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Counties with the biggest primary health care worker shortages

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June 17, 2021 // Shutterstock

This story originally appeared on Nursing Education and was produced and distributed in partnership with Stacker Studio.

Counties with the biggest primary health care worker shortages

The shortage of health care providers across the United States, particularly in rural areas and poor urban neighborhoods, is growing. A 2020 study from the Association of American Medical Colleges projects a 54,100 to 139,000 physician shortage by 2033. Further it found that more than 7,000 lives could be saved each year if the shortage is alleviated.

NursingEducation analyzed 2021 data from the Health Resources and Services Administration’s Health Professional Shortage Area (HPSA) tool to determine the counties with the largest shortages of health care workers. This story focuses on the 15 U.S. counties with the biggest primary care provider shortages, based on available data for 916 counties nationwide.

This analysis looked at the number of full-time equivalent practitioners needed in each county to achieve the population-to-practitioner target ratio. For primary care, the target ratio must be at least 3,500 people per provider, or 3,000-to-1 in areas with especially high needs. In addition to the target ratio, an HPSA score is determined by the National Health Service Corps to identify areas that should take priority when assigning workers, with a maximum score of 25. This score is based on the population-to-provider ratio, poverty levels, infant health index, and travel time to the nearest source of care.

Keep reading to learn which counties in the U.S. have the biggest shortage of primary health care workers.

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#15. Parker County, Texas

- Full-time practitioners needed: 13.02
- HPSA score: 10

The Texas population is growing more than twice as fast as the national average, but there are too few physicians to handle health care needs in places such as Parker County. More than 80% of the state’s counties lack enough mental health professionals, and about 40% of primary care health needs are not being met, according to the Texas Hospital Association. The Texas Department of State Health Services expects a severe shortage of nurses by 2032. The coronavirus has worsened shortages across the country, and Texas is among the states that offered wages of up to $150 an hour to attract workers to their medical facilities.

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#14. Mason County, Washington

- Full-time practitioners needed: 13.13
- HPSA score: 16

A record-high number of nurses in Washington—140,000 as of December 2020—wasn't enough to care for all the COVID-19 patients statewide, and many nurses quit out of exhaustion. The Washington State Hospital Association has expedited licensing for nurses from other states and new graduates. The state’s population is aging: By 2040, 22% of the population will be older than 60—and health care delivery is shifting to community clinics, creating other shortages.

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#13. Kauai County, Hawaii

- Full-time practitioners needed: 13.16
- HPSA score: 16

Kauai as of December 2020 had a 33% shortage of physicians, a longtime problem that only worsened in 2020. The state has struggled to attract health care providers due to high overhead, Hawaii's general excise tax on medical care, and reimbursement rates from Medicare, Medicaid, and private insurance. The Legislature can no longer afford to fund a loan repayment program paid for with a federal grant that requires a dollar-for-dollar match.

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#12. Churchill County, Nevada

- Full-time practitioners needed: 13.50
- HPSA score: 15

Nevada’s shortage of health care providers is driven by a growing and aging population, an increase in insured people due to the expansion of Medicaid eligibility and the Silver State Health Insurance Exchange, and the state's poor showing in meeting health care needs. Like other states, Nevada hospitals have seen staff shortages worsen during the coronavirus. A bill under consideration by the Legislature would examine home care in Nevada and issue recommendations to improve the quality of care and working conditions.

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#11. Bedford County, Virginia

- Full-time practitioners needed: 14.02
- HPSA score: 12

Even before the coronavirus, officials in Bedford County, Virginia, utilized incentives to try filling almost 50 full- and part-time nursing jobs at the Bedford County Nursing Home. Shortages have been a problem for more than four years at the facility, one of five county-owned in Virginia. The Virginia Health Care Foundation awarded a $286,600 grant to the Johnson Health Center to hire a full-time psychiatric nurse practitioner and other staff for services in Bedford County and elsewhere.

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#10. Livingston Parish, Louisiana

- Full-time practitioners needed: 14.19
- HPSA score: 10

Louisiana is one of the least healthy states, according to a 2019 Louisiana Primary Care Needs Assessment. The assessment is being used to develop a plan to recruit health care providers and reduce shortages in rural and underserved areas such as Livingston Parish. The state's population is growing and aging, with most families make less than $50,000 a year. Black families have a median income of just over half that of white families.

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#9. South Thurston County, Washington

- Full-time practitioners needed: 17.38
- HPSA score: 15

Washington state is working to hire health care providers in a number of ways, from direct recruitment to loan repayment programs to coordinating the J-1 Visa Waiver program. The goal is to increase the number of physicians working in rural and underserved areas of the state such as South Thurston County after efforts to recruit U.S.-trained physicians have failed. The state will sponsor up to 30 waivers a year, with at least 20 available to primary care physicians.

