Closing the Gap: Finding and Encouraging Physicians Who Will Care for the Underserved

Abstract

Geographical distribution of U.S. physicians does not promote equitable access to health care. In 2006, nearly 75 percent of U.S. counties or partial counties were designated Health Professional Shortage Areas (HPSAs), meaning that the population-to-physician ratio in these areas exceeded the minimum (3,500:1) considered necessary for adequate access [1]. Meanwhile, experts estimate that, in aggregate, non-HPSAs have a surplus of more than 70,000 physicians [1]. Though HPSAs may be urban or rural, the problem is particularly acute in rural areas. While 21 percent of Americans live in rural areas, fewer than 10 percent of physicians practice in these areas [2]. As a result, rural residents (and the urban underserved) receive fewer preventive services and suffer from worse health outcomes [3,4]. There is debate over whether a physician shortage is imminent, but the evidence for physician maldistribution is clear [1,5,6]. Equitable access to health care is threatened when physicians disproportionately practice in urban and suburban areas.