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August 14, 2014
Doc Shortage or Maldistribution?
The shortage of primary care physicians is a well-known, well-documented, and generally accepted fact of American health care. The Health Resources and Services Administration has identified 6,100 areas with less than one primary care physician for every 3,500 people and estimate that the medical workforce would need over 8,000 additional physicians to address the shortage. However, an in-depth review of physician training by the Institute of Medicine (IOM) suggests that the shortage is not necessarily a reflection of a deficit of doctors, merely poor distribution—both in specialization and geography.
Theoretically, the United States employs enough primary care physicians to properly care for its population by most definitions of the appropriate physician-to-population ratio. Nationwide, there are 2.6 physicians for every 3,500 people. Unfortunately, doctors are highly concentrated in urban areas, leading to shortages in large swaths of rural America. To illustrate the problem, the map below colors the physician shortage or surplus in each county, where “shortage” and “surplus” are defined as the total number of physicians above or below the population-adjusted national average.
 Shortage Design: Health Professional Shortage Areas & Medically Underserved Areas/Populations, Health Resources and Services Administration, available at: http://www.hrsa.gov/shortage/
 Graduate Medical Education That Meets the Nation's Health Needs, Institute of Medicine, Washington, DC: The National Academies Press, 2014, available at: http://www.iom.edu/Reports/2014/Graduate-Medical-Education-That-Meets-the-Nations-Health-Needs.aspx
 Area Health Resources Files (AHRF) 2012-2013, US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Rockville, MD, available at: http://ahrf.hrsa.gov/download.htm
 In this analysis, we examined non-federal primary care physicians under the age of 75. Primary care residents are counted as 0.1 full time primary care physicians.