Estimating the de-designation of single-county HPSAs in the United States by counting naturopathic physicians as medical doctors

An incomplete database containing approximately one-third of the known work addresses of naturopathic physicians (NDs) was compiled for seven US states in 2003. NDs were factored into the criteria used by the Shortage Designation Branch to determine shortage status. Three out of 93 counties within the seven states lost health professional shortage area (HPSA) designation when NDs were included in the supply of primary care providers. Assuming a complete ND location database, and using simple extrapolation, estimates of HPSA de-designations were calculated for the study area and for all 50 US states and territories. It was estimated that up to nine counties would lose HPSA status in the seven state study areas and 33-142 counties could lose HPSA status within the United States and territories. With a continued spread of state licensing for naturopathic physicians and a phenomenal increase in the workforce, the impact of a fully diffused profession could dramatically reduce the number of HPSAs should the Bureau of Health Profession count NDs on par with medical doctors MDs.