Abstract
The rapidly growing population of older adults and their concomitant high prevalence of chronic health conditions require an increased supply in the specialized geriatric workforce to meet increasing health care demands. Understanding trends and geographic disparities in the supply of the geriatric workforce is essential for developing effective policies. To examine temporal and geographic trends in the supply of geriatric physicians (GMDs) and geriatric nurse practitioners (GNPs) from 2010 to 2020 and to assess potential disparities between metropolitan and nonmetropolitan counties. This repeated cross-sectional study used annual county-level data from 2010 to 2020, encompassing all counties in the 50 US states and Washington, DC. Statistical analysis was performed from June 2023 to March 2024. The primary outcomes were the numbers of GMDs, GNPs, and the combined number of GMDs and GNPs per 100 000 older adults. The secondary outcome included the proportion of counties with or without any GMDs or GNPs. From 2010 to 2020, the national per capita supply of GMDs decreased by 12.7%, from 13.4 per 100 000 older adults in 2010 to 11.7 per 100 000 older adults in 2020, while GNPs increased by 125.0%, from 4.4 per 100 000 older adults in 2010 to 9.9 per 100 000 older adults in 2020. The combined GMD and GNP workforce increased by 21.3%, from 17.8 per 100 000 older adults in 2010 to 21.6 per 100 000 older adults in 2020. The distributions of older adults, GMDs, and GNPs closely resembled the distribution of metropolitan and nonmetropolitan counties, with GMDs and GNPs highly concentrated in metropolitan counties where the number of older adults was greatest. Throughout the study period, 63.9% of counties (2008 of 3142 in 2010-2019; 2009 of 3143 in 2020), predominantly small and nonmetropolitan counties, had no GMDs or GNPs, which was associated with the disparities between metropolitan and nonmetropolitan counties. This repeated cross-sectional study found that from 2010 to 2020, the overall national supply of GMDs and GNPs kept pace with the growth of the older population, largely due to the rapid growth in the number of GNPs. However, significant geographic disparities persisted, particularly in small and nonmetropolitan counties. Future efforts should focus on increasing the availability of GMDs and GNPs in underserved small and nonmetropolitan counties to ensure equitable access to geriatric care.
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