The contribution of physicians, physician assistants, and nurse practitioners toward rural primary care: findings from a 13-state survey

Med Care. 2014 Jun;52(6):549-56. doi: 10.1097/MLR.0000000000000135.


Background: Estimates of the relative contributions of physicians, physician assistants (PAs), and nurse practitioners (NPs) toward rural primary care are needed to inform workforce planning activities aimed at reducing rural primary shortages.

Objectives: For each provider group, this study quantifies the average weekly number of outpatient primary care visits and the types of services provided within and beyond the outpatient setting.

Methods: A randomly drawn sample of 788 physicians, 601 PAs, and 918 NPs with rural addresses in 13 US states responded to a mailed questionnaire that measured reported weekly outpatient visits and scope of services provided within and beyond the outpatient setting. Analysis of variance and χ(2) testing were used to test for bivariate associations. Multivariate regression was used to model average weekly outpatient volume adjusting for provider sociodemographics and geographical location.

Results: Compared with physicians, average weekly outpatient visit quantity was 8% lower for PAs and 25% lower for NPs (P<0.001). After multivariate adjustment, this gap became negligible for PAs (P=0.56) and decreased to 10% for NPs (P<0.001). Compared with PAs and NPs, primary care physicians were more likely to provide services beyond the outpatient setting, including hospital care, emergency care, childbirth attending deliveries, and after-hours call coverage (all P<0.001).

Conclusions: Although our findings suggest that a greater reliance on PAs and NPs in rural primary settings would have a minor impact on outpatient practice volume, this shift might reduce the availability of services that have more often been traditionally provided by rural primary care physicians beyond the outpatient clinic setting.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Community Health Centers
  • Delivery of Health Care / statistics & numerical data
  • Female
  • Health Care Surveys
  • Health Services Needs and Demand
  • Humans
  • Male
  • Medically Underserved Area*
  • Middle Aged
  • Nurse Practitioners / supply & distribution*
  • Physician Assistants / supply & distribution*
  • Physicians / supply & distribution*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Primary Health Care / statistics & numerical data*
  • Rural Health Services / statistics & numerical data*
  • United States
  • Workforce
  • Workload / statistics & numerical data