While lower incomes are an oft-cited obstacle to recruiting physicians to practice in rural America, average physician incomes in rural and urban areas do not differ significantly, according to a national study released today by the Center for Studying Health System Change (HSC).
Moreover, after adjusting for differences in the cost of living, physician work effort, specialty and other physician and practice characteristics, rural physicians on average have 13 percent more purchasing power than their urban counterparts, the study found.
"The study should dispel the myth that lower income potential is a major obstacle to recruiting physicians to most rural areas," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded primarily by The Robert Wood Johnson Foundation.
"Nonetheless, the higher purchasing power of rural physician incomes may be needed to compensate physicians for other disadvantages of rural practice, including less control over work hours, professional isolation and a lack of amenities associated with urban areas," Ginsburg said.
Rural areas have fewer physicians per capita than urban areas, prompting persistent concerns about inadequate access to medical care in many rural areas. To illustrate, rural residents on average have 53 primary care physicians (PCPs)—internists, family/general practitioners and pediatricians—per 100,000 people compared with 78 PCPS per 100,000 urban residents. The gap is even wider for specialists—54 specialists in rural areas vs. 134 in urban areas per 100,000 people.
The disparity in physician supply, however, does not necessarily mean that rural areas overall lack enough physicians. Instead, it may reflect the use of urban physicians—particularly specialists—by rural residents or an oversupply of physicians in urban areas. Other research indicates that across the full population, access to care in rural areas is on par with and, perhaps, slightly better than in urban areas, except for access to mental health services.
"While some rural areas have an inadequate physician supply, in general rural America does not appear to lack enough physicians," said HSC Senior Health Researcher James D. Reschovsky, Ph.D., who co-authored the study with HSC Health Research Analyst Andrea B. Staiti.
The study's findings are detailed in an HSC Issue Brief—Physician Incomes in Rural and Urban America. The study is based on results from HSC's 2001 Community Tracking Study Physician Survey, a nationally representative survey involving about 12,000 practicing physicians. Information about physician incomes was adjusted to 2003 values.