Geographic Care Disparities in Pediatric Populations

When it comes to access to a primary care physician, significant geographic disparities exist, particularly for those who live in rural areas, according to a study published in Pediatrics.

Nearly one million children in the United States live in areas (often rural) where there is no local primary care physician, whereas many urban areas have abundant coverage—an average of one physician for every 140 children in some locations. Although the overall number of pediatricians and family physicians has grown dramatically, this has proven to be an inefficient mechanism to improve children’s geographic access to primary care, according to researchers.

In the study, Scott A. Shipman, MD, MPH, of Dartmouth Medical School, Hanover, NH, and colleagues examined the growth that has occurred in the primary care physician workforce for children, as well as the geographic distribution of the workforce, using national data to calculate the local per-capita supply of clinically active general pediatricians and family physicians, measured at the level of primary care service areas.

They found that between 1996 and 2006, the general pediatrician workforce expanded by 51% and the family physician workforce grew by 35%, while the child population increased by only 9%. The 2006 per-capita supply varied by >600% across local primary care markets.

Nearly 15 million children, which equates to about 20% of the US child population, lived in local markets with less than 710 children per child physician (an average of 141 child physicians per 100,000 children), whereas another 15 million lived in areas with more than 4,400 children per child physician (an average of 22 child physicians per 100,000 children).

Shipman and colleagues also determined that almost 1 million children lived in areas with no local child physician, and nearly all 50 states had evidence of similar extremes of physician maldistribution.

In light of the disparity in physician resources, the authors believe that other approaches, including targeted incentives to physicians, are needed to promote practice in underserved areas. Physician training should expand efforts to produce primary care physicians who are interested in practicing in underserved areas, they wrote, adding that “medical schools and residency programs need to identify students more likely to work in underserved areas and foster their interest and desire in helping these communities.”

Public funding for physician training could be leveraged to include efforts to reduce these geographic disparities, they added.

For more on this topic:

• What Will Open the Doors for Children and Youth with Special Health Care Needs from Traditionally Underserved Communities? (Pediatrics)
• Health Behaviors and Health-Related Quality of Life among Middle School Children in Southern Appalachia (Journal of Pediatric Psychology)
• Primary Care Physician Supply and Children's Health Care Use, Access, and Outcomes: Findings from Canada (Pediatrics)