Trends: Twenty-year trends in regional variations in the U.S. physician workforce

Health Affairs

Volumn 23, Issue SUPPL., 2004, Pages

  Goodman, David C ^a  

^a DARTMOUTH MEDICAL SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CONTROLLED STUDY; EMPLOYMENT; HEALTH CARE DELIVERY; HUMAN; PHYSICIAN; REVIEW; UNITED STATES;

EID: 8844269544     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.var.90     Document Type: Review

References (34)

1. T. Pasko and D. Smart, Physician Characteristics and Distribution in the U.S. (Chicago: American Medical Association, 2004). These numbers are for all physicians, including those in clinical practice, research, teaching, administration, and graduate medical education training programs. The analyses presented in this paper are restricted to post-training physicians spending the majority of their professional time in clinical practice.
2. D.C. Goodman, "Do We Need More Physicians?" Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.67 (15 June 2004); F. Mullan, "My Dad Was Not a Prepaid Group Practice Patient," Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/ content/abstract/hlthaff.w4.70 (15 June 2004); K. Grumbach, "Fighting Hand to Hand over Physician Workforce Policy," Health Affairs 21, no. 5 (2002): 13-27; R.A. Cooper et al., "Economic and Demographic Trends Signal an Impending Physician Shortage," Health Affairs 21, no. 1 (2002): 140-154; and W.B. Fye, "Cardiology Workforce: A Shortage, Not a Surplus," Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/content/abstract/ hlthaff.w4.64 (15 June 2004).
3. D.C. Goodman, "Do We Need More Physicians?" Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.67 (15 June 2004); F. Mullan, "My Dad Was Not a Prepaid Group Practice Patient," Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/ content/abstract/hlthaff.w4.70 (15 June 2004); K. Grumbach, "Fighting Hand to Hand over Physician Workforce Policy," Health Affairs 21, no. 5 (2002): 13-27; R.A. Cooper et al., "Economic and Demographic Trends Signal an Impending Physician Shortage," Health Affairs 21, no. 1 (2002): 140-154; and W.B. Fye, "Cardiology Workforce: A Shortage, Not a Surplus," Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/content/abstract/ hlthaff.w4.64 (15 June 2004).
4. D.C. Goodman, "Do We Need More Physicians?" Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.67 (15 June 2004); F. Mullan, "My Dad Was Not a Prepaid Group Practice Patient," Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/ content/abstract/hlthaff.w4.70 (15 June 2004); K. Grumbach, "Fighting Hand to Hand over Physician Workforce Policy," Health Affairs 21, no. 5 (2002): 13-27; R.A. Cooper et al., "Economic and Demographic Trends Signal an Impending Physician Shortage," Health Affairs 21, no. 1 (2002): 140-154; and W.B. Fye, "Cardiology Workforce: A Shortage, Not a Surplus," Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/content/abstract/ hlthaff.w4.64 (15 June 2004).
5. D.C. Goodman, "Do We Need More Physicians?" Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.67 (15 June 2004); F. Mullan, "My Dad Was Not a Prepaid Group Practice Patient," Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/ content/abstract/hlthaff.w4.70 (15 June 2004); K. Grumbach, "Fighting Hand to Hand over Physician Workforce Policy," Health Affairs 21, no. 5 (2002): 13-27; R.A. Cooper et al., "Economic and Demographic Trends Signal an Impending Physician Shortage," Health Affairs 21, no. 1 (2002): 140-154; and W.B. Fye, "Cardiology Workforce: A Shortage, Not a Surplus," Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/content/abstract/ hlthaff.w4.64 (15 June 2004).
6. D.C. Goodman, "Do We Need More Physicians?" Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.67 (15 June 2004); F. Mullan, "My Dad Was Not a Prepaid Group Practice Patient," Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/ content/abstract/hlthaff.w4.70 (15 June 2004); K. Grumbach, "Fighting Hand to Hand over Physician Workforce Policy," Health Affairs 21, no. 5 (2002): 13-27; R.A. Cooper et al., "Economic and Demographic Trends Signal an Impending Physician Shortage," Health Affairs 21, no. 1 (2002): 140-154; and W.B. Fye, "Cardiology Workforce: A Shortage, Not a Surplus," Health Affairs, 4 February 2004, content.healthaffairs.org/cgi/content/abstract/ hlthaff.w4.64 (15 June 2004).
