What Drives the Distribution of Rural Doctors?

A number of media stories document a “shortage” of doctors in rural communities. The distribution of primary care physicians (PCP) is remarkably similar to the distribution of other services, including grocery stores, suggesting the role of regional economic factors in determining doctor location. This national study examines variables associated with the number of PCP per 100,000 people at the county level. Demographic factors significantly associated with the PCP rate include population density, the share of the population living outside urban cluster or urbanized areas, and the share of Hispanic residents. Economic factors include post-secondary education, out-commuting, the share of the workforce in agriculture and natural resource industries, employer law establishments per 100,000 people, and the presence of broadband. Being located in a Medicaid expansion state was the only significant insurance-related variable, but significance was sensitive to how expansion status was determined. Results suggest that decision makers should be cognizant of the role of economic changes in affecting, as well as reflecting, changes in the healthcare sector