Despite the growing contribution of nurse practitioners (NPs) and physician assistants (PAs) to rural primary care, discussions of rural provider shortages have focused largely on physicians, and little is known about the contributions across all three provider types to primary care in rural areas of the U.S. Goals: This study will examine the contributions of NPs, PAs and physicians to rural primary care. Specific research questions to be addressed include: 1) what is the total contribution to rural primary care outpatient productivity made by each of these professional categories; 2) how do relative provider contributions to primary care vary by state, degree of rurality, and practice autonomy; 3) what is the role of each of these provider types in providing primary care in rural primary care HPSAs; and 4) what is the role of each provider type in inpatient care and after hours call coverage? Study findings will be used to shed light on a range of rural primary care workforce needs in the coming decades.

Methods: This is a two-year study that began in September 2010. The study team currently is surveying 10,000 rural NP, PA and physician primary care providers in thirteen states representing all U.S. Census Regions. Survey samples were drawn from state licensing boards. Independent variables being collected in this survey include provider type (physician, PA, NP), provider demographics, practice location in terms of the rural spectrum and primary care health professional shortage area (HPSA) status, practice configuration, provider history in rural practice, and practice autonomy. The primary dependent variables will include a measure of provider outpatient productivity and secondary dependent variables will include measures of after hours call coverage and hospital coverage.

Anticipated Publications: Findings will be presented as a Final Report and Policy Brief, a manuscript for publication, and presentations at national research and policy meetings.

Publications

• The Contribution of Physicians, Physician Assistants, and Nurse Practitioners Toward Rural Primary Care: Findings From a 13-state Survey
  Journal Article
  WWAMI Rural Health Research Center
  Date: 06/2014
  Evaluates a questionnaire that measures weekly outpatient visits and services provided in a rural setting.