7. J.E. Wennberg et al., "Geography and the Debate over Medicare Reform," Health Affairs, 13 February 2002, content.healthaffairs.org/cgi/ content/abstract/hlthaff.w2.96 (15 June 2004).
8. Council on Graduate Medical Education, Tenth Report: Physician Distribution and Health Care Challenges in Rural and Inner-City Areas (Washington: COGME, 1998).
9. J.E. Wennberg and M.M. Cooper, eds., The Quality of Medical Care in the United States: A Report on the Medicare Program - The Dartmouth Atlas of Health Care 1999 (Chicago: AHA Press, 1999).
10. J.P. Newhouse, "Geographic Access to Physician Services," Annual Review of Public Health 11 (1990): 207-230; G.R. Wilensky, "Alleviating the Physician Glut: What's the Government's Role?" Journal of American Medical Association 277, no. 1 (1997): 73; and W.B. Schwartz et al., "The Changing Geographic Distribution of Board-Certified Physicians," New England Journal of Medicine 303, no. 18 (1980): 1032-1038.
11. J.P. Newhouse, "Geographic Access to Physician Services," Annual Review of Public Health 11 (1990): 207-230; G.R. Wilensky, "Alleviating the Physician Glut: What's the Government's Role?" Journal of American Medical Association 277, no. 1 (1997): 73; and W.B. Schwartz et al., "The Changing Geographic Distribution of Board-Certified Physicians," New England Journal of Medicine 303, no. 18 (1980): 1032-1038.
12. J.P. Newhouse, "Geographic Access to Physician Services," Annual Review of Public Health 11 (1990): 207-230; G.R. Wilensky, "Alleviating the Physician Glut: What's the Government's Role?" Journal of American Medical Association 277, no. 1 (1997): 73; and W.B. Schwartz et al., "The Changing Geographic Distribution of Board-Certified Physicians," New England Journal of Medicine 303, no. 18 (1980): 1032-1038.
13. In particular, see Newhouse, "Geographic Access to Physician Services"; Schwartz et al., "The Changing Geographic Distribution"; C.E. McConnel and L.A. Tobias, "Distributional Change in Physician Manpower, United States, 1963-80," American Journal of Public Health 76, no. 6 (1986): 638-642; Y. Shih, "Growth and Geographic Distribution of Selected Health Professions, 1971-1996," Journal of Allied Health 28, no. 2 (1999): 61-70; R. Politzer, J. Cultice, and A. Meltizer, "The Geographic Distribution of Physicians in the United States and the Contribution of International Medical Graduates," Medical Care Research and Review 55, no. 1 (1998): 116-130; and R.K. Chang and N. Halfon, "Geographic Distribution of Pediatricians in the United States: An Analysis of the Fifty States and Washington, DC," Pediatrics 100, no. 2 (1997): 172-179.
14. In particular, see Newhouse, "Geographic Access to Physician Services"; Schwartz et al., "The Changing Geographic Distribution"; C.E. McConnel and L.A. Tobias, "Distributional Change in Physician Manpower, United States, 1963-80," American Journal of Public Health 76, no. 6 (1986): 638-642; Y. Shih, "Growth and Geographic Distribution of Selected Health Professions, 1971-1996," Journal of Allied Health 28, no. 2 (1999): 61-70; R. Politzer, J. Cultice, and A. Meltizer, "The Geographic Distribution of Physicians in the United States and the Contribution of International Medical Graduates," Medical Care Research and Review 55, no. 1 (1998): 116-130; and R.K. Chang and N. Halfon, "Geographic Distribution of Pediatricians in the United States: An Analysis of the Fifty States and Washington, DC," Pediatrics 100, no. 2 (1997): 172-179.
