Where are the doctors?

at 10:00 AM ET, 12/03/2011

In health reform, there’s a lot of talk about an impending “doctor shortage,” where we’ll have too few physicians to treat a population that’s getting increasingly older and sicker. By 2020, we’ll have 90,000 fewer doctors than we need, according to projections from the Association of American Medical Colleges.

That big number, however, masks a lot of geographic variation. Some states are hugely lacking in doctors; others have many physicians. A few maps released Friday, also by AAMC, probe the geography of our impending doctor shortage and what makes particular states more susceptible than others.

First, let’s start with where the doctors are. Northeastern states have the highest concentration of doctors, while Southern states, as well as those in the West, have some of the lowest. It’s a pretty striking disparity. Massachusetts, for example, has twice as many doctors per capita as Mississippi:

Why do doctors practice where they do? Some of the reasons that particular states have more doctors than others are easy: Rural areas have traditionally had trouble attracting physicians, and doctors tend to stay where they train. AAMC finds in this study that about two-thirds of doctors stay in a state where they did at least part of their medical education.

But that doesn’t really explain what’s going on in this map. Texas, for example, is home to two of the country’s largest cities, Dallas and Houston. It graduated more than 1,200 medical students last year, second only to New York. About 80 percent of doctors who train in Texas stay in Texas. Yet it has one of the lowest levels of doctors seen in the country.

Compare that to Maine, a state with one medical school that somehow manages to have one of the highest levels of physicians.

What drives doctors out of one state and into another is actually pretty difficult to figure out. The map of physicians doesn’t line up nicely with one showing a state’s average income or its population size. Rates of uninsurance or aggressive tort reform laws don’t really predict much, either. States with fewer doctors tend to be more rural, but there are certainly exceptions: Nevada has an exceptionally low rate of doctors despite 91 percent of its population living in urban areas, according to census data.

One factor that the AAMC report points to is the percentage of international medical graduates. Nearly all the states with higher rates of doctors also show a larger percentage of their physician workforce educated outside the United States. Aside from that, though, why doctors practice where they do remains difficult to decipher.

Correction: A previous version of this post incorrectly stated that Maine does not have a medical school. It has one medical school, the University of New England.

 
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