Who is Caring for the Underserved? A Comparison of Primary Care Physicians and Nonphysician Clinicians in California and Washington

One reason that the under-served are under-served is that most clinicians practice in urban areas near insured patients. As Grumbach and his collaborators show, about 13% of Californians and 24% of Washingtonians live in rural areas of their states, but pediatricians, internists and obstetricians work in cities, for the most part. Only family physicians and especially physician assistants are consistently more likely to settle in rural areas than general members of the population at large.

The most fascinating part of this article in my opinion is the extent to which physician assistants have distributed themselves in under-served locations. This is a case where an entire profession was created largely around the need to augment the supply of health professionals to under-served populations – and it worked! Family physicians and nurse practitioners have also followed this pattern, fulfilling the expectation of those who sparked these programs. We can affect the distribution of health professionals, and we can do it with the programs that we have built and sustained over the last 30 years.

So the question is why don't we do more of it? Given the failure of attempts to craft universal health insurance, health professional interventions are relatively inexpensive ways to affect access to health care. Although Grumbach's evidence is indirect, it certainly suggests that we do know how to make a difference. So let's do more of it!

Competing interests: None declared