The Spatial Distribution of Physicians in the United States: A Review of the Literature

Abstract

One manifestation of a contemporary concern with equality in the provision of health care services is the growing interest that appears to be developing in the spatial location of medical manpower. There is no evidence that any country has ever achieved, much less sustained, a statistical balance between the spatial distribution of its population and its stock of medical manpower, yet increasingly the judgement appears to be made that imbalances are excessive and should be corrected. Indeed, although some imbalance is inevitable in any country, whatever its methods of organising health care delivery or remunerating physicians, countries with quite small variations in physician-population ratios (PPRs) seem as ready to perceive a distributional problem as those with gross imbalances. Variations of up to ten-fold are not uncommon between the PPRs of urban and rural areas in many countries (WHO, 1976), yet the difference between the average list sizes of primary care physicians in the best and worst areas in England in 1970, when financial incentives to encourage the movement of physicians to under-serviced areas were increased, was only one and a half-fold (Butler, et. al, 1973). There are special historical reasons why the notion of inequality may be defined more rigorously in Britain than in many other countries, but attempts by governmental and other agencies to influence the locational decisions of physicians appear to be widespread (Glaser, 1976). Together with this burgeoning policy interest in the spatial distribution of medical manpower has been a similar growth in the academic study of the nature, causes and possible solutions to the 'problem' of maldistribution, much of it of American origin. This paper is an attempt by an outside observer to summarise the American literature on the theme and to offer some comments on the problems and potentialities of current research