Psychologists, physicians, and other patient-facing health care professionals may be less accessible in nonmetropolitan areas compared with in metropolitan communities, according to a cross-sectional analysis. Investigators found fewer health care workers per capita across all 23 patient-facing health care occupations examined, with the largest differences occurring among highly trained clinical and behavioral health professions.
The investigators analyzed data from the 2019 to 2023 American Community Survey Public Use Microdata Sample, a nationally representative survey representing approximately 5% of the US population. In the analysis, they included 588,489 respondents employed in patient-facing health care occupations with known workplace locations, representing an estimated 12.9 million health care workers nationwide. Workplace urbanicity was classified using Rural-Urban Continuum Codes, and the investigators compared health care worker rates per 10,000 residents in metropolitan and nonmetropolitan areas.
An estimated 8% (n = 1.1 million) health care workers were employed in nonmetropolitan areas, although 14% of the US population lived in those communities. Overall, nonmetropolitan areas had 231 health care workers per 10,000 residents compared with 415 per 10,000 residents in metropolitan areas, representing about 44% fewer workers per capita.
The largest workforce differences were observed among psychologists and physicians. Nonmetropolitan areas had about one-quarter as many psychologists per capita as metropolitan areas and about one-third as many physicians. Similar patterns were observed among surgeons, dentists, podiatrists, pharmacists, physician assistants, physical therapists, registered nurses, and advanced practice nurses.
The investigators found that occupations requiring more extensive formal training generally showed larger metropolitan–nonmetropolitan differences compared with related support occupations. The smallest disparities were observed among nursing assistants, physical therapist assistants and aides, and occupational therapy assistants and aides. In sensitivity analyses, the overall pattern remained similar, although some assistant-level occupations were more common in nonmetropolitan areas under alternative workplace classifications.
The study had several limitations. The analysis was designed to describe workforce distribution and could not determine the causes of geographic differences or their effects on health care access, quality, or outcomes. Occupations were self-reported, physician specialties could not be assessed, and workplace urbanicity was assigned using broad geographic units that could not distinguish micropolitan areas. Some workplace locations required statistical imputation, although sensitivity analyses produced similar findings. The data also may not reflect more recent changes in the health care labor market.
"Nonmetropolitan areas had fewer patient-facing health care workers relative to population size than metropolitan areas, with the largest gaps found in highly trained clinical and behavioral health roles," wrote study authors Todd Burus, PhD, of the Markey Cancer Center at the University of Kentucky, and Jason Semprini, PhD, MPP, of the Department of Public Health at the College of Health Sciences at Des Moines University.
Full disclosures of the study authors can be found in the study.
Source: Annals of Internal Medicine
