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Physician Distribution and February 1998 The full version of this report is available in PDF format (470 KB)
Purpose of This Report
Access to health care in the United States is affected
by where physicians locate. The tendency for physicians to practice in
affluent urban and suburban areas - a phenomenon known as geographic maldistribution
of physicians—creates barriers to care for people living in rural and
inner-city areas. This report summarizes the extent of this problem, discusses
the effect of an impending physician over-supply on the locational patterns
of physicians, and proposes concrete recommendations to improve the geographic
distribution of physicians in the United States.
The Persistence
of Geographic Maldistribution in Rural and Inner-City America.
Geographic maldistribution of health care providers and service is
one of the most persistent characteristics of the American health care
system. Even as an oversupply of some physician specialties is apparent
in many urban health care service areas across the country, many inner-city
and rural communities still struggle to attract an adequate number of
health professionals to provide high-quality care to local people. This
is the central paradox of the American health care system: shortages
amid surplus.
Geographic maldistribution is related to a large extent to the career
choices of U.S. medical school graduates. Physicians who enter into
the primary care disciplines - and particularly those who choose to
be become family physicians - are much more likely to practice in underserved
areas than their peers who enter narrowly defined specialties. Private
and governmental interventions in the medical education system to increase
the production of family physicians and other primary care physicians
have been successful, particularly when coupled with federal programs
that deliver care to the underserved and offer incentives to those physicians
who provide that care. Programs such as the National Health Service
Corps (NHSC), the Community Health Center (CHC) Program, and targeted
incentives provided through Medicare and Medicaid, provide vehicles
to bring physicians to areas where they would not otherwise practice.
Geographic maldistribution did not develop overnight. In fact it is
one of the most enduring features on the American health care landscape.
Yet it should not be assumed that it is an unalterable rift that cannot
be bridged. It is the opinion of COGME that geographic maldistribution
can - and will - yield to combined efforts of public and private institutions.
The challenge is to ensure that a variety of public and private interventions
are tightly integrated and mutually supportive.
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