% | 3.6% | 1732 | 84.6% | 7.9% | 6.8% | 0.7% | 7.3% | 5.2% | 3.3% |
| IN | 277 | 82.3% | 6.1% | 9.0% | 2.5% | 1049 | 74.9% | 14.5% | 9.2% | 1.4% | 13.1% | 11.8% | 5.5% |
| KS | 465 | 50.1% | 26.0% | 11.4% | 12.5% | 525 | 60.0% | 18.7% | 11.8% | 9.5% | 23.8% | 9.9% | 11.1% |
| KY | 519 | 60.9% | 17.7% | 15.2% | 6.2% | 485 | 51.8% | 24.1% | 15.5% | 8.7% | 17.3% | 21.2% | 15.5% |
| LA | 272 | 81.6% | 11.8% | 4.4% | 2.2% | 506 | 79.1% | 13.4% | 6.7% | 0.8% | 13.2% | 12.9% | 5.2% |
| MA | 869 | 92.9% | 2.0% | 4.1% | 1.0% | 573 | 97.4% | 0.9% | 1.2% | 0.5% | 2.7% | 2.6% | 1.9% |
| MD | 1,080 | 95.3% | 3.2% | 0.9% | 0.6% | 479 | 90.2% | 5.4% | 3.5% | 0.8% | 4.0% | 2.2% | 2.2% |
| ME | 380 | 47.9% | 12.6% | 21.8% | 17.6% | 351 | 51.0% | 18.8% | 13.7% | 16.5% | 15.0% | 17.3% | 22.8% |
| MI | 1,635 | 79.3% | 9.8% | 4.6% | 6.2% | 1706 | 79.8% | 10.9% | 7.0% | 2.3% | 7.4% | 4.3% | 6.9% |
| MN | 586 | 68.5% | 9.2% | 9.2% | 12.6% | 1188 | 64.9% | 14.9% | 12.5% | 7.7% | 10.9% | 8.9% | 12.5% |
| MO | 299 | 75.3% | 8.7% | 10.0% | 6.0% | 822 | 66.5% | 17.4% | 10.6% | 5.5% | 10.2% | 11.4% | 10.8% |
| MS | 36 | 83.3% | 11.1% | 5.6% | 337 | 48.4% | 31.2% | 13.9% | 6.5% | 27.1% | 21.5% | 13.2% | |
| MT | 179 | 40.2% | 15.6% | 19.6% | 24.6% | 208 | 29.8% | 22.6% | 32.2% | 15.4% | 27.2% | 16.7% | 20.6% |
| NC | 2,094 | 73.1% | 12.1% | 7.8% | 7.0% | 1195 | 73.2% | 15.0% | 6.9% | 4.9% | 15.5% | 11.3% | 10.5% |
| ND | 194 | 42.8% | 9.3% | 11.9% | 36.1% | 160 | 54.4% | 18.8% | 8.8% | 18.1% | 18.0% | 8.4% | 30.2% |
| NE | 456 | 55.9% | 14.7% | 15.1% | 14.3% | 335 | 52.2% | 18.5% | 17.6% | 11.6% | 18.4% | 12.1% | 17.0% |
| NH | 220 | 60.5% | 25.5% | 6.4% | 7.7% | 237 | 57.4% | 22.8% | 7.6% | 12.2% | 17.3% | 5.8% | 12.9% |
| NJ | 484 | 97.9% | 2.1% | 800 | 97.8% | 2.3% | 0.0% | 0.0% | 1.2% | 0.4% | 0.1% | ||
| NM | 332 | 55.7% | 28.6% | 10.5% | 5.1% | 317 | 63.4% | 27.8% | 5.4% | 3.5% | 29.0% | 8.3% | 5.6% |
| NV | 221 | 83.3% | 7.2% | 5.9% | 3.6% | 258 | 89.1% | 7.0% | 3.1% | 0.8% | 6.7% | 4.9% | 2.0% |
| NY | 4,917 | 88.7% | 4.4% | 3.8% | 3.1% | 1826 | 89.4% | 5.3% | 3.7% | 1.7% | 5.0% | 3.7% | 3.3% |
| OH | 1,143 | 89.9% | 7.3% | 2.0% | 0.8% | 1839 | 80.3% | 13.1% | 5.2% | 1.5% | 13.7% | 5.8% | 2.5% |
| OK | 597 | 64.0% | 16.4% | 13.9% | 5.7% | 564 | 61.2% | 17.7% | 15.2% | 5.9% | 19.1% | 14.1% | 7.9% |
| OR | 362 | 69.3% | 21.3% | 3.6% | 5.8% | 610 | 68.4% | 22.1% | 7.7% | 1.8% | 19.9% | 8.0% | 3.1% |
| PA | 2,211 | 77.6% | 7.1% | 9.9% | 5.4% | 1943 | 84.3% | 10.9% | 2.6% | 2.2% | 7.1% | 8.0% | 6.8% |
| RI | 126 | 99.2% | 0.8% | 127 | 100.0% | 0.0% | 0.0% | 0.0% | 0.8% | 0.0% | 0.1% | ||
| SC | 328 | 82.6% | 6.7% | 7.6% | 3.0% | 635 | 69.0% | 22.4% | 6.0% | 2.7% | 12.0% | 14.1% | 6.8% |
| SD | 238 | 34.9% | 25.2% | 10.5% | 29.4% | 151 | 49.7% | 18.5% | 9.3% | 22.5% | 24.0% | 10.6% | 28.8% |
| TN | 483 | 70.0% | 13.5% | 9.9% | 6.6% | 816 | 69.2% | 15.0% | 11.3% | 4.5% | 16.2% | 16.7% | 7.2% |
| TX | 2,475 | 80.9% | 9.2% | 6.6% | 3.3% | 2891 | 83.9% | 8.8% | 5.4% | 2.0% | 8.5% | 5.7% | 3.6% |
