Variation in Scope of Practice and Services Provided by Rural vs Urban Primary Care Providers

While past studies have documented rural-urban differences in health care access and provider availability, there is limited recent evidence describing actual clinical practice patterns and scopes of practice using health care data. The objective of this research is to examine differences in clinical practice patterns between rural and urban primary care providers (PCPs) by analyzing insurance claims data to determine variations in the density and intensity of services provided directly by general practice physicians (family medicine physicians, internal medicine physicians, and pediatricians) nurse practitioners (NPs), and physician assistants (PAs) across different geographic settings. It will address the following research questions:

1. Do rural PCPs bill for a higher density of diagnostic and therapeutic services per encounter compared to their urban counterparts?
2. Do rural PCPs demonstrate higher service intensity compared to urban providers?
3. Does the relationship between service density and intensity vary systematically across the rural-urban continuum and differ by provider specialty or type?