Concentration of clinicians varies state to state, which can lead to variation in healthcare costs and access throughout the nation.
David Muhlestein, PhD, and Scott Hammer with Leavitt Partners explored this dispersion in a recent whitepaper. The following are five things to know about the geographic dispersion of providers in the U.S.
1. Primary care physicians are not equally distributed throughout the nation. States in the upper Midwest, the West and the Northeast have a higher supply than states in the South. The lack of primary care physicians could have contributed to Southern states' decisions to not expand Medicaid, the authors postulated. "In some respects, it's no wonder some Southern states, like Texas, have bypassed expansion of Medicaid at this time," they wrote. "While there are likely several reasons, perhaps one is the lack of primary care physicians available to meet the needs of its potential newly covered lives."
2. Nurse practitioner density by state seems to closely following each state's scope of practice laws for NPs. For example, Texas, Georgia and California all have a low supply of NPs, and all three of those states have restricted practice laws, according to the American Association of Nurse Practitioners. These states require NPs to have supervision, delegation or team-management from an outside health discipline to provide patient care. States with a greater supply of NPs, like Arizona, Washington and Oregon, all allow full practice for NPs, meaning they can practice independently.
3. Family practice and internal medicine physicians, though extremely similar, are dispersed unevenly throughout the country. Family practice physicians tend to favor the Midwest and Western states, while internal medicine physicians can be found in New England and the South. The Leavitt Partners experts chalked the disparity up to two possible reasons. The first is these physicians could be categorized differently based on where in the country they practice. The other reason could be that more outpatient care — the setting in which family medicine physicians typically practice — is provided in the Midwest and West, while more inpatient care is provided in the internal medicine-dominated states.
4. Emergency medicine physicians are in moderate supply throughout the nation. However, as the industry continues to try to drive patients away from high-cost sites of care like the ED, the supply of emergency medicine physicians could be affected, according to Leavitt Partners. "It will be fascinating to see if the development of new models to better manage the care of patients will have influence on slowing the need for emergency medicine physicians throughout the country," the report authors wrote.
5. Patient access to optometrists varies widely state to state, even though the demand for optometrists should conceivably be equal throughout the nation. Texas stands out as a state with very few optometrists, while Midwestern states like Minnesota and Iowa have a heavy supply of the physicians.