Local Economic Inequality and the Primary Care Physician Workforce in North Carolina

Background: Income inequality has been associated with multiple adverse health outcomes including diabetes and obesity, with this relationship potentially mediated by limited access to primary care. We explore the association between county-level economic inequality and the primary care physician (PCP) workforce in North Carolina. Methods: County-level economic and demographic data were obtained for 2013 to 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 PCP workforce by 0.58 physicians/1000 residents in a given county. Within family medicine, a 0.1 increase in the Gini coefficient was associated with a decrease of 0.53 family medicine physicians per 1000 residents. Conclusions: Local increases in economic inequality are associated with local decreases in PCP workforce (per capita), particularly in family medicine. Although further research is needed to identify specific reasons for the decrease, medical schools in areas with high economic inequality should consider prioritizing training of physicians in family medicine and other primary care specialties to better serve community health care needs.