At least five of Washington's eight wards contain fewer doctors in private medical practice than are needed to provide primary care for ward residents, according to a city survey released yesterday.
The study showed that the supply of private physicians is lowest in the neighborhoods east of the Anacostia River. Of 1,269 full-time practices surveyed over the past year, only 22 were located in Ward 7 and 42 in Ward 8, both populated mostly by poor and middle-income black residents. The study found a total of 934 doctors' offices in Ward 2, which includes downtown and the inner-city areas, and Ward 3, west of Rock Creek Park.
The survey dealt only with doctors practicing full-time in private offices and did not evaluate health care available from private or public community health centers or hospitals.
It said patients make more use of those kinds of facilities in Wards 7 and 8 than elsewhere in the city, and that more study is needed to determine whether that is due to the absence of private practices in those areas.
The survey draws no conclusions about what the distribution of physicians means for total health care in the city, which is the subject of a separate study still in progress. Larry J. DeNeal prepared the report for Washington's State Health Planning and Development Agency.
Based solely on the availability of private doctors, the report said Wards 2 and 3 are the only areas of the city with "a sufficient supply of primary care practitioners." The report based its definition of sufficient supply on a 1972 study printed in the New England Journal of Medicine, which said that 1.3 physicians are needed for every 1,000 residents in an area.
A chart accompanying the report showed that Ward 4, the mostly middle-income area of Northwest Washington just east of Rock Creek Park, also has enough doctors' offices to meet that standard. Officials last night could not explain the discrepancy between the text and the chart.
The chart showed 76 private practice physicians in Ward 1, or .98 doctors per 1,000 residents; 519 in Ward 2, or 7.14 per 1,000; 360 in Ward 3 or 4.08 per 1,000; 126 in Ward 4 or 1.52 per 1,000 residents; 67 in Ward 5 or .82 per 1,000; and 57 in Ward 6, or .78 per 1,000. Ward 7 has .26 doctors per 1,000 residents, according to the study, while Ward 8 has .54 doctors per 1,000.
The high number of doctors concentrated in Wards 2 and 3 gives Washington as a whole a ratio of 1.99 doctors per 1,000 persons.
Carl W. Wilson, director of the state health planning and development agency, said the survey's results show that "although the District is frequently characterized as having a significant amount of private practice physicians, we found the District does not have the highest number to serve all the city."
All those statistics are based on ward lines before this spring's redistricting, and the numbers for individual wards may have changed slightly as a result of the redrawing of the ward lines. The most significant ward adjustment, however, was a shifting of the line between wards 2 and 3.
The report said federal studies of major cities have shown that some areas fail to attract private physicians because they do not offer access to "comparable office space, professional contacts, patient access, technically advanced medical facilities and opportunities for financial and professional advancement" found in central business cores. "In addition, higher crime rates and poverty deter the establishment of private practices," the study said.
DeNeal said that the largest number of private offices are located on K Street NW at Washington Circle and Farragut Square, both near the George Washington University hospital.
"The doctors tend to cluster around the area's medical centers," DeNeal said.
Ruth Richardson, an Advisory Neighborhood commissioner in Ward 8 and a registered nurse, said yesterday that residents in Ward 7 and 8 are forced to use hospitals for emergency treatment and general care. "There's no chance for preventive health care. People come when they have an ailment."
DeNeal said the city is working with the U.S. Public Health Service in an effort to attract more of its physicians to the areas of the city with few private health services. "This year we have four coming. We hope to get more," DeNeal said of the federal program that helps pay for education costs and equipment for doctors who agree to locate in underserved areas of the country.
DeNeal said there are 7,175 physicians licensed to practice medicine in the District, but his office found only 4,100 of them actually had Washington addresses listed with the medical societies here and the 1980 public telephone book.
Of those 4,100, DeNeal said, the office found that 1,372 of the physicians had died, retired or moved away. Another 697, he said, did not respond to the survey. An additional 731 said they did not have private practices in the District.