By the Numbers: Where the Doctors Aren't; October 1998; Scientific American Magazine; by Doyle; 1 Page(s)

The U.S. has more than 640,000 physicians involved in patient care--one for every 420 Americans. This ratio would seem to be adequate, but because the distribution of doctors is not even, one of every 10 Americans is medically underserved solely by reason of geography. Both urban and rural areas are affected, the latter in part because, in an age of growing specialization and technological advances, young physicians are drawn increasingly to urban hospitals. Moreover, medical schools discourage development of primarycare physicians, who are far more apt to go to rural areas than specialists are. Another factor is doctors¿ spouses, who are pursuing professional careers in greater numbers than before and thus are unlikely to find jobs in the countryside. Minority communities are more likely to suffer shortages because white physicians are reluctant to work there. Because minority physicians are more apt than their white counterparts to practice in minority neighborhoods, the dismantling of affirmative action programs in higher education systems, as has happened in California, could worsen the shortages.

The Health Resources and Services Administration of the U.S. Department of Health and Human Services (HHS) has identified more than 2,750 regions where the number of primary- care physicians is inadequate. These areas, which were chosen on the basis of low physician-to-population ratio, high infant mortality and traveling time to physician offices, are home to 27 million medically underserved people, of whom 57 percent are in metropolitan areas. According to the HHS, more than 12,000 additional physicians are needed to bring these places up to the standard of one primary-care physician per 2,000 people (the minimum needed to serve a population adequately). Shortages may occur in towns, neighborhoods, correctional facilities, school districts or whole counties.