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Research Question

  1. What effects might several policy options to address a perceived shortage of primary care physicians in rural Washington State have on the state's rural primary care workforce through the year 2025?

The Washington State legislature has recently considered several policy options to address a perceived shortage of primary care physicians in rural Washington. These policy options include opening the new Elson S. Floyd College of Medicine at Washington State University in 2017; increasing the number of primary care residency positions in the state; expanding educational loan-repayment incentives to encourage primary care physicians to practice in rural Washington; increasing Medicaid payment rates for primary care physicians in rural Washington; and encouraging the adoption of alternative models of primary care, such as medical homes and nurse-managed health centers, that reallocate work from physicians to nurse practitioners (NPs) and physician assistants (PAs). RAND Corporation researchers projected the effects that these and other policy options could have on the state's rural primary care workforce through 2025. They project a 7-percent decrease in the number of rural primary care physicians and a 5-percent decrease in the number of urban ones. None of the policy options modeled in this report, on its own, will offset this expected decrease by relying on physicians alone. However, combinations of these strategies or partial reallocation of rural primary care services to NPs and PAs via such new practice models as medical homes and nurse-managed health centers are plausible options for preserving the overall availability of primary care services in rural Washington through 2025.

Key Findings

If There Are Shortages of Primary Care Physicians and Services in Rural Washington, These Shortages Are Likely to Worsen in the Coming Decade

  • The number of rural primary care physicians per capita will decrease by approximately 3.66 per 100,000 by 2025 — a 7-percent reduction from 2013 levels.
  • Urban areas of Washington State will experience a reduction of 4.14 primary care physicians per 100,000 — a 5-percent reduction from 2013 levels.
  • None of the policy options modeled in this report, on its own, will offset this expected decrease by relying on physicians alone.
  • Combinations of these strategies or partial reallocation of rural primary care services to nurse practitioners and physician assistants via such new practice models as medical homes and nurse-managed health centers are plausible options for preserving the overall availability of primary care services in rural Washington through 2025.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Background

  • Chapter Three

    Methods

  • Chapter Four

    Findings from Interviews

  • Chapter Five

    Logic Model

  • Chapter Six

    Washington State's Primary Care Workforce: Projections Under Policy Options

  • Chapter Seven

    Conclusions

  • Appendix A

    Expanded Literature Review

  • Appendix B

    Expanded Methods

  • Appendix C

    Supplemental Fit Statistics for Predictive Model

Research conducted by

The research described in this report was sponsored by the Washington State legislature via the Washington State Institute for Public Policy and conducted by the RAND Health.

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