Robert C. Bowman, M.D. [email protected]
PA data is from http://depts.washington.edu/uwrhrc/uploads/CHWSWP105.pdf and FPGP data is (including osteopathic FPs) from the 2005 OfficeMax version of the AMA Masterfile. Also note that this is older data. The Physician Assistants rural distributions are quite different now as PA declines in the family practice component have involved each class year and each year after graduation as PAs move to orthopedic, ER, surgical subspecialty, and other urban and hospital and specialty careers.
It is important to understand that departures from the FP mode defeat rural workforce, especially in most needed areas. The family practice physician assistants that remain in the FP mode deliver 30% rural practice rates, 30 times the federally qualified rural health clinic contributions of non-FP physician assistants, and 6 - 7 times the Community Health Center contributions. Changes in physician and non-physician primary care are similiar - flat with no increase.
For the year 2000 prior to major deteriorations in PA rural contributions, 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.
For Health Access Contributions - Try the Report Card Comparing Primary Care Forms in the Major Elements Many failing grades and clear evidence of design failure.
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
www.physicianworkforcestudies.org
