Differences in rural and urban ambulatory physician assistant practice

Disparities in health care have been a persistent and intractable problem in the United States. Despite federal, state, and local efforts to recruit and retain physicians, large areas of the United States continue to be designated as medically underserved. Rural America suffers disproportionately from this problem, and most federally designated underserved areas are in rural counties. The number of physician assistants practicing in the United States has increased considerably in recent years, and while physician assistants have been promoted as a solution to the access to care problem, no research has demonstrated a general improvement in access to care for the medically underserved as a consequence of physician assistant practice. The purpose of this study was to determine whether there are quantifiable and statistically significant differences in rural and urban physician assistant practice based on patient demographic variables that are associated with the medically underserved.; Eight years of data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed for each of the following variables: age, sex, race, ethnicity, method of payment, preventive or illness/injury care, and medical specialty area. Each variable was compared across rural/urban location and physician/physician assistant medical provider. Chi-square analyses were performed using SAS and SUDAAN statistical software.; Comparisons revealed few differences in the medical practices of physicians or physician assistants. Urban physicians and physician assistants were more likely to see persons of Latino or Hispanic ethnicity. Urban physicians were more likely than rural physicians to see patients with private insurance. And physicians were more likely to see patients for preventive care than physician assistants. However, there were essentially no differences in physician assistant practice across rural and urban location that would support the premise that physician assistants are increasing access to care for the medically underserved in rural locations. Physician assistant practice largely mirrors physician practice. Increasing the supply of health care providers---whether physicians or physician assistants---may be insufficient in addressing the problem of access to care.