15. In particular, see Newhouse, "Geographic Access to Physician Services"; Schwartz et al., "The Changing Geographic Distribution"; C.E. McConnel and L.A. Tobias, "Distributional Change in Physician Manpower, United States, 1963-80," American Journal of Public Health 76, no. 6 (1986): 638-642; Y. Shih, "Growth and Geographic Distribution of Selected Health Professions, 1971-1996," Journal of Allied Health 28, no. 2 (1999): 61-70; R. Politzer, J. Cultice, and A. Meltizer, "The Geographic Distribution of Physicians in the United States and the Contribution of International Medical Graduates," Medical Care Research and Review 55, no. 1 (1998): 116-130; and R.K. Chang and N. Halfon, "Geographic Distribution of Pediatricians in the United States: An Analysis of the Fifty States and Washington, DC," Pediatrics 100, no. 2 (1997): 172-179.
16. In particular, see Newhouse, "Geographic Access to Physician Services"; Schwartz et al., "The Changing Geographic Distribution"; C.E. McConnel and L.A. Tobias, "Distributional Change in Physician Manpower, United States, 1963-80," American Journal of Public Health 76, no. 6 (1986): 638-642; Y. Shih, "Growth and Geographic Distribution of Selected Health Professions, 1971-1996," Journal of Allied Health 28, no. 2 (1999): 61-70; R. Politzer, J. Cultice, and A. Meltizer, "The Geographic Distribution of Physicians in the United States and the Contribution of International Medical Graduates," Medical Care Research and Review 55, no. 1 (1998): 116-130; and R.K. Chang and N. Halfon, "Geographic Distribution of Pediatricians in the United States: An Analysis of the Fifty States and Washington, DC," Pediatrics 100, no. 2 (1997): 172-179.
17. In particular, see Newhouse, "Geographic Access to Physician Services"; Schwartz et al., "The Changing Geographic Distribution"; C.E. McConnel and L.A. Tobias, "Distributional Change in Physician Manpower, United States, 1963-80," American Journal of Public Health 76, no. 6 (1986): 638-642; Y. Shih, "Growth and Geographic Distribution of Selected Health Professions, 1971-1996," Journal of Allied Health 28, no. 2 (1999): 61-70; R. Politzer, J. Cultice, and A. Meltizer, "The Geographic Distribution of Physicians in the United States and the Contribution of International Medical Graduates," Medical Care Research and Review 55, no. 1 (1998): 116-130; and R.K. Chang and N. Halfon, "Geographic Distribution of Pediatricians in the United States: An Analysis of the Fifty States and Washington, DC," Pediatrics 100, no. 2 (1997): 172-179.
18. In particular, see Newhouse, "Geographic Access to Physician Services"; Schwartz et al., "The Changing Geographic Distribution"; C.E. McConnel and L.A. Tobias, "Distributional Change in Physician Manpower, United States, 1963-80," American Journal of Public Health 76, no. 6 (1986): 638-642; Y. Shih, "Growth and Geographic Distribution of Selected Health Professions, 1971-1996," Journal of Allied Health 28, no. 2 (1999): 61-70; R. Politzer, J. Cultice, and A. Meltizer, "The Geographic Distribution of Physicians in the United States and the Contribution of International Medical Graduates," Medical Care Research and Review 55, no. 1 (1998): 116-130; and R.K. Chang and N. Halfon, "Geographic Distribution of Pediatricians in the United States: An Analysis of the Fifty States and Washington, DC," Pediatrics 100, no. 2 (1997): 172-179.
19. COGME, "Physician Workforce Policy Guidelines for the U.S., 2000-2020" (draft report), www.ahme.org/publications/ COGME_physician_workforce.pdf (6 August 2004).
20. D.C. Goodman et al., "Benchmarking the U.S. Physician Workforce: An Alternative to Needs-based or Demand-based Planning," Journal of the American Medical Association 276, no. 22 (1996): 1811-1817.
21. Wennberg and Cooper, eds., The Quality of Medical Care in the United States.
22. More than 3,000 people per primary care provider is a criterion used to identify Health Professional Shortage Areas. See COGME, Tenth Report.
23. Primary Care Service Areas are utilization-based health markets analogous to Dartmouth Atlas hospital service areas (HSAs) and hospital referral regions (HRRs). See Health Resources and Services Administration, "HRSA Geospatial Data Warehouse: Primary Care Service Areas (PCSA)," datawarehouse.hrsa.gov/ pcsa.htm (15 June 2004); and D.C. Goodman et al., "Primary Care Service Areas: A New Tool for the Evaluation of Primary Care Services," Health Services Research 38, no. 1 (2003): 287-309.
