Relationship between rural hospital closures and the supply of nurse practitioners and certified registered nurse anesthetists

Abstract

Background: Reductions in primary care and specialist physicians follow rural hospital closures. As the supply of physicians declines, rural healthcare systems increasingly rely on nurse practitioners (NPs) and certified registered nurse anesthetists (CRNAs) to deliver care.

Purpose: We sought to examine the extent to which rural hospital closures are associated with changes in the NP and CRNA workforce.

Method: Using Area Health Resources Files (AHRF) data from 2010-2017, we used an event-study design to estimate the relationship between rural hospital closures and changes in the supply of NPs and CRNAs.

Findings: Among 1,544 rural counties, we observed 151 hospital closures. After controlling for local market characteristics, we did not find a significant relationship between hospital closure and the supply of NPs and CRNAs.

Discussion: We do not find evidence that NPs and CRNAs respond to rural hospital closures by leaving the healthcare market.

Keywords: Clinician supply; Hospital closures; Nurse practitioner workforce; Rural health.