Primary Care Providers in North Dakota

North Dakota

Primary care physicians are typically a patient’s first point of contact with the health care system and provide critical preventive care, disease management and referrals to specialists. 

The Health Resources and Services Administration has estimated that, as of September 2023, an additional 17,000 primary care providers are necessary to meet current U.S. health care needs in designated health workforce shortage areas. That deficit is expected to grow to 48,000 physicians by 2034, mainly due to population growth and aging. Having a better or sufficient supply of primary care physicians in a community has numerous benefits, including: 

• Lower rates of infants with low birth weight.
• Lower all-cause mortality and longer life spans.
• Reductions in health system costs.
• Reductions in health disparities.

The COVID-19 pandemic had a profound impact on primary care. Many providers have had to adjust how they provide care and rapidly increase their use of telehealth services.

Populations disproportionately affected by lack of access to primary care include:

• Hispanic and non-Hispanic Black adults compared with non-Hispanic white adults.
• Those living in rural areas compared with those in urban areas.
• Those living in low-income households compared with those in high-income households. 
• Uninsured adults compared with adults who have private insurance.

Immediate and long-term measures to address the nation’s primary care shortage include: 

• Increasing primary care capacity by expanding the roles of nurse practitioners and physician assistants to perform more responsibilities. 
• Increasing federal funding for medical residency training positions.
• Promoting primary care practice among medical residents. 

Another important approach to the shortage is increasing diversity within the physician workforce, which includes establishing:

• High-quality education within underserved and underrepresented communities.
• Programs to encourage minority students to pursue medicine as a career.
• College and medical school admissions procedures that allow for the consideration of race and ethnicity.
• Mentorship for minority students in medical school.

The effects of increased telehealth use on the demand for primary care providers are uncertain. The U.S. Department of Health and Human Services implemented policy changes in response to the COVID-19 public health emergency to make telehealth more accessible. Continuation of those policies may allow more physicians to continue to offer those services to expand geographic access to primary care. Remote patient monitoring is one area that may be particularly well-suited to telehealth adaptations, allowing providers to manage chronic conditions in patients who face travel or transportation barriers. 

The Centers for Medicare and Medicaid Services has developed the Rural Health Strategy in response to the modern needs of rural Americans. Educational interventions are particularly effective at increasing and retaining a rural health workforce. These include selecting university students with rural backgrounds, university and post-graduate training in rural locations and supporting further education for qualified rural health professionals. However, more research is needed to address the physician shortage in rural areas. 

Healthy People 2030 has multiple objectives related to primary care physicians, including:

• Increasing the proportion of people with a usual primary care provider.
• Reducing the proportion of people who can’t get medical care when needed.

Agency for Healthcare Research and Quality. “2021 National Healthcare Quality and Disparities Report.” Rockville, MD: Agency for Healthcare Research and Quality, December 2021. https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr.pdf.

Brotman, Joshua J., and Robert M. Kotloff. “Providing Outpatient Telehealth Services in the United States.” Chest 159, no. 4 (April 2021): 1548–58. https://doi.org/10.1016/j.chest.2020.11.020.

Corlette, Sabrina, Robert Berenson, Erik Wengle, Kevin Lucia, and Tyler Thomas. “Impact of the COVID-19 Pandemic on Primary Care Practices.” U.S. Health Reform – Monitoring and Impact. The Urban Institute, February 2021. https://www.urban.org/sites/default/files/publication/103596/impact-of-the-covid-19-pandemic-on-primary-care-practices.pdf.

IHS Markit Ltd. “The Complexities of Physician Supply and Demand: Projections From 2019 to 2034.” Washington, D.C.: Association of American Medical Colleges, June 2021. https://www.aamc.org/media/54681/download.

Jabbarpour, Yalda, Ann Greiner, Anuradha Jetty, Ann Kempski, Douglas Kamerow, Grace Walter, and Jamie Sibel. “Relationships Matter: How Usual Is Usual Source of (Primary) Care?” PCC 2022 Evidence Report. Primary Care Collaborative, November 2022. https://thepcc.org/sites/default/files/resources/pcc-evidence-report-2022_1.pdf.

Rajan, Suja S., Julia M. Akeroyd, Sarah T. Ahmed, David J. Ramsey, Christie M. Ballantyne, Laura A. Petersen, and Salim S. Virani. “Health Care Costs Associated with Primary Care Physicians versus Nurse Practitioners and Physician Assistants.” Journal of the American Association of Nurse Practitioners 33, no. 11 (November 2021): 967–74. https://doi.org/10.1097/JXX.0000000000000555.

Russell, Deborah, Supriya Mathew, Michelle Fitts, Zania Liddle, Lorna Murakami-Gold, Narelle Campbell, Mark Ramjan, et al. “Interventions for Health Workforce Retention in Rural and Remote Areas: A Systematic Review.” Human Resources for Health 19, no. 1 (August 26, 2021): 103. https://doi.org/10.1186/s12960-021-00643-7.

Starfield, Barbara, Leiyu Shi, and James Macinko. “Contribution of Primary Care to Health Systems and Health.” The Milbank Quarterly 83, no. 3 (September 2005): 457–502. https://doi.org/10.1111/j.1468-0009.2005.00409.x.