Ricketts Thomas C, Randolph Randy
Rural Health Research Program, Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA.
J Rural Health. 2007 Autumn;23(4):277-85. doi: 10.1111/j.1748-0361.2007.00104.x.
Physician supply is anticipated to fall short of national requirements over the next 20 years. Rural areas are likely to lose relatively more physicians. Policy makers must know how to anticipate what changes in distribution are likely to happen to better target policies.
To determine whether there was a significant flow of physicians from urban to rural areas in recent years when the overall supply of physicians has been considered in balance with needs.
Individual records from merged AMA Physician Masterfiles for 1981, 1986, 1991, 1996, 2001, and 2003 were used to track movements from urban to rural and rural to urban counties. Individual physician locations were tracked over 5-year intervals during the period 1981 to 2001, with an additional assessment for movements in 2001-2003.
Approximately 25% of physicians moved across county boundaries in any given 5-year period but the relative distribution of urban-rural supply remained relatively stable. One third of all physicians remained in the same urban or rural practice location for most of their professional careers. There was a small net movement of physicians from urban to rural areas from 1981 to 2003.
The data show a net flow from urban to rural places, suggesting a geographic diffusion of physicians in response to economic forces. However, the small gain in rural areas may also be explained by programs that are intended to counter normal market pressures for urban concentrations of professionals. It is likely that in the face of an overall shortage, rural areas will lose physician supply relative to population.
预计在未来20年里，医生供应将无法满足国家需求。农村地区可能会流失相对更多的医生。政策制定者必须知道如何预测可能发生的分布变化，以便更好地制定针对性政策。
在医生总体供应被认为与需求平衡的近年来，确定是否存在医生从城市大量流向农村地区的情况。
利用1981年、1986年、1991年、1996年、2001年和2003年合并后的美国医学协会医生主文件中的个人记录，追踪医生从城市到农村以及从农村到城市县的流动情况。在1981年至2001年期间，每隔5年追踪一次医生的个人所在地，并对2001 - 2003年的流动情况进行额外评估。
在任何给定的5年期间，约25%的医生跨县流动，但城乡供应的相对分布仍相对稳定。三分之一的医生在其职业生涯的大部分时间里都留在同一个城市或农村执业地点。1981年至2003年期间，有少量医生从城市净流向农村地区。
数据显示存在从城市到农村地区的净流动，这表明医生因经济因素而出现地理扩散。然而，农村地区的少量增长也可能是由旨在应对专业人员集中在城市的正常市场压力的项目所导致的。面对总体短缺的情况，农村地区相对于人口而言可能会失去医生供应。
