Physicians in Poverty Series

Robert C. Bowman, M.D.

Distribution: Index Concentrations of Physician Distribution - compare and contrast the various types that distribute to rural underserved and urban underserved locations. How do international medical graduate internal medicine physicians compare to family physicians? What does birth origin have to do with practice location?

Physicians in Poverty Discussion: Major Medical Center Locations

Areas Without a Community Health Center or a Family Medicine Residency Program - 80% of Physicians

Location All Other FP IM Ob-Gyn Peds FP / PC Total
Urban Served 47% 22% 16% 11% 9% 41% 43512
Urban Underserved 46% 20% 18% 12% 10% 37% 8810
Rural Served 41% 32% 14% 14% 6% 54% 16308
Rural Underserved 39% 30% 18% 13% 7% 49% 7905
Urban MMC 62% 8% 17% 9% 7% 21% 133445
Rural MMC 59% 13% 13% 10% 7% 33% 4934
This subtotal 56% 14% 16% 10% 8% 32% 214914
All 1987 - 1999 grads 56% 14% 16% 9% 7% 32% 267430

 

Urban major medical centers concentrate those outside of primary care. Family physicians avoid urban major medical centers and lead in all other categories. Internal medicine remains about 15% regardless of location or medical school origin. Ob-Gyn trends slightly away from major medical centers. Pediatrics is popular in urban areas with some concentration in underserved locations. With increasing distance from major medical centers, family medicine provides an increasing share of primary care physicians and total physicians.

Areas With a CHC or FP Residency - 20% of Physicians

 

fppluschc Location All Other FP IM Ob-Gyn Peds FP / PC Total
CHC Zip Urban Underserved 41% 25% 18% 15% 9% 42% 1360
CHC Zip Rural Underserved 36% 38% 15% 12% 7% 59% 941
CHC Zip Urban MMC 63% 10% 16% 7% 6% 26% 5404
CHC Zip Rural MMC 57% 14% 17% 8% 7% 33% 550
FP Res Zip Urban Served 59% 21% 8% 9% 7% 51% 576
FP Res Zip Urban Underserved 58% 17% 12% 9% 6% 41% 179
FP Res Zip Rural Underserved 43% 16% 28% 17% 5% 28% 150
FP Res Zip Urban MMC 61% 13% 15% 8% 6% 32% 17579
FP Res Zip Rural MMC 51% 25% 13% 10% 5% 51% 719
Both CHC + FP Res Urban Served 64% 18% 6% 11% 6% 48% 159
Both CHC + FP Res Urban Underserved 54% 26% 7% 4% 9% 57% 211
Both CHC + FP Res Rural Served 29% 55% 6% 0% 6% 77% 31
Both CHC + FP Res Rural Underserved 48% 32% 9% 7% 7% 61% 85
Both CHC + FP Res Urban MMC 61% 13% 13% 8% 6% 35% 23930
Both CHC + FP Res Rural MMC 59% 24% 8% 10% 3% 59% 642
  This subtotal 60% 14% 14% 8% 6% 35% 52516
  All 1987-1999 Grads 56% 14% 16% 9% 7% 32% 267430

CHC zip code areas have greater concentrations of family physicians, considerably with rural underserved areas. The highest levels of Ob-Gyn physicians are in CHC zip codes in rural and urban underserved areas and in FP Residency zip code areas of rural underserved areas. Pediatrics continues to show an urban underserved trend. FP percentages of total primary care are higher in all but major medical center locations.

Poverty Locations and Physicians

Differences and Definitions

Physician Workforce Studies

www.ruralmedicaleducation.org