The growth and evolution of rural primary care practice: The National Health Service Corps experience in the Northwest

The economic growth and development of 12 rural primary care practices established by the National Health Service Corps (NHSC) in the Pacific Northwest between 1973 and 1975 was examined. The 12 practices represented four types of rural health care delivery systems based on the size of the service area, the presence and type of hospital within that service area, and the number and kinds of providers in the service area. The results indicate that rural primary care practices, begun with a reasonable degree of stability and sound management, can approach financial self sufficiency in two to three years. However, practices grow at different rates, depending on the nature of their surrounding environment. Provider retention appeared to be highly correlated with practice growth and stability. Practices in which physicians were the major providers and which had ready access to hospital facilities grew relatively rapidly, approaching financial self-sufficiency within two to two-and-a half years. Practices which contained physicians who did not have ready access to a hospital grew significantly more slowly and had more erratic growth patterns than all other types of practices. Practices staffed solely by nurse practitioners initially had slow growth but approached self-sufficiency after three years of operation. The results suggest that it may be preferable to place nurse practitioners in small towns that lack access to inpatient care, rather than rely on the more traditional type of physician practice. The study has improved the ability of the Public Health Service to predict the rate of growth of different types of rural primary care practice, and hence the amount of external financial subsidy required by each. This has proven helpful in allowing the Public Health Service to more accurately advise inquiring rural communities about alternatives for health care delivery systems.