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Geographic access to most types of doctors has improved, but some smaller specialties have not spread to the most rural areas

Geographic access to most types of physicians has continued to improve over the past 20 years. However, some smaller specialties have not spread to the most rural areas, according to a study supported by the Agency for Healthcare Research and Quality (HS10803). Current measures of geographic access to physicians are misleading, overstating the extent of maldistribution and yielding an incorrect ranking of areas according to geographic accessibility of physicians. The researchers suggest that more accurate measures of physician access will improve resource allocation.

Researchers used multiple measures of geographic access, including physician-to-population ratios, average distance traveled to the nearest physician, and projected average caseload per physician, to measure physician access in 23 States with low physician-population ratios. Between 1979 and 1999, the number of physicians doubled in the sample States. The multiple access measures used confirmed that residents of metropolitan areas continued to have better geographic access to physicians, followed by residents in rural counties adjacent to metropolitan areas, and lastly by isolated rural areas. Although most specialties experienced greater diffusion everywhere, smaller specialties had not yet diffused to the smallest towns.

In 1999, with the exception of general practitioners/family physicians, metropolitan counties had the highest physician-to-population ratios for all specialties. Fringe counties of metropolitan areas of 1 million or more, however, had markedly fewer physicians of each specialty than the smaller metropolitan areas. Differences were significant for 11 of 17 specialties examined. Distance-traveled and caseload models that allow patients to cross county lines showed less geographic disparity in physician access. Even in the most remote counties, the average distance to the nearest doctor of any type was less than 5 miles. Also, very few patients, even in the most rural counties, were assigned to physicians with a caseload that exceeded Federal guidelines for defining physician shortage areas.

See "The geographic distribution of physicians revisited," by Meredith B. Rosenthal, Ph.D., Alan Zaslavsky, Ph.D., and Joseph P. Newhouse, Ph.D., in the December 2005 HSR: Health Services Research 40(6), pp. 1931-1952.

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