Joseph Nenow, MD; Andrew Nenow; Allison Priest; Dmitry Tumin, PhD; Kendall M. Campbell, MD
Corresponding Author: Joseph Nenow, MD; Brody School of Medicine at East Carolina University. Email: josephnenow@gmail.com
Section: Original Research
Publication Date: 1/13/2022
Background: Income inequality has been associated with multiple adverse health outcomes including diabetes and obesity, with this relationship being potentially mediated by limited access to primary care. We explore the association over time between county-level economic inequality and the primary care physician (PCP) workforce in North Carolina. Methods: County-level economic and demographic data were obtained from the 5-year American Community Survey estimates for 2013-2018. Economic inequality was quantified using the Gini coefficient of household income. PCP workforce data were obtained from a statewide database and correlated with county characteristics using fixed effects linear regression. Results: The analysis included 600 county-years. An increase of 0.1 in the Gini coefficient was correlated with a decrease in the PCP workforce by 0.58 physicians / 1,000 residents in a given county (95% confidence interval [CI]: -1.12, -0.04; p=0.036). Within Family Medicine, a 0.1 increase in the Gini coefficient was associated with a decrease of 0.53 Family Medicine physicians per 1,000 residents (95% CI: -0.94, -0.12; p = 0.011). Conclusions: Local increases in economic inequality are associated with local decreases in the PCP workforce (per capita), particularly in Family Medicine. While further research is needed to identify specific reasons for the decrease (e.g., underinvestment in primary care in economically unequal communities), medical schools in areas with high economic inequality should consider prioritizing the training of physicians in Family Medicine and other primary care specialties to better serve the health care needs of their community.