Geographic distribution of pediatricians in the United States: An analysis of the fifty states and Washington, DC
Geographic distribution of pediatricians in the United States: An analysis of the fifty states and Washington, DC
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DOI：
10.1542/peds.100.2.172
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发表时间：
1997-08-01
期刊：
影响因子：
8
通讯作者：
Halfon, N
中科院分区：
文献类型：
--
作者：
Chang, RKR;Halfon, N
目标.确定目前美国儿科医生的地理分布，评估1982年至1992年儿科医生地理分布的变化，并确定与50个州儿科医生分布相关的因素。使用多个已发布的数据源构建数据集，包括美国医学会医师主文件作为医师信息的主要来源。计算儿科医生与儿童人口比率（PCPR，每10万18岁以下人口中的儿科医生数量），以比较各州儿科医生的分布以及1982年至1992年间的分布变化。洛伦茨曲线和基尼指数被用来描述分布和比较不同时期的分布。对9个预测变量与PCPR（因变量）的关系进行线性回归分析。1982年至1992年，美国儿童人口增长了5.4%，儿科医生的数量增加了46.1%。在此期间，PCPR增加了38.6%，从每10万人35.1人增加到每10万人48.6人。1992年，最高的州（马里兰州，84.3）和最低的州（爱达荷州，18.5）的PCPR差异超过4倍。所有50个州的PCPR都有所增加，但从怀俄明州的4.1%到马萨诸塞州的63.4%不等。洛伦兹曲线显示，儿科医生的分布比所有医生都不均匀，但比儿科心脏病专家分布更均匀。在1982年至1992年期间，所有医生的基尼指数下降了9.8%，儿科心脏病专家下降了10.2%，但儿科医生只下降了1.9%。由于基尼系数的下降意味着更好的整体分布，这些变化是相对温和的儿科医生作为一个整体，特别是当与其他医生相比。回归分析显示，较高的PCPR与每10万名儿童中更多的居住职位以及该州的人均收入相关（A = 0.93）。儿科医生的分布与美国儿童人口的分布并不平行，尽管PCPR增加了38.6%，但这种分布也没有发生实质性变化。儿科医生往往集中在人均收入高的州和住院医师培训职位较多的州。市场力量未能改善地理分布，可能需要改变人力政策，以改善代表性不足的州的分布。由于管理式医疗的使用增加，市场变化的不确定影响可能会影响未来儿科医生的分布要求。
Objectives. To determine current geographic distribution of pediatricians in the United States, to assess the changes in the geographic distribution of pediatricians between 1982 and 1992, and to identify factors associated with the distribution of pediatricians among the 50 states.Methods. A data set was constructed using several published data sources including the American Medical Association Physician Masterfile as the principal source for physician information. The pediatrician-to-child population ratio (PCPR, the number of pediatricians per 100 000 people under 18 years of age) was calculated to compare the distribution of pediatricians among states and the distributional changes between 1982 and 1992. Lorenz curves and Gini indices were used to describe distributions and to compare distributions across time periods. Linear regression analysis was performed to assess the relationship between PCPR (dependent variable) with 9 predictor variables.Results. Between 1982 and 1992, there was a 5.4% increase in the United States (US) child population and a 46.1% increase in the number of pediatricians in patient care. During that time period, the PCPR increased by 38.6% from 35.1 per 100 000 to 48.6 per 100 000. There was a more than 4-fold difference in the PCPRs of the highest state (Maryland, 84.3) and the lowest state (Idaho, 18.5) in 1992. The PCPR increased in all 50 states, but varied from a 4.1% increase in Wyoming to a 63.4% increase in Massachusetts. The Lorenz curve showed that pediatricians were less evenly distributed than all physicians, but more evenly distributed than pediatric cardiologists. Between 1982 to 1992 the Gini index decreased 9.8% for all physicians and 10.2% for pediatric cardiologists, but only 1.9% for pediatricians. Since a decrease in the Gini index signifies better overall distribution, these changes are relatively modest for pediatricians as a whole, especially when compared to other physicians. Regression analysis showed that a higher PCPR was associated with a greater number of residency positions per 100 000 children and with the per capita income of the state (A = .93).Conclusions. The distribution of pediatricians does not parallel the distribution of the child population in the US, nor has this distribution changed substantially in spite of a 38.6% increase in the PCPR. Pediatricians tend to concentrate in states with high per capita income and in states with a larger number of residency training positions. The failure of market forces to improve the geographic distribution may require manpower policy changes designed to improve distribution in underrepresented states. The uncertain impact of market changes due to increased use of managed care could affect distributional requirements of pediatricians in the future.