A 2018 rural health care workforce report issued by the University of Nebraska Medical Center reveals that while there has been an 11 percent increase in the number of physicians in the state over the last 10 years, there are 13 counties that still do not have a primary care physician, according to a press release published by the University of Nebraska Medical Center.
According to the April 4 press release, that finding was one of a number of key findings that appeared in a the 64-page report, "The Status of the Healthcare Workforce in the State of Nebraska,” published this month. "The health care workforce is an essential component in making Nebraska the healthiest state in the union and timely and accurate data such as this report will help inform initiatives and policies to help address those challenges," said Jeffrey P. Gold, M.D., UNMC Chancellor, in a statement included in the press release.
The study was commissioned and funded by the Nebraska Area Health Education Center Program (AHEC) and used the most recent data from the UNMC Health Professions Tracking Service and the state of Nebraska.
"This report helps to measure the progress we have made in the state in dealing with some of the workforce issues in rural Nebraska and in planning for the future," said Mike Sitorius, M.D., professor and chair of family medicine in the UNMC College of Medicine.
"Some programs have helped increase the number of rural health professionals, but there still exist substantial recruiting challenges to bolstering the health workforce and access to health care in rural and underserved areas," said Fernando Wilson, Ph.D., acting director of the UNMC Center for Health Policy and lead author of the report.
Among those challenges, the report found these:
- The reality that nearly one-fifth of physicians in Nebraska are more than 60 years old, and thus likely to retire in the near future;
- 18 of 93 Nebraska counties have no pharmacist; and
- Demographics in many counties are becoming more diverse, but the current health workforce doesn’t necessarily reflect the populations being served.
"In partnership with stakeholders from Scottsbluff to Omaha, we’ve made progress over the years. But the landscape of health care is rapidly changing, and we must remain diligent to sustain the progress we’ve made and close the gaps," Dr. Wilson said, in his statement in the news release.
Dr. Wilson led a nine-person research team representing several professions from UNMC and with input from Thomas Rauner, director of the primary care office in the Office of Rural Health for the state of Nebraska.
Interestingly, one inevitable response to the ongoing physician shortage in Nebraska has been that, “Since 2007, there has been a large increase in the number of active physician assistants (PAs) in the state,” the report noted. “There are 908 PAs (or 47.3 PAs per 100,000 population) versus 598 (33.5 {As per 100,000 population) in 2007—a 52-percent difference in number of PAs. PAs currently provide a total of 35,878 work hours, equating to 897 FTE PAs. Half of the PAs are 40 years old or younger, and over 70 percent of PAs are female.” Further, the reported stated, “Analysis of the distribution of PAs by county showed that 16 counties in Nebraska do not have an active PA.”
Meanwhile, the reported noted that, “In 2017, there were 1,148 nurse practitioners (NPs), 36 certified nurse midwives (CNMs), 49 clinical nurse specialists (CNSs), and 308 certified registered nurse anesthetists (CRNAs). The number of NPs rose from 767 to 1,148 in 2007-2017—a 50-percent increase. For CNMs, the increase was from 22 to 36 professionals.”
In their concluding section, the authors of the report noted that “The State of Nebraska has historically faced substantial challenges in maintaining access to healthcare in rural communities. Despite the importance of reducing rural-urban disparities in the state, a comprehensive study of the distribution of Nebraska’s healthcare workforce has not occurred since 2009. Our study uses recent data on numbers and work hours of licensed and active providers to provide a demographic profile of the current workforce.”
Importantly, the report’s authors state, “Our results highlight the substantial deficit in the supply of physicians across counties in Nebraska, particularly for the primary care specialties of internal medicine, OB/GYN and pediatrics. In addition, nearly one in five physicians in the state are older than age 65, and thus are likely to retire in the near future. In contrast, the number and rates of physician assistants and nurse professionals have grown substantially over the last decades and provide wide-ranging geographical coverage in Nebraska. The greater reliance on physician assistants and nurse practitioners,” they wrote, “has helped to offset the inadequate supply of primary care physicians. Legislative Bill 107 (passed in 2015) grants full practice authority to Nebraska nurse practitioners, so that they are now able to provide the full scope of services for which they are trained and educated. This legislative change will significantly enhance access to care in rural and underserved areas within Nebraska. However,” they noted, “there remains substantial variation in the rate of nurse professionals across the state, with relatively low numbers of RNs, LPNs and APRNs in west and central Nebraska.”
