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Geographic maldistribution of primary care for children
Scott A Shipman1, Jia Lan, Chiang-Hua Chang
1Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Suite 202, Lebanon, NH 03766, USA. scott.shipman@dartmouth.edu
Insights
The primary care physician workforce for children grew significantly, but its geographic distribution became profoundly uneven. This maldistribution leaves millions of children with inadequate access to essential pediatric care.
Area of Science:
- Pediatric Workforce Analysis
- Health Services Research
- Geographic Health Disparities
Background:
- The primary care physician workforce is crucial for child health.
- Understanding workforce growth and distribution is essential for equitable healthcare access.
Purpose of the Study:
- To examine the growth and geographic distribution of the primary care physician workforce for children in the US.
- To identify disparities in access to pediatric primary care physicians.
Main Methods:
- Utilized national data to calculate the per-capita supply of general pediatricians and family physicians.
- Analysis was conducted at the primary care service area level.
- Data spanned the period from 1996 to 2006.
Main Results:
- The pediatrician and family physician workforces grew by 51% and 35%, respectively, outpacing child population growth (9%).
- Significant geographic maldistribution was observed, with per-capita supply varying over 600% across markets.
- Approximately 20% of US children lived in areas with critically low physician supply, and nearly 1 million lived in areas with no local child physician.
Conclusions:
- Aggregate, undirected growth of the child physician workforce has led to severe geographic maldistribution.
- Policies are needed to address disparities in geographic access to primary care physicians for children.
- Accountability for public funding of physician training should incorporate strategies to reduce these access inequities.
Objectives:
This study examines growth in the primary care physician workforce for children and examines the geographic distribution of the workforce.
Methods:
National data were used to calculate the local per-capita supply of clinically active general pediatricians and family physicians, measured at the level of primary care service areas.
Results:
Between 1996 and 2006, the general pediatrician and family physician workforces expanded by 51% and 35%, respectively, whereas the child population increased by only 9%. The 2006 per-capita supply varied by >600% across local primary care markets. Nearly 15 million children (20% of the US child population) lived in local markets with <710 children per child physician (average of 141 child physicians per 100 000 children), whereas another 15 million lived in areas with >4400 children per child physician (average of 22 child physicians per 100 000 children). In addition, almost 1 million children lived in areas with no local child physician. Nearly all 50 states had evidence of similar extremes of physician maldistribution.
Conclusions:
Undirected growth of the aggregate child physician workforce has resulted in profound maldistribution of physician resources. Accountability for public funding of physician training should include efforts to develop, to use, and to evaluate policies aimed at reducing disparities in geographic access to primary care physicians for children.
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