Children's doctors don't always practice where the need is greatest

Physicians who care for children, including pediatricians and family care physicians, often locate their practices in areas where the number of child practitioners already is high and not where they are needed most, according to a new study published online in Pediatrics. Researchers found that the concentration of children’s physicians in certain geographic areas leaves up to 1 million children in other regions without access to nearby medical care.

According to the study, between 1996 and 2006, the workforces of general pediatricians (38,981) and family physicians (83,081) expanded by 51% and 35%, respectively, while the overall child population (under 18 years of age) increased by only 9%.

Using geographic representations of primary care service areas (PCSAs) in the United States, researchers found that 15% of PCSAs (984 of 6,542) had no local child physician, whereas 10% of the PCSAs with the highest concentration of child practitioners had 1 or more full-time child physicians for every 661 children. Nearly 15 million children (20% of the US child population) lived in high physician-supply areas where there were fewer than 710 children per child physician (an average of 141 child physicians per 100,000 children); another 15 million lived in low physician-supply areas with more than 4,400 children per child physician (an average of 22 child physicians per 100,000 children); and nearly 1 million children lived in areas without any local primary care physician.

Data showed uneven distribution of physicians in 47 states. Mississippi (42.2%) and Arkansas (37.7%) had the highest percentages of children living in low physician-supply regions. Washington, DC, offered the highest proportion (100%) of physicians for children, with virtually no children living in a low-supply area. Other states, including Vermont, Maine, Hawaii, Missouri, and West Virginia, demonstrated high and low extremes in local primary care distribution relative to the child population.

Researchers point out that this paradox in supply may mask actual shortages as well as excesses of primary care physicians for children in different regions of the United States. They suggest that state and federal policies aimed at increasing the overall supply of physicians be secondary to efforts at improving the distribution of both current and newly trained primary care workforces. The incentive-based National Health Service Corps that offers loan forgiveness and financial support, or state-sponsored programs that offer scholarships and grants to retain homegrown physicians, could encourage new residency graduates to establish practices in underserved areas.

Unless expansion of the primary care workforce for children is targeted toward serving child populations with the greatest needs, say the researchers, the growth in this healthcare sector may lead to greater disparities with little improvement in quality and outcomes of care.

Shipman SA, Lan J, Chang C, Goodman DC. Geographic maldistribution of primary care for children. Pediatrics. 2010. Epub ahead of print.