This important report reviews current workforce and needs for physicians. It also used an expert analysis. Based on this expert analysis, the nation needs 15441 more physicians just to move shortage areas up to adequate physician numbers.
| From Table 1 | MetroCore | MetroFringe | Small City | Rural | Sparse | All |
| Primary Care
|
74.6 | 46.8 | 61.4 | 48.1 | 37.4 | 64.1 |
| 13.4 | 6.8 | 10.1 | 4.4 | .1 | 10.4 | |
| Population | 118 m | 20 m | 87 m | 30 m | 6 m | 262 m |
| Number of PC Docs | 88456 | 9467 | 53378 | 14491 | 2351 | 168039 |
| Number of Gen OB-Gyn | 15889 | 1376 | 8780 | 1326 | 6 | 27264 |
40 % non metro in shortage - 51 million people in non metro US and 20 million of these non metro citizens live in shortage area Sheps Center UNC
10 % metro in shortage - 211 million people in metro US and 21 million of these metro citizens live in shortage areas
Note also that public health funding is grossly maldistributed as well Rural Public Health
|
Number of Federal Safety Net physicians COGME Aug 2000 |
|
| Federally Qualified Health Centers | 3409 |
| National Health Service Corps | 946 60% in rural (sheps 1996) |
| Indian Health Service | 840 |
| Total | 5195 |
| J-1 Visa waiver doctors | 2700 |
|
Calculations of Contribution of Family Medicine Residency Training |
|
| Family Medicine Resident Contributions .3 FTE (average for all 3 years x 9000 residents conservative) | 2700 - often in shortage areas or serving underserved populations |
| Family Medicine Faculty Contributions (3000 MD and DO faculty x .3 FTE) | 900 - often in shortage areas or serving underserved populations |
| Even if a fraction of this FTE involves shortage, this is still a considerable direct contribution to the safety net, over and above previously reported contributions of FP graduates at http://www.aafp.org/afp/20010501/policy.html | |
Maps of Rural demographics, Shortage, etc http://www.shepscenter.unc.edu/research_programs/Rural_Program/maps/maps.html
Facts About Rural Physicians http://www.shepscenter.unc.edu/research_programs/rural_program/phy.html excellent, more from this site below, complete site link above
The Federal government designates areas with a shortage of practitioners
as Health Professional Shortage Areas or HPSAs. Such designation
qualifies these areas for federal grant dollars, National Health
Service Corps placement of practitioners, and some enhancement
of federal insurance reimbursements in order to bolster health
care services in those localities. The Department of Health and
Human Services uses a ratio of one primary care physician per
3,500 population or more (1:3,500) as the standard for a primary
care HPSA designation.The Department's recommended ratio for an
"adequately served" population is one primary care physician for
2,000 people.
More than 20 million Americans live in nonmetropolitan areas with
a shortage of primary care physicians. Persons living in nonmetropolitan
areas are nearly 4 times more likely to live in a HPSA than persons
in metropolitan areas.
In 1997, more than 2,200 physicians are needed in nonmetropolitan
areas to remove all nonmetropolitan HPSA designations for primary
care. More than twice that number are needed to achieve a 2,000:1
ratio in those HPSAs.5
As of June 1997, of the 2,597 designated primary medical care
HPSAs, 1,742 (67%) were in nonmetropoltian areas:5 763 whole county nonmetropolitan HPSAs and 732 partial county
nonmetropolitan HPSAs.
As an incentive to physicians to practice in HPSAs, both nonmetropolitan
and metropolitan, Medicare adds a 10% bonus to its payments for
services provided in HPSAs. Physicians in nonmetropolitan areas
received a higher percentage of gross practice revenue (33%) from
Medicare than metropolitan physicians (27%) in 1994.7
A greater proportion of bonus payments in nonmetropolitan areas
is for primary care physicians' services than in metropolitan
areas. Nearly two-thirds of payments in nonmetropolitan HPSAs
were made to primary care physicians, compared to about one-third
of payments in metropolitan HPSAs.