Primary Care
About
Primary Care measures the rate of primary care providers per 100,000 population in a county. Individuals from all races and ethnicities are included. Primary care providers include physicians specializing in internal medicine, family practice, pediatrics, and general medicine, as well as nurse practitioners and physician assistants actively engaged in primary care services. The availability of primary care providers is a crucial determinant of a community’s health outcomes. The availability of primary care physicians varies significantly by urbanization level, with rural areas generally having lower ratios of primary care physicians to population compared to urban areas 1-3. As of 2022, 7.8% of U.S. counties lacked a single primary care physician, and the national average of the ratio of primary care physicians to population was 83.8 per 100,000 population 4,5.
Why is Primary Care important to the Structural Racism and Discrimination (SRD) Index?
Access to primary care is a key indicator of health equity and reflects broader systemic disparities rooted in long-standing legacies and the impact of segregation and income inequality. Institutional neglect and discrimination contribute to poor engagement with primary care among Black and African American individuals in the U.S., as structural racism influences every stage of the care continuum 6. Unequal access to primary care further leads to advanced and complex health outcomes. Black preterm infants in California experience adverse postnatal outcomes linked to structural racism 7, while newborn drug testing practices reveal discriminatory decision-making processes 8. Including primary care as an indicator of the SRD Index is essential for identifying and addressing disparities in access to healthcare services, promoting equity, and improving outcomes for racially marginalized populations. This integration highlights the need to dismantle systemic barriers and ensure that all individuals have fair and equitable access to comprehensive primary care.
What is the expected relation to Structural Racism and Discrimination?
A lower rate of primary care providers represents a higher need for medical resources in a county. A higher rate of primary care providers contributes to the lower score of the SRD Index.
How is Primary Care calculated?
Data Source
We obtained data from the Health Resources & Services Administration (HRSA) 9. The data is publicly available.
Data
We used the following two variables at the county level.
| Variables* | Year | Unit |
|---|---|---|
| Total population | 2000 | 2010 | 2020 | Number |
| Primary Care Physician, Patient Care, Hospital Residents | 2000 | 2010 | 2020 | Number |
Methodology
We calculated Primary Care using a ratio formula:
$$
RTotPCphy = \left( \frac{TotPCPhy}{TotPop} \right) \times 100000
$$
Where:
RTotPCphy: Rate of primary care providers per 100,000 population (all races)
TotPCPhy: Primary Care Physician, Patient Care
TotPop: Total Population
Missing Data
Missing values were filled using the median value of the adjacent neighbors. The adjacent neighbors were identified using the PolygonNeighbors tool in Python’s arcpy.analysis module 10. The adjacency is defined by any common boundary or vertex between two counties. After imputation of missing data, we have 13 counties with no data in 2020, and none for the 2010 and 2020 years.
Limitations
There are inconsistencies in the type of primary care providers’ data across the years 2020, 2010, and 2000, which may affect comparability and interpretation.
For the years 2020 and 2010, primary care providers include both MDs and DOs, whereas the 2000 dataset included only MDs, which may result in an undercount for the year 2000. Furthermore, the 2020 and 2010 datasets exclude physicians aged 75 and older, while the 2000 dataset encompasses physicians of all ages. In addition, there was no primary care data available for the year 1990.
References
1. Agency for Healthcare Research and Quality. Fact sheet: The distribution of the U.S. primary care workforce. Content last reviewed July 2018. Retrieved November 20, 2024.
2. Fraze, T. K., Lewis, V. A., Wood, A., Newton, H., & Colla, C. H. (2022). Configuration and delivery of primary care in rural and urban settings. Journal of General Internal Medicine, 37(12), 3045-3053.
3. Zhang, D., Son, H., Shen, Y., Chen, Z., Rajbhandari-Thapa, J., Li, Y., … & Pagán, J. A. (2020). Assessment of changes in rural and urban primary care workforce in the United States from 2009 to 2017. JAMA network open, 3(10), e2022914-e2022914.
4. U.S. Census Bureau. Annual estimates of the resident population for counties: April 1, 2020 to July 1, 2023. Retrieved November 20, 2024.
5. Based on an analysis of the American Medical Association’s 2022 AMA Physician Professional Data.
6. Freeman, R., Gwadz, M. V., Silverman, E., Kutnick, A., Leonard, N. R., Ritchie, A. S., … & Martinez, B. Y. (2017). Critical race theory as a tool for understanding poor engagement along the HIV care continuum among African American/Black and Hispanic persons living with HIV in the United States: a qualitative exploration. International journal for equity in health, 16, 1-14.
7. Karvonen, K. L., McKenzie-Sampson, S., Baer, R. J., Jelliffe-Pawlowski, L., Rogers, E. E., Pantell, M. S., & Chambers, B. D. (2023). Structural racism is associated with adverse postnatal outcomes among Black preterm infants. Pediatric Research, 94(1), 371-377.
8. Shetty, C., Oshman, L., Costa, A., Waidley, V., Madlambayan, E., Joassaint, M., … & Chandanabhumma, P. P. (2024). Structural racism in newborn drug testing: perspectives of health care and child protective services professionals. The Annals of Family Medicine, 22(4), 271-278.
9. Health Resources and Services Administration. (n.d.). Area Health Resource File (AHRF) county-level data. U.S. Department of Health and Human Services.
10. Virtanen, P., Gommers, R., Burovski, E., Oliphant, T. E., Weckesser, W., Cournapeau, D., … & Feng, Y. (2021). scipy/scipy: SciPy 1.6. 0. Zenodo.