24. Primary Care Service Areas are utilization-based health markets analogous to Dartmouth Atlas hospital service areas (HSAs) and hospital referral regions (HRRs). See Health Resources and Services Administration, "HRSA Geospatial Data Warehouse: Primary Care Service Areas (PCSA)," datawarehouse.hrsa.gov/ pcsa.htm (15 June 2004); and D.C. Goodman et al., "Primary Care Service Areas: A New Tool for the Evaluation of Primary Care Services," Health Services Research 38, no. 1 (2003): 287-309.
25. E.S. Fisher et al., "The Implications of Regional Variations in Medicare Spending, Part 1: The Content, Quality, and Accessibility of Care," Annals of Internal Medicine 138, no. 4 (2003): 273-287, and "The Implications of Regional Variations in Medicare Spending, Part 2: Health Outcomes and Satisfaction with Care," Annals of Internal Medicine 138, no. 4 (2003): 288-298; and K. Baicker and A. Chandra, "Medicare Spending, the Physician Workforce, and Beneficiaries' Quality of Care," Health Affairs, 7 April 2004, content.health affairs.org/cgi/content/abstract/ hlthaff.w4.184 (6 August 2004).
26. E.S. Fisher et al., "The Implications of Regional Variations in Medicare Spending, Part 1: The Content, Quality, and Accessibility of Care," Annals of Internal Medicine 138, no. 4 (2003): 273-287, and "The Implications of Regional Variations in Medicare Spending, Part 2: Health Outcomes and Satisfaction with Care," Annals of Internal Medicine 138, no. 4 (2003): 288-298; and K. Baicker and A. Chandra, "Medicare Spending, the Physician Workforce, and Beneficiaries' Quality of Care," Health Affairs, 7 April 2004, content.health affairs.org/cgi/content/abstract/ hlthaff.w4.184 (6 August 2004).
27. E.S. Fisher et al., "The Implications of Regional Variations in Medicare Spending, Part 1: The Content, Quality, and Accessibility of Care," Annals of Internal Medicine 138, no. 4 (2003): 273-287, and "The Implications of Regional Variations in Medicare Spending, Part 2: Health Outcomes and Satisfaction with Care," Annals of Internal Medicine 138, no. 4 (2003): 288-298; and K. Baicker and A. Chandra, "Medicare Spending, the Physician Workforce, and Beneficiaries' Quality of Care," Health Affairs, 7 April 2004, content.health affairs.org/cgi/content/abstract/ hlthaff.w4.184 (6 August 2004).
28. Detailed findings are available on request; send e-mail to David Goodman, david.goodman@ dartmouth.edu.
29. D.W. Light, "Equity and Efficiency in Health Care," Social Science and Medicine 35, no. 4 (1992): 465-469; Wennberg and Cooper, eds., The Quality of Medical Care in the United States; and V.R. Fuchs, "Floridian Exceptionalism," Health Affairs, 13 August 2003, content.healthaffairs.org/ cgi/content/abstract/hlthaff.w3.357 (6 August 2004).
30. D.W. Light, "Equity and Efficiency in Health Care," Social Science and Medicine 35, no. 4 (1992): 465-469; Wennberg and Cooper, eds., The Quality of Medical Care in the United States; and V.R. Fuchs, "Floridian Exceptionalism," Health Affairs, 13 August 2003, content.healthaffairs.org/ cgi/content/abstract/hlthaff.w3.357 (6 August 2004).
31. D.W. Light, "Equity and Efficiency in Health Care," Social Science and Medicine 35, no. 4 (1992): 465-469; Wennberg and Cooper, eds., The Quality of Medical Care in the United States; and V.R. Fuchs, "Floridian Exceptionalism," Health Affairs, 13 August 2003, content.healthaffairs.org/ cgi/content/abstract/hlthaff.w3.357 (6 August 2004).
32. M. Gonzalez, Socioeconomic Characteristics of Medical Practice (Chicago: AMA, 1995); and P. Zhang and S. Thran, Physician Sociocconomic Statistics, 1999-2000 (Chicago: AMA, 1999).
33. M. Gonzalez, Socioeconomic Characteristics of Medical Practice (Chicago: AMA, 1995); and P. Zhang and S. Thran, Physician Sociocconomic Statistics, 1999-2000 (Chicago: AMA, 1999).
34. Cooper et al., "Economic and Demographic Trends."