Nonphysician Clinicians Supply of Medical Services

Can nurse practitioners increase access to care in rural areas?

According to a recent paper by Young, Gruca and Nelson (2020), the answer is ‘yes’.

The authors use data from the Iowa Health Professions Inventory (IHPI) to measure the number of professionals in a given area, data from the US Census’ American Community Survey (ACS) to measure the number of individuals in a given area. Census minor civil division (MCD) were assigned one of a 10-level urban-rural continuum using ruralā€urban commuting areas (RUCA) definitions. They assumed that physician assistants/nurse practitioners were 11.4% less productive than primary care physicians.

Using these data, the authors apply the following optimization model:

The allocation procedure starts with population demand points located at MCD centroids. One MCD is selected at random and its population is allocated to the nearest provider until the capacity of that provider is reached or the entire population is allocated. Any unallocated population can be apportioned to the next nearest provider within the maximum travel time threshold of 30 minutes. Once demand has been allocated or all available capacity within the maximum travel time threshold has been exhausted, another MCD is selected at random and the process repeats until no further allocation can occur.

This approach is repeated multiple times with the order in which the MCDs are selected done at random. The models were run two ways: the first just with primary care physicians counting as potential providers, and then second including physicians as well as physician assistants and nurse practitioners as potential providers in the primary care setting.

Using this approach, the authors find the following:

Considering only primary care physicians, the average unallocated population for primary care was 222 109 (7 percent of Iowa’s population). Most of the unallocated population (86 percent) was in rural areas with low population density (< 50/square mile). The addition of NPPs to the primary care workforce reduced unallocated population by 65 percent to 78 252 (2.5 percent of Iowa’s population). Despite the majority of NPPs being located in urban areas, most of the improvement in spatial accessibility (78 percent) is associated with sparsely populated rural areas.

While this paper may be of academic interest, the question of interest may be much more relevant if there is a surge in demand due to COVID-19.


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