Physician scarcity is a predictor of further scarcity in US, and a predictor of concentration in Japan

Inoue, Kazuo; Bowman, R.C.; Noguchi, Satoko; Kajii, Eiji

doi:10.1016/j.healthpol.2009.11.012

Cited by 16 publications

(15 citation statements)

References 31 publications

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“…Of great concern are the higher mobility rates and risk of leaving rural practice altogether, irrespective of age, of physicians who work in counties with poorer supply (lower PPR). These results are consistent with those of other non-rural-specific studies 1,29 but highlight the difficult battle to improve physician availability for small rural communities. Rural areas that can least afford to lose physicians are those dealing with difficulties of increased mobility.…”

Section: Discussionsupporting

confidence: 90%

“…22,28 Poorer availability of physicians, most prominent in rural areas, has been linked to increased mobility of physicians in some areas. 24,29 Physicians working in small rural communities additionally report that many community-led factors such as integration, connection, and appreciation contribute to increased retention, but these factors cannot readily be measured. 30,31 Place attractiveness has been linked to migration of rural populations [32][33][34] ; however, its influence on rural physicians' retention or mobility decisions remains unclear.…”

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confidence: 99%

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Mobility of US Rural Primary Care Physicians During 2000–2014

et al. 2017

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PURPOSE Despite considerable investment in increasing the number of primary care physicians in rural shortage areas, little is known about their movement rates and factors influencing their mobility. We aimed to characterize geographic mobility among rural primary care physicians, and to identify location and individual factors that influence such mobility. METHODSUsing data from the American Medical Association Physician Masterfile for each clinically active US physician, we created seven 2-year (biennial) mobility periods during 2000-2014. These periods were merged with countylevel "rurality," physician supply, economic characteristics, key demographic measures, and individual physician characteristics. We computed (1) mobility rates of physicians by rurality; (2) linear regression models of county-level rural nonretention (departure); and (3) logit models of physicians leaving rural practice. RESULTSBiennial turnover was about 17% among physicians aged 45 and younger, compared with 9% among physicians aged 46 to 65, with little difference between rural and metropolitan groups. County-level physician mobility was higher for counties that lacked a hospital (absolute increase = 5.7%), had a smaller population size, and had lower primary care physician supply, but arealevel economic and demographic factors had little impact. Female physicians (odds ratios = 1.24 and 1.46 for those aged 45 or younger and those aged 46 to 65, respectively) and physicians born in a metropolitan area (odds ratios = 1.75 and 1.56 for those aged 45 or younger and those aged 46 to 65, respectively) were more likely to leave rural practice.CONCLUSIONS These findings provide national-level evidence of rural physician mobility rates and factors associated with both county-level retention and individual-level departures. Outcomes were notably poorer in the most remote locations and those already having poorer physician supply and professional support. Rural health workforce planners and policymakers must be cognizant of these key factors to more effectively target retention policies and to take into account the additional support needed by these more vulnerable communities. Ann Fam Med 2017;15:322-328. https://doi.org/10.1370/afm.2096. INTRODUCTIONR ural populations continue to experience relative shortages of the supply of primary care physicians, 1 with associated links to poorer health.2 Difficulties of both recruitment and retention of physicians in rural areas, which greatly contribute to experienced shortages, are well acknowledged. 3,4 There are many reasons for this ongoing workforce supply disparity, including professional, economic, infrastructural, political, educational, and sociocultural aspects. 5 Although considerable research has identified factors that facilitate or impede supply of physicians in rural areas, macro-level empirical evidence of observed rural mobility of physiciansnotably, which are more likely to move and why-is limited.6-9 Additionally, the frequencies with which specific rural physicians move over ...

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Section: Discussionsupporting

confidence: 90%

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confidence: 99%

Mobility of US Rural Primary Care Physicians During 2000–2014

et al. 2017

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“…Previous studies of trends in geographic disparities in the allocation of physicians report that the gap between urban and rural areas has widened, despite an increase in the total number of physicians [1,4,5,7,8,13,23-25]. These studies measure the number of physicians per population by county [7,13,23] or municipality [1,4,5].…”

