Does subsidizing rural community health centers hurt private practice physicians?

Area of Science:

• Health Services Research
• Rural Health Policy
• Physician Workforce Studies

Background:

• Rural areas face a shortage of primary care physicians.
• Community Health Centers (CHCs) are federally subsidized practices serving these areas.
• The competitive impact of CHCs on private rural physicians is not well understood.

Purpose of the Study:

• To compare practice characteristics of rural physicians.
• To investigate the relationship between private practice physicians and CHC-based physicians.
• To determine if CHCs create competitive barriers for private rural physicians.

Main Methods:

• Utilized survey data from a two-state subset of a national representative sample.
• Compared practice characteristics of physicians in CHCs, private practices within CHC areas, and private practices outside CHC areas.
• Analyzed physician income and patient demographics (Medicaid, uninsured).

Main Results:

• Rural physicians competing with CHCs reported comparable incomes to those not competing.
• The percentage of Medicaid and uninsured patients in private practices did not increase in areas without CHCs.
• No evidence suggests CHCs create competitive barriers impacting income or patient mix for existing private practices.

Conclusions:

• Community Health Centers (CHCs) do not appear to pose competitive barriers for established private rural physicians.
• Further research is needed to ascertain if CHCs deter new private physicians from entering rural communities.
• Findings suggest other factors may contribute to the rural physician shortage.