Building and Supporting the Healthcare Workforce South Carolina Needs Who is Providing Primary Care in Rural South Carolina and Why is it Important to Know? Kathleen Greenberg, Katie Gaul, Ann Lefebvre South Carolina Office of Rural Health Annual Conference | September 29, 2021 Building and Supporting the Healthcare Workforce South Carolina Needs Our Plan for this Session 2 • Tell you a little bit about South Carolina AHEC and introduce you to the Office for Healthcare Workforce , a division of SC AHEC • Present some data showing that the supply of nurse practitioners and physician assistants who provide primary care is growing much faster than is the supply of primary care physicians in the state’s most economically isolated counties. • Discuss the implications of these trends with respect to policy, access to care, and the health of South Carolina’s rural communities. Building and Supporting the Healthcare Workforce South Carolina Needs What is an AHEC? 3 A rea H ealth E ducation C enters • Increase diversity among health professionals • B roaden the distribution of the health workforce • Enhance healthcare quality • Improve health care delivery to rural and underserved populations Building and Supporting the Healthcare Workforce South Carolina Needs South Carolina AHEC System 4 regional centers serve the entire state 1 program office housed at MUSC 4 Building and Supporting the Healthcare Workforce South Carolina Needs South Carolina AHEC OUR MISSION South Carolina AHEC builds and supports the healthcare workforce South Carolina needs for every community to have access to diverse , high - quality , patient - focused care. SC A rea H ealth E ducation C onsortium Building and Supporting the Healthcare Workforce South Carolina Needs t Program Areas Health Careers Pipeline Program Health Professions Student Program Graduate Medical Education Recruitment & Retention Program Continuing Professional Development SC Office for Healthcare Workforce Building and Supporting the Healthcare Workforce South Carolina Needs SC Office for Healthcare Workforce (SCOHW) – a division of SCAHEC Our primary mission is to develop accurate, reliable information about the healthcare workforce in South Carolina and to make that information widely available in order to support planning and policy decisions. Building and Supporting the Healthcare Workforce South Carolina Needs SC Office for Healthcare Workforce (SCOHW) – a division of SCAHEC We share and communicate that information in several ways • Data Briefs • Reports • Presentations • Responses to data requests Building and Supporting the Healthcare Workforce South Carolina Needs SCOHW tracks 19 licensed healthcare professions • Clinical Social Workers • Dentists, Dental Hygienists • Nurses: LPNs, RNs, NPs, CNMs, CRNAs, CNSs • Occupational Therapists, OT Assistants • Optometrists • Pharmacists • Physical Therapists, PT Assistants • Physician Assistants • Physicians • Psychologists • Respiratory Care Practitioners Building and Supporting the Healthcare Workforce South Carolina Needs Where do our data come from? • Regulatory boards within the SC Department of Labor, Licensing and Regulation collect self - reported data from licensees at time of initial application or renewal. • SC Revenue and Fiscal Affairs Office, Health and Demographics Division (RFA - HDD) cleans, maintains, and stores these data. • SCOHW obtains de - identified data files from RFA - HDD. Building and Supporting the Healthcare Workforce South Carolina Needs What we wanted to know, and why. • Primary care plays a key role in ensuring the health of those who live rural communities. • Nationally, physicians comprise the largest segment of the primary care workforce; however, both physician assistants (PAs) and nurse practitioners (NPs) provide primary care through specialized training in the areas of family medicine, pediatrics, and obstetrics/gynecology. o How has the supply , distribution , and composition of the primary care workforce in South Carolina changed over time? o Who is providing primary care in South Carolina’s rural communities? Building and Supporting the Healthcare Workforce South Carolina Needs How did we define the primary care workforce? • Adult NP • Family NP • Gerontological NP • Pediatric NP • Obstetrical Gynecological NP • Women’s Health NP • Family Medicine • Internal Medicine • Obstetrics/Gynecology • Pediatrics NPs PAs Physicians (MDs, DOs) • Family Medicine • Internal Medicine • Obstetrics/Gynecology • Pediatrics