Medical Professionals - Is There A Doctor In The Area?

The map shows the number of active patient care physicians per 100,000 population in 1998. That year, the national average was 198. The map shows that the District of Columbia far exceeded the national average with 447 physicians. Following were Massachusetts (277.3), New York (265), Maryland (261.4), Connecticut (258.5), Rhode Island (247.6), New Jersey (243), Pennsylvania (234.2), and Vermont (223).

Data like those on the map are assembled into 51 reports and are used by policymakers and educators in the 50 states and the District of Columbia and by the U.S. Bureau of Health Professions to analyze and interpret workforce needs. For instance, the information permits the identification of Health Professional Shortage Areas (HPSA).⁴ To address shortages, incentives can be offered and new health professions programs can be developed or enrollment limited in overrepresented programs.

A look at the report for the District of Columbia reveals that of their 477 physicians per 100,000 population, 111 were active primary care physicians, compared to a national average of 59 (the remaining doctors were specialists, a topic covered in the next panel.) The federal Council on Graduate Medical Education considers 60 to 80 per 100,000 people to be desirable. The American Academy of Family Physicians recommends 76.⁵

Looking at the map, one might wonder: Why are so many doctors concentrated on the East Coast?⁶ One reason: Doctors tend to concentrate in urban and suburban areas. Doctors' preferences have led to a national mismatch between physician supply and need. A typical result of the mismatch is described by Roger W. Wilkins in American Medical News: "Medical care is still hard to find for minorities, especially if they are poor. In Harlem, there is one physician for every 7,000 people. On the east side of Manhattan, where the rich people live, there is one physician for every 600 people." Like minorities, rural residents have problems with access to health care.

It wasn't always this way. Kevin Grumbach provides historical background, hearkening back to the evolution of health care delivery in the 20th century. He writes that in 1900 America was home to 160 medical schools with more than 25,000 students. Health care was provided by "a heterogeneous mixture of minimally regulated purveyors of medical services calling themselves physicians [who] sought their livelihood in a market largely devoid of third-party payment" (and the ratio was about 175 physicians per 100,000).

Along came reformer Abraham Flexner, who stated in his influential 1910 report: "The curse of medical education is the excessive number of schools. The situation can improve only as weaker and superfluous schools are extinguished." Flexner called for stronger regulation of medical schools and stricter licensing policies for medical practitioners, a policy that resulted over the next few decades in the closing of more than 30 medical schools. Physician supply grew smaller and physicians' incomes rose. By 1930, the number had dropped to about 125 physicians per 100,000 population. Impoverished rural areas and later, inner cities, were left to fend for themselves as doctors abandoned them for more lucrative pastures. The trend toward fewer doctors reversed in the last third of the 20th century. We look at that issue next as it relates to physician specialization.

Sources: Map: National Center for Health Workforce Information and Analysis, State Health Workforce Profiles, http://bhpr.hrsa.gov/healthworkforce/profiles/default.htm; Primary source: American Medical Association. Biviano, Marilyn, and Farzaneh Makarehchi, Globalization and the Physician Workforce in the United States, Bureau of Health Professions, 2002, http://bhpr.hrsa.gov/healthworkforce/. Kevin Grumbach, "Fighting Hand To Hand Over Physician Workforce Policy," September/October 2002, http://www.healthaffairs.org/freecontent/v21n5/s6.htm. Vanselow, Neal A., M.D., "Are we headed for a surplus of 'generalist' healthcare providers?" Postgraduate Medicine, Vol 105 no 7 June 1999. Kolata, Gina, "Study finds health care spending doesn't correlate with wellness," July 21, 2002, http://seattletimes.nwsource.com/html/healthscience/134497499_care21.html. Greene, Jay "Academic Matters: Medical educators must increase diversity in medicine by recruiting strong minority students," American Medical News, Vol. 41, No. 46, Dec. 14, 1998, http://www.ama-assn.org/sci-pubs/msjama/articles/vol_280/no_21/ammcdive.htm.Information retrieved September 26, 2002. Information retrieved September 26,2002.