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#8. Harnett County, North Carolina

- Full-time practitioners needed: 18.28
- HPSA score: 11

Shortages of health care providers persist in North Carolina’s rural counties despite millions of dollars in loan repayment initiatives. The state should have added 250 new doctors, nurses, dentists and nurse practitioners in those areas, but the numbers are actually lower. Harnett County has 200 licensed practical nurses, one certified nurse-midwife, 20 dentists, and 72 dental hygienists. It had an estimated 135,976 people as of July 1, 2019, according to the Census Bureau.

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#7. Kitsap County, Washington

- Full-time practitioners needed: 18.80
- HPSA score: 10

Kitsap County’s shortage of doctors was apparent in 2018 when the county had only 443, or 2.4% of Washington’s total, and was below the state average for every primary care specialty, according to the Kitsap Sun. In all, only 6% of physicians practiced in the state’s rural counties, taking care of 16% of the population. In Kitsap County, an increase in the number of access points for care is needed as well, and health services are working with community organizations to help deliver this care through mobile units and in-school clinics. In 2017, shortages were already apparent existed for primary care, dental care, and mental health care. The population has increased by 1% every year between 2000 and 2019, and on average is slightly older than the state’s average.

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#6. Spokane County, Washington

- Full-time practitioners needed: 19.39 (North Spokane), 18.97 (Southeast Spokane)
- HPSA score: 15 (North Spokane), 15 (Southeast Spokane)

Before the pandemic, there were more than 62,000 registered nurses working in Washington. Another 30,000 were licensed to work there, but did not, according to an analysis by the University of Washington Center for Health Workforce Studies. Finding enough registered nurses for long-care facilities was already difficult before the coronavirus began. In 2020, the state’s nursing commission issued 3,857 of what are called temporary practice permits, which allow nurses to work while background checks are completed.

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#5. Maui County, Hawaii

- Full-time practitioners needed: 23.50
- HPSA score: 14

Maui County has a physician shortage of 43%, according to a 2020 Hawaii Physician Workforce Assessment. Statewide, there are 2,812 full-time physicians, which falls short of the 3,529 that are needed. The Hawaii Physician Shortage Crisis Task Force was formed in 2019 to find solutions to the problem. Among Hawaii’s physicians, 46% are 55 or older, while 21% are 65 and older. Some have deferred retirement because of the coronavirus.

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#4. Webb County, Texas

- Full-time practitioners needed: 24.93
- HPSA score: 17

The shortage of primary care physicians across Texas is expected to reach 3,375 by 2030, an increase of 67% since 2017, according to research by the Texas Department of State Health Services. The greatest need will be for those practicing general internal medicine. The Rio Grande Valley is expected to be short 722 primary care doctors by 2030, and as a result, 32% of need will be unmet. An increase in the number of doctors would not alone solve the problem because of the way they are distributed throughout the state, with a particular divide between urban and rural areas.

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#3. Hawaii County, Hawaii

- Full-time practitioners needed: 29.13
- HPSA score: 15

Hawaii County has 53% fewer doctors than similar-sized communities on the mainland United States, according to a 2020 Hawaii Physician Workforce Assessment. It has 287 fewer doctors than it needs, the biggest shortage in the state. Over the past year, across the state, 110 doctors have retired, 139 have moved and 120 worked shorter hours. Hawaii is the only state that taxes Medicare benefits, and only one of two that taxes health care services.

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#2. Paulding County, Georgia

- Full-time practitioners needed: 29.55
- HPSA score: 12

Paulding County had fewer than one hospital bed for every 1,000 residents, according to a 2016 study from the Georgia Budget and Policy Institute. On a per-capita basis, the state’s total health care spending placed it third from last in the country. The state’s 211 doctors per 100,000 residents are not distributed evenly, meaning 141 of its 159 counties are below the state average. That trend also is true for nurses and physician assistants.

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#1. Colfax County, New Mexico

- Full-time practitioners needed: 52.24
- HPSA score: 21

The University of New Mexico is putting $30 million toward a new nursing and population health building, part of an effort to address a shortage of 6,000 nurses statewide. The 2019 New Mexico Health Care Workforce Committee recommended providing $6 million for tuition-free training for medical students at public universities who promise to practice in New Mexico. It also recommended doubling funding for the loan-for-service programs for doctors, nurses, and allied health professionals. More than  850,000 New Mexicans live in areas in which there is a shortage of dentists and other dental health professionals, including Colfax County.

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