Note. All data in this analysis include providers actively practicing in a nonfederal setting in South Carolina as of the end of their respective renewal periods in 2009/2010 and 2018/2019. Physician counts include residents - in - training. Building and Supporting the Healthcare Workforce South Carolina Needs How did we define rural? Graphic credit: South Carolina Center for Rural and Primary Healthcare: https://sc.edu/study/colleges_schools/medicine/centers_and_institutes_new/center_for_rural_and_primary_healthcare/what_is_rur al/ index.php Building and Supporting the Healthcare Workforce South Carolina Needs Nonmetropolitan (12 counties) Oconee Pickens Anderson Greenville Spartanburg Cherokee York Union Chester Lancaster Chesterfield Marlboro Dillon Lee Sumter Darlington Florence Marion Horry Williamsburg Clarendon Calhoun Orangeburg Berkeley Dorchester Colleton Bamberg Barnwell Allendale Hampton Jasper Beaufort Charleston Georgetown Abbeville Saluda Laurens Newberry Fairfield Kershaw Richland Lexington Edgefield Aiken McCormick Greenwood Micropolitan (8) M etropolitan (26) Source: Definitions updated March 2020, U.S. Census Bureau, http://www.census.gov/population/metro/data/def.html South Carolina Metropolitan Statistical Area (MSA) County Designations Metro = urban core of 50,000 or larger Micro = urban core between 10,000 and 50,000 Non - Metro = counties without urban areas of 10,000 or more and without strong economic ties to the urban centers in their adjoining counties. These are the most economically isolated counties in our state. Building and Supporting the Healthcare Workforce South Carolina Needs A Clarification • Nurses renew their licenses during even years. • PAs and physicians renew during odd years 2009 2019 PC NPs* # # PC PAs # # PC Physicians # # *comparison period is 2010 - 2018 Building and Supporting the Healthcare Workforce South Carolina Needs Statewide , South Carolina’s primary care workforce grew between 2009 and 2019... 2009 2019 Change in Number Percent Change 5,686 8,445 2,759 48.5% ...but, as the next slide shows, the rate of growth differed across the three types of providers. Table 1. Change in the number of primary care providers, South Carolina, 2009 - 2019. Building and Supporting the Healthcare Workforce South Carolina Needs 1,317 241 4,128 3,006 347 5,092 Primary Care NPs Primary Care PAs Primary Care Physicians 2009 2019 + 23.4 % + 44.0 % + 128.2 % The number of primary care physicians and primary care PAs increased between 2009 and 2019. But most of this growth was driven by primary care NPs , whose numbers more than doubled between 2009 and 2019. Figure 1. Percent change in the number of primary care NPs, PAs, and physicians, 2009 - 2019. Building and Supporting the Healthcare Workforce South Carolina Needs This strong growth in the size of the primary care NP workforce took place in all regions of the state. PAs and physicians grew most strongly in metropolitan areas, but in nonmetropolitan areas, the number of primary care physicians declined. 132.6% 98.2% 98.1% 50.0% 21.7% 10.0% 25.9% 15.5% - 17.7% PC NPs PC PAs PC Physicians Metropolitan Micropolitan Nonmetropolitan Figure 2. Percent change in the number of primary care NPs, PAs, and physicians, by region, 2009 - 2019. Building and Supporting the Healthcare Workforce South Carolina Needs 2009 Percent of Total 2019 Percent of Total Change in Number 2009 - 2019 Percent Change 2009 - 2019 Metropolitan 3,809,024 83.5% 4,405,408 85.6% 596,384 15.7% Micropolitan 439,358 9.6% 445,597 8.7% 6,239 1.4% Nonmetropolitan 312,860 6.9% 297,709 5.8% - 15,151 - 4.8% Total 4,561,242 5,148,714 587,472 12.9% South Carolina saw a loss in population in its nonmetropolitan areas between 2009 and 2019... ...but the rate of decline in the number of primary care physicians in these areas exceeded the rate of population loss Table 2. Population Changes by Metropolitan Status, 2009 - 2019, SC Building and Supporting the Healthcare Workforce South Carolina Needs On a per population basis, the pattern of gains and losses in the number of primary care NPs, PAs, and physicians is the same, with decreases in the concentration of primary care physicians taking place exclusively in the state’s nonmetropolitan areas. 101.1% 95.4% 108.2% 29.7% 20.0% 15.6% 8.9% 13.9% - 13.5% PC NPs PC PAs PC Physicians Figure 4. Percent change in the number of primary care NPs, PAs, and physicians per 10,000 population by MSA region, SC, 2009 - 2019. Metropolitan Micropolitan Nonmetropolitan