Geographic Maldistribution of Primary Care for Children

Abstract

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.

Characteristics of Rural Children Admitted to Pediatric Hospitals

“…6 Delivering high-quality health care to children living in rural areas, particularly children with special health care needs, can be challenging. In rural areas, fewer general practice and specialty pediatricians per capita are in practice [7][8][9] and fewer homeand community-based services (eg, physical therapists and home nurses) may be available. [10][11][12] Furthermore, children's hospitals, often the leading site for pediatric medical and surgical specialty care in a region, are almost exclusively located in nonrural areas.…”

Social Media and the Science of Health Behavior

“…22,25 Consequently, information about treatments, medicines, and screenings may be disproportionately available to some patient populations and not to others. 26 The remarkable growth of Internet-based health and wellness communities allows patients from a variety of social and geographic backgrounds to share information about novel health resources, ranging from information about diet and nutrition to opportunities to learn about patient advocacy, preventive health screenings, and new treatment technologies. 27,28 …”

Factors Influencing Family Physicians' Contribution to the Child Health Care Workforce

“…Additionally, current geographic maldistribution of the child health care physician workforce is leading to difficulty with access to care for many children and families. 13 Fostering medical student interest in family medicine and pediatrics is an important first step in strengthening the primary care child health physician workforce. Future policy aimed at reducing medical student debt load and increased attention to the work-life balance of primary care physicians may help bolster medical student interest in both family medicine and pediatrics.…”