Section: Discussionmentioning

confidence: 99%

Urbanization and physician maldistribution: a longitudinal study in Japan

Tanihara

Kobayashi

Une

et al. 2011

BMC Health Serv Res

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BackgroundThe relative shortage of physicians in Japan's rural areas is an important issue in health policy. In the 1970s, the Japanese government began a policy to increase the number of medical students and to achieve a better distribution of physicians. Beginning in 1985, however, admissions to medical school were reduced to prevent a future oversupply of physicians. In 2007, medical school entrants equaled just 92% of their 1982 peers. The urban annual population growth rate is positive and the rural is negative, a trend that may affect denominator populations and physician distribution.MethodsOur data cover six time points and span a decade: 1998, 2000, 2002, 2004, 2006, and 2008. The spatial units for analysis are the secondary tier of medical care (STM) as defined by the Medical Service Law and related legislation. We examined trends in the geographic disparities in population and physician distribution among 348 STMs in Japan. We compared populations and the number of physicians per 100,000 populations in each STM. To measure maldistribution quantitatively, we calculated Gini coefficients for physician distribution.ResultsBetween 1998 and 2008, the total population and the number of practicing physicians for every 100,000 people increased by 0.95% and 13.6%, respectively. However, the inequality of physician distribution remained constant, although small and mostly rural areas experienced an increase in physician to population ratios. In contrast, as the maldistribution of population escalated during the same period, the Gini coefficient of population rose. Although the absolute number of practicing physicians in small STMs decreased, the fall in the denominator population of the STMs resulted in an increase in the number of practicing physicians per population in those located in rural areas.ConclusionsA policy that increased the number of physicians and the physician to population ratios between 1998 and 2008 in all geographic areas of Japan, irrespective of size, did not lead to a more equal geographical distribution of physicians. The ratios of physicians to population in small rural STMs increased because of concurrent trends in urbanization and not because of a rise in the number of practicing physicians.

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“…The Gini coefficient is generally used to measure the geographical maldistribution of physicians [6][7][8][9][10][11][12][13][14][15] and municipal population is usually used for weighting. The present study calculated the Gini coefficient using population, as well as the Gini coefficient using demand for medical services, measured by the age structure of each municipality.…”

Section: Gini Coefficientmentioning

confidence: 99%

“…[6] Matsumoto and Inoue also calculated the population-weighted Gini coefficient for physicians across municipalities, and reported that there was no remarkable improvement in distribution after 1990. [7][8][9][10][11] Toyabe calculated the Gini coefficient, Atkinson index and Theil index across municipalities from 1996 to 2006 for university hospital physicians, other hospital physicians and clinic physicians, and found that for other hospital and university hospital physicians each index had increased after 2004, indicating that the new postgraduate program had exacerbated the geographical maldistribution of physicians. [12] Sakai et al measured pediatrician distribution across municipalities by a 0-14 population-weighted Gini coefficient, and reported that the Gini coefficient had increased in urban prefectures after 2004.…”

Section: Introductionmentioning

confidence: 99%

Population aging and physician maldistribution: A longitudinal study in Japan

Matsumoto

Seto

Fujita

et al. 2015

JHA

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Background: Over the past two decades, population aging and the introduction of the new postgraduate medical education program in 2004 have impacted on the geographic maldistribution of physicians in Japan. The purpose of this study was to evaluate recent changes in physician distribution across municipalities from 1996 to 2012 using Gini coefficients and to clarify the impact of the new medical education program on physician distribution. Methods: We extracted the number of physicians classified by type of medical institution and municipal bodies. Gini coefficients were calculated using both population and demand for medical services. We calculated the contribution ratio (CR) of maldistribution within each type of medical institution to the whole maldistribution using Rao's method. In addition, we calculated the incremental difference in Gini coefficients between 2002 and 2010, and calculated the CR of the incremental Gini coefficient difference for each medical institution type using Seki's method. Results: Both Gini coefficients decreased from 1996 to 2002, and increased after 2006. The CR of other hospitals increased from 2004. The incremental difference in the Gini coefficient using demand between 2002 and 2010 was 0.012, and the CR of each type of medical institution was -25.1% (university hospitals), 131.0% (other hospitals) and -5.9% (clinics). Conclusions: Our analysis showed that the geographic maldistribution of physicians has worsened since the introduction of the new postgraduate medical education program, and the CR of maldistribution in other hospitals was high. Our study suggested that new medical resource distribution policies should be discussed to improve maldistribution.

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Physician scarcity is a predictor of further scarcity in US, and a predictor of concentration in Japan

Cited by 16 publications

References 31 publications

Mobility of US Rural Primary Care Physicians During 2000–2014

Mobility of US Rural Primary Care Physicians During 2000–2014

Urbanization and physician maldistribution: a longitudinal study in Japan

Population aging and physician maldistribution: A longitudinal study in Japan

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