UNC-CH study shows fewer dentists, more physicians per capita across state

November 16, 2000

CHAPEL HILL - The supply of dentists per 10,000 residents dropped in almost two-thirds of North Carolina counties over the past 20 years, according to a new University of North Carolina at Chapel Hill study.

Between 1979 and 1988, the per capita supply of dentists declined in 41 counties, the research showed, and between 1989 and 1998, it dropped in 64.

"What that means is that the population of those counties grew faster than the number of dentists able to serve them," said Erin Fraher, policy associate at the Cecil G. Sheps Center for Health Services Research. "In 1979, our state had 2,207 dentists, and in 1998, we had 3,037. Four counties - Tyrell, Jones, Hyde and Camden -- had no primary practice dentist locations."

Good news is that back in 1971, North Carolina ranked 36th in the United States in its supply of physicians, but by 1998, it had risen to 24th.

"We think the rise in the number of doctors is chiefly due to efforts of the UNC School of Medicine-based Area Health Education Centers program and the state's Office of Rural Health, along with creation of the East Carolina University School of Medicine," Fraher said. "There's also been a steady increase in primary care doctors, especially in non-metropolitan areas, which may improve access to care."

The study, conducted by N.C. Health Professions Data System staff at UNC-CH's Sheps center, collected and analyzed two decades of information on what has happened to the supply of doctors, nurses, dentists, nurse practitioners, pharmacists, physical therapists and other health professionals.

Between 1989 and 1998, every N.C. county increased its supply of registered nurses, she said. Dramatic growth also has occurred in the number of nurse practitioners and certified nurse midwives. "Clearly, efforts to increase these non-physician providers have been working," she said. "We're also getting these people to where we need them better than before." Some disparities remain, Fraher said.

"There are still federally designated health professional shortage areas in North Carolina," she said. "For example, in metropolitan areas there are about 4.5 dentists per 10,000 people, but only three per 10,000 in rural areas. That's really a large difference."

For the 21 counties considered shortage areas, 7.63 physicians were available in 1998 for every 10,000 people, as compared with 23.15 physicians per 10,000 for the 56 counties not federally designated as shortage areas.

Between 1979 and 1998, the overall number of doctors increased from 7,242 to 15,135, and those with a specialty in primary care increased from 3,644 to 6,380. Physician assistants increased from 318 to 1,440, chiropractors from 311 to 972 and podiatrists from 70 to 207.

Over the two decades, the number of registered nurses grew from 26,807 to 68,050, nurse practitioners from 279 to 1,321, certified nurse midwives from 29 to 138 and licensed practical nurses from 12,164 to 17,665.

Other professions showing growth were dental hygienists, from 1,368 to 3,395; optometrists, from 410 to 794; pharmacists, from 3,003 to 6,497; physical therapists, from 677 to 2,815 and psychologists from 519 to 1,434.

"Collaboration between the Sheps center, AHEC and the licensure boards in maintaining the data system has paid huge dividends for North Carolina," said Dr. Thomas J. Bacon, AHEC Program director. "The system is truly unique in the country and gives us a source of information for planning more effectively for programs to meet the health workforce needs of the state. At a time of serious and growing shortages of several key health professional groups, this report is timely in helping to guide our policy decisions."

UNC-CH's Office of the Provost, AHEC and the Duke Endowment have supported the health professions report, which incorporates more than 100 figures, including scores of maps and graphs. Others involved in preparing it were data coordinator Laura M. Smith, programmer Hazel Hadley and Sheps center deputy director Dr. Thomas C. Ricketts.

"We have received great feedback from state policy-makers on how helpful the report has been to them," Fraher said. "We've also had many contacts from people in other states who want to begin creating their own health workforce data systems."
Note: Fraher, who can discuss health professional totals for every N.C. county, can be reached at (919) 966-5012 or via e-mail at fraher@mail.schsr.unc.edu.

Sheps center contact: Carolyn Busse, (919) 966-3847
News Services contact: David Williamson, (919) 962-8596

University of North Carolina at Chapel Hill

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