The Taxonomy of Experiential Place is an excellent framework for understanding physician distribution.
Those born outside of concentrations of physicians, income, education, professionals, and medical schools are 2 - 3 times more likely to be found outside of physician concentrations in practice. Those born, raised, educated, and trained for 30 years in concentrations are the least likely to leave. They are 70% or more of admissions so they set the average for physicians at a level just below national averages. The physicians with combinations of concentration factors (scores, income, professionals, most urban, physicians in self, location, parents) are found in rural, primary care, family practice, and underserved careers at the lowest levels.
Physician Distribution by Concentration Coding
|
My codes |
Major Medical Center or MMC
|
Outside of Major Medical Centers |
Totals | |||
|
Half Served |
Military |
One-Third or One-Fourth Served | ||||
|
Poverty > 20% |
Designated - CHC, NHSC, Whole County | |||||
|
Zip Codes |
3,335 |
19,225 |
115 |
3,845 |
5,457 |
31,977 |
|
Graduates since 1971 |
361,939 |
129,781 |
1,943 |
14,588 |
14,566 |
522,817 |
|
Population at zip 2000 |
89,994,404 |
129,935,621 |
905,395 |
24,604,434 |
28,363,078 |
273,802,932 |
|
Poverty Pop |
10,445,200 |
11,433,014 |
85,042 |
5,951,025 |
5,967,802 |
33,882,083 |
|
mean % for poverty |
11.6% |
8.80% |
9.4% |
24.2% |
21.0% |
12% |
|
Physicians per 1000 pop |
4.02 |
1.00 |
2.15 |
0.593 |
0.515 |
1.909 |
|
Physicians per 1000 in poverty |
34.65 |
11.35 |
22.85 |
2.45 |
2.44 |
15.430 |
The naming of the location reflects the physician concentrations. Major Centers (over 75) and Super Centers (over 200) have top concentrations with 400 - 1500 physicians per 100000 people. These are the only locations with over the national average of 300 physicians per 100000 and the only locations with over the recommended 100 primary care per 100000. They have 150 - 350 primary care physicians per 100000.
Half served urban locations have 150. One-Fourth Served locations have 80. Half Served Rural locations have 120 physicians per 100,000 while One-Third Served Rural locations average 100 or one third the 300 national average. All of these locations have only 20 - 50% of the recommended primary care levels.
Those born outside have 2 - 3 times the location rate outside and this doubles for urban locations outside of concentrations and triples for rural locations outside.
Those born inside concentrate inside below averages, except for family physicians born inside who double or triple location outside.
Birth Origin and Ethnicity of Family Medicine Graduates