General practitioners in German metropolitan areas – distribution patterns and their relationship with area level measures of the socioeconomic status

Abstract Background Geographical variation of the general practitioner (GP) workforce is known between rural and urban areas. However, data about the variation between and within urban areas are lacking. Method We analyzed distribution patterns of GP full time equivalents (FTE) in German cities with a population size of more than 500,000. We correlated their distribution with area measures of social deprivation in order to analyze preferences within neighborhood characteristics. For this purpose, we developed two area measures of deprivation: Geodemographic Index (GDI) and Cultureeconomic Index (CEI). Results In total n = 9034.75 FTE were included in n = 14 cities with n = 171 districts. FTE were distributed equally on inter-city level (mean: 6.49; range: 5.12–7.20; SD: 0.51). However, on intra-city level, GP distribution was skewed (mean: 6.54; range: 1.80–43.98; SD: 3.62). Distribution patterns of FTE per 10^4 residents were significantly correlated with GDI (r = −0.49; p < 0.001) and CEI (r = −0.22; p = 0.005). Therefore, location choices of GPs were mainly positively correlated with 1) central location (r = −0.50; p < 0.001), 2) small household size of population (r = −0.50; p < 0.001) and 3) population density (r = 0.35; p < 0.001). Conclusion Intra-city distribution of GPs was skewed, which could affect the equality of access for the urban population. Furthermore, health services planners should be aware of GP location preferences. This could be helpful to better understand and plan delivery of health services. Within this process the presented Geodemographic Index (GDI) could be of use

Linear projection of the development of female authorships on the global level.

<p>The prognosis for the next decades forecasts a slow harmonization of authorship odds between the two genders and the persistence of the unfavorable FAOR-pattern with a negative <i>Prestige Index</i>. A FAP of 33.1% is prognosticated for the year 2025.</p

Classification of <i>Chemistry</i>-journals.

<p>Classification of <i>Chemistry</i>-journals.</p

Female authorships by continents.

<p>The continents were descendingly ordered by the <i>Prestige Index</i>.</p

Classification of countries descendingly ordered by the Prestige Index.

<p>Classification of countries descendingly ordered by the Prestige Index.</p

Classification of <i>Earth & Environmental</i> journals.

<p>Classification of <i>Earth & Environmental</i> journals.</p

Classification of <i>Life science</i> journals.

<p>Classification of <i>Life science</i> journals.</p

Female authorships by journal category.

<p><b>(A)</b> The subject category <i>Earth & Environmental</i> has much favorable authorship odds for women than other categories. The number of considered male and female authorships is given in brackets. (B) In all categories, the FAP exhibits a positive annual growth with a relatively higher growth for first and last authorships and a relatively lower growth for co-authorships.</p

Gender-specificity of citations & scholarly productivity.

<p>(<b>A</b>) The descendingly ordered citation rates shows that articles with male key authorships are more frequently cited than articles with female key authorships. The mean citation rate of 37.5 citations/article is depicted by a dotted line (Kruskal-Wallis test, (*): p < .05 (**): p < .01). (<b>B</b>) Average citation rates of both, ungrouped articles (bars) and articles that were grouped by the gender of their key authorships (lines), plotted as a function of the number of authors. Statistically, the citation rate of an article is higher the more authors are involved. The differences in citation rates between the two genders increase with the number of authors per article. (<b>C</b>) Gender-specific distribution of the number of articles per author. Women dominate the sub-groups 'author has 1 or 2 article(s)'. All other sub-groups are characterized by a relatively over-representation of male authors. This finding correlates with the higher productivity of male authors, as 61.0% male authors are responsible for 70.2% of all authorships.</p

Correlation of journal parameters.

<p>(A) There is no correlation between the 5-Year-Impact-Factor of a journal and its FAP. (B) A large negative correlation between the 5-Year-Impact-Factor of a journal and its <i>Prestige Index</i> was revealed. (C) The graph shows a small, but not significant negative correlation between the FAP and the <i>Prestige Index</i> of a journal.</p