The national physician supply grew at twice the rate of the U.S. population in the last decade, but geographic disparities persist, according to a report released today by the U.S. General Accounting Office.
The overall physician population in the United States increased 21% between 1991 and 2001, the GAO study finds.
Even though rural counties with a large town of 10,000 to 20,000 residents had the biggest increase in number of physicians per 100,000 people, the physician supply in nonmetropolitan counties remained less than those of large and small metropolitan counties, the report says.
Sen. Judd Gregg (R-N.H.), chairman of the Committee on Health, Education, Labor and Pensions, requested the study in anticipation of the reauthorization of several programs administered by the Health Resources and Services Administration (HRSA), a division of HHS, that fund physician education and encourage physicians to practice primary care in underserved areas.
The average number of physicians per 100,000 nationwide was 214 in 1991 and 239 in 2001. The mix of generalists and specialists remained steady during that time, at about one-third generalists and two-thirds specialists.
In metropolitan areas, the number of physicians per 100,000 grew from 242 in 1991 to 267 in 2001. In nonmetropolitan areas, the number rose from 99 physicians per 100,000 people in 1991 to 122 physicians per 100,000 in 2001.
In the 1990s, the Council on Graduate Medical Education, or COGME, forecast a national surplus of physicians based on its determination that appropriate physician supply ranged from 145 to 185 doctors per 100,000 people. COGME reversed its position in September, saying there is a shortage of physicians and calling for a 15% increase in the number of medical school graduates by 2015.
"Disagreement about the adequacy of physician supply arises because there is no single accepted approach to estimating physician supply or demand," the GAO study says, citing a report by the Institute of Medicine. "In spite of the difficulty of determining whether the overall number of physicians is indeed the right number, there is little disagreement that physicians have been located disproportionately in metropolitan areas relative to the U.S. population."
Various economic factors and professional preferences have been offered as explanation for why physicians, particularly specialists, opt to practice in metropolitan areas.
In its comments on a draft copy of the report, HRSA notes that rural citizens are still "grossly underserved" and that physician supply can be a "rough measure" of access to physician services in a given area, which is dependent on a number of other factors.
HRSA suggested a future study could discuss the physician and healthcare resources needed to ensure sufficient care for the U.S. population. The GAO says assessing the adequacy of physician access was beyond the scope of their work.