| UT | 332 | 77.7% | 9.9% | 6.0% | 6.3% | 380 | 83.9% | 3.9% | 10.0% | 2.1% | 7.9% | 5.9% | 4.3% |
| VA | 641 | 85.0% | 7.6% | 3.7% | 3.6% | 1030 | 84.8% | 2.8% | 7.5% | 5.0% | 6.8% | 6.9% | 8.6% |
| VT | 122 | 38.5% | 9.0% | 27.0% | 25.4% | 142 | 34.5% | 19.0% | 18.3% | 28.2% | 12.1% | 22.5% | 38.7% |
| WA | 1,156 | 80.4% | 8.9% | 5.7% | 4.9% | 1198 | 84.9% | 6.6% | 5.3% | 3.2% | 8.9% | 4.7% | 3.3% |
| WI | 843 | 70.5% | 8.3% | 11.9% | 9.4% | 1082 | 67.3% | 9.7% | 14.9% | 8.1% | 8.6% | 11.1% | 12.7% |
| WV | 457 | 30.4% | 28.7% | 16.6% | 24.3% | 375 | 58.9% | 17.3% | 15.7% | 8.0% | 17.9% | 17.7% | 24.5% |
| WY | 111 | 34.2% | 20.7% | 28.8% | 16.2% | 110 | 34.5% | 21.8% | 34.5% | 9.1% | 28.7% | 26.2% | 15.3% |
| 39,477 | 79.7% | 8.6% | 6.7% | 5.0% | 40428 | 78.4% | 10.7% | 7.4% | 3.5% | 9.1% | 7.2% | 5.4% |
Rural Coding for poverty and population numbers by RUCA 2.0.
Such comparisons should not be seen as competitive, but complimentary. PAs have slightly greater distribution to isolated rural areas. Family Physicians have greater large rural and small rural distributions.
There is one difference however.
Family medicine remains 99% active, 98% in family medicine, 90% within primary care, 50% outside of major medical centers, 24% rural, and 10% underserved.
Primary Care Years: New Measures of Total Workforce Contribution
2006 Estimates of locations
|
|
PA |
NP |
M.D. |
D.O. |
Family Practice |
US Pop 2000 |
US Pop 2040 |
|
Active Practice |
60,000 - 80,000 |
90,000 - 161,000 |
763,200 |
54300 |
126000 |
280m |
377m |
|
FTE per Trained |
75% |
70% |
95% |
95% |
95% |
||
| Active Primary Care per FTE Trained in Programs or Primary Care Retention | 60% | 54% |
IM - 20% MPD - 15% Peds - 70% FM - 90% |
Higher in All | 90% |
|
|
| Reductions needed for inactive, part time, productivity | Y | Y | N | N | N | ||
| Military Significant Component | Y | N | N | Y | Y | ||
| Steady decline after underserved obligation | Y | Y | Y | Y | N | ||
| Supplies to CHCs (Rosenblatt and Hart in Jama) | 1095 |
NP - 2103 CNM - 400 estimate RN 3429 |
FM- 3084 IM - 1443 Peds - 1247 Ob-Gyn 525 Psych - 197 |
3084 | |||
| Rural CHCs Increase | Y | N | N | 61% | |||
|
Full Time Primary Care |
24000 - 30,000 |
30,000 - 38,000 |
271,400 |
34,700 |
114,000 |
|
|
|
Full Time Primary Care % |
30 - 40% |
30- 40% |
25 - 40% |
45 - 60% |
90% |
|
|
|
All Rural* |
18% |
11% |
11% |
18% |
24% |
20% |
17% |
|
Small/Isolated Rural* |
9% |
4% |
4% |
8% |
10% |
10% |
8% |
|
65% - 70% |
65% - 70% |
75% |
55% |
45 - 50% |
33% |
38% |
Health Care Workforce Estimates
Five Periods of Health Policy and Physician Career Choice
Retention Within the Specialty of Family Medicine
Instate Retention of Family Physicians - those with origins most similar to the populations in a state and those with humble origins are the most likely to be found in a state. Family medicine choice facilitates a return to desired location and population.
Patterns of Rural Workforce - FP state distributions
Patterns of Distribution - distributional medical schools graduate distributional physicians
Probability of admission tables