General practitioner distribution and population dynamics: Munich, 1950-1990

The problem of variable geographic distribution of physicians appears to be universal and intransigent. There is growing evidence from several developed countries of primary physicians avoiding areas in large cities increasingly populated by poor and ethnic minorities. This paper extends the research to Germany. Here, the changing population structure of Munich from 1950 through 1990, characterized by a large influx of foreign guestworkers, is illustrated. Selected changes in the medical care system and the role of the general practitioner pertinent to the question of supply and distribution are also discussed. Within this context, the geographic distribution of general practitioners' offices is examined for possible response to the concentration of foreigners in Districts within the City. In the aggregate, the distribution of general practitioners follows the geographic trends of the general population during the study period. However, geographic distribution of general practitioners varies widely on a District by District assessment. Though the exception, in several Districts there are indications that general practitioners may be avoiding locating offices in areas characterized by high density of foreign populations. This paper also draws attention to the importance of investigative scale to conclusions relating general practitioner distribution to spatial-temporal population trends.