Greater Physician Supply Associated with Lower Mortality in Rural Counties: A 23-Year County-Level Longitudinal...

Area of Science:

• Health Services Research
• Rural Health
• Public Health Policy

Background:

• Rural U.S. residents experience higher mortality rates and limited access to primary care physicians compared to urban counterparts.
• Existing research on physician supply and health outcomes shows mixed results, with few studies addressing rural-urban mortality disparities.
• Rural areas, despite having more hospital beds, exhibit lower and slower-growing physician supply than urban areas.

Purpose of the Study:

• To quantify the marginal benefits of additional primary care physician supply in rural and urban U.S. counties.
• To examine the impact of physician supply on mortality rates, independent of other healthcare and socioeconomic factors.
• To assess the potential of increased physician supply in reducing rural-urban mortality disparities.

Main Methods:

• A 23-year county-level longitudinal observational study (1992-2014) encompassing 2942 U.S. counties.
• Utilized data from CDC WONDER for mortality rates, Area Health Resource File for physician supply and socioeconomic data, and USDA Rural-Urban Continuum Codes for rurality classification.
• Employed regression analyses to estimate the association between age-adjusted mortality rates and physician supply, controlling for county-level characteristics.

Main Results:

• A negative association was found between physician supply and mortality rates at the county level.
• In rural counties, increased physician supply correlated with lower mortality. An additional physician per 100,000 population was associated with 1.4 fewer deaths in adjacent rural counties and 0.936 fewer deaths in non-adjacent rural counties.
• Urban areas saw a smaller reduction of 0.038 deaths per 100,000 population with an additional physician.

Conclusions:

• Declining physician supply in already underserved rural areas is a critical public health concern.
• Policy interventions aimed at expanding rural health networks and increasing medical personnel are essential to mitigate mortality disparities.
• The findings underscore the persistent relevance of rural physician shortages and widening mortality gaps in the U.S.