Nurse practitioners, physician assistants fill rural health care gap

By Anthony Hennen | The Center Square

HARRISBURG, PA — Data shows other health care workers proliferate in rural regions, filling the gap left behind by doctors and specialists who migrate to larger communities.

From 2010 to 2020, rural Pennsylvania has seen a 178% growth in nurse practitioners and 104% in physician assistants, according to data from the federal Health Resources and Services Administration analyzed by the Center for Rural Pennsylvania. Dentists have also increased by 17%, a much-needed boost as the rural dentist per-capita count drops.

However, rural parts have seen a 14% drop in OB-GYNs, a 7% drop in psychiatrists, and a 4% decline in primary care physicians.

Urban parts of the commonwealth, in contrast, have seen growth in every category from 7% for PCPs to 62% for NPs, with only psychiatrist numbers falling by 6%.

The pattern is a familiar one. Urban areas give doctors more opportunities, especially to specialize in certain areas of medicine.

“What we see is that physicians are used to training in larger areas where they have higher access to all of the services that they might need — radiology, all the other supports,” Lisa Davis, director of the Pennsylvania Office of Rural Health, said. “They have opportunities for more expansive practice … there’s also the potential to have less on-call hours because you have more providers to choose from.”

Pennsylvania also has almost a dozen medical schools, all of them in urban areas. Nursing programs, Davis said, tend to be based in rural areas, which helps get more nurses in rural areas.

Those local ties play a role in where doctors and nurses work.

“The number one predictor of whether or not you will practice in a rural or medically underserved area is if you come from that specific community or one like it,” Davis said.

Though rural and urban parts of the commonwealth are split on where PCPs and NPs end up, the change isn’t necessarily bad. Some argue that, for specialized care, patients could be transported to suburban or urban hospitals, benefiting both patients and improving the quality of care.

NPs and rural health clinics, Davis said, provide high-quality health care for many procedures just like larger hospitals, but she warned that expecting patients to travel long distances can cause problems. Patients could suffer — as well as towns without health care facilities.

“Especially in rural communities, health care is one of the top leading economic drivers and employers,” Davis said.

Without health care facilities, rural areas can lose out on local business expansions and economic growth, she said.

“By investing in the local health care delivery system, you are keeping it viable and you are keeping your community viable,” Davis said.

Rural Pennsylvanians tend to be older and rural parts of the state have more people with disabilities, as well as higher rates of preventable diseases. In some parts, doctors have warned that private practice has become financially unsustainable, threatening the viability of the rural health safety net.