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State report: APRNs drive rural primary care growth while physician supply shows aging and regional gaps
Summary
A DHHS workforce report presented April 25 found rapid growth among APRNs in New Hampshire but warned that primary care physician supply is aging, the physician training pipeline is thin, and rural regions remain unevenly served.
State officials presented the New Hampshire Health Care Workforce report — data collected during state fiscal year 2022 — to the House Health and Human Services Oversight Committee on April 25, highlighting rapid growth in advanced practice registered nurses (APRNs) and persistent vulnerabilities in the primary care physician and dental workforces.
Danielle Hernandez, administrator of the Health Professions Data Center, said the center is moving to a consolidated dashboard for multi‑year workforce trend analysis and summarized net supply changes: APRNs showed a 42 percent net increase in licensed supply for the year, physicians rose modestly and dentists experienced a net loss (about 8 percent).
The nut graf: While APRNs and physician assistants are expanding access, especially in rural public health regions, the physician pipeline looks fragile — a higher share of physicians are approaching retirement, only 16 percent have under five years of practice in New Hampshire, and about 15 percent of primary care physicians said they expect no clinical practice in the state in five years — raising access and continuity concerns.
Hernandez said APRNs have higher rates of full‑ or part‑time clinical practice in New Hampshire (mid‑80s percentage range) compared with physicians (around 70 percent), and APRNs are more likely to practice in rural areas. The report shows physicians’ primary care practice per 100,000 residents in rural areas dropped about 20 percent from the prior year to roughly 47 per 100,000; APRNs and PAs now comprise more than half of the primary care provider capacity in most rural public health regions except the Upper Valley.
Committee members asked about the meaning of rising APRN counts. Hernandez and members noted APRN educational pipelines are more numerous and accessible than physician pipelines and that emergency COVID‑era licensure flexibilities and telemedicine expansion likely contributed to recent APRN growth. Representative Woods asked whether many APRNs work per diem; Hernandez said the survey indicated APRNs report higher rates of active clinical practice compared with physicians, but the agency will continue monitoring hours and practice patterns.
Hernandez outlined regional disparities: Greater Sullivan County and Central New Hampshire have some of the lowest primary care rates; Upper Valley’s presence of Dartmouth‑affiliated training programs skews regional statistics upward. She said public health region analysis helps target interventions, and the office can produce county‑level or alternate geographies on request.
On recommended actions, the report highlights expanding in‑state training and residency opportunities, strengthening proven pipeline programs (state loan repayment, teaching health centers, AHEC initiatives), and sustaining targeted recruitment funds. A sample testimonial from a dentist with $320,000 in school debt urged continued support for the State Loan Repayment Program to keep clinicians in rural public‑health and public‑health practice.
Ending: DHHS officials said they will publish a new dashboard early in state fiscal year 2026 with multi‑year trend data and stand ready to return to the committee with more granular regional breakdowns if requested.
