Ahmed Harris, Price Marla J, Robbins Wayne, Braich Puneet S
J Am Osteopath Assoc. 2020 Jun 25. doi: 10.7556/jaoa.2020.090.
While existing data demonstrate that osteopathic physicians (ie, DOs) in primary care are more likely than allopathic physicians (ie, MDs) to practice in rural areas, no data exist on practice patterns of DO surgical subspecialists, such as ophthalmologists. Michigan has a relatively high number of DOs and, formerly, the most osteopathic ophthalmology residency programs in the United States. Analyzing the distribution of ophthalmologists in Michigan may reveal patterns and predict trends about the geographic distribution of DO surgical subspecialists across the country.
To compare geographic distributions of DO and MD ophthalmologists in Michigan and identify differences in community size and type (eg, urbanized area, urban cluster, or rural area) of practice.
A list of Michigan's ophthalmologists practicing in 2018 was developed using the Centers for Medicare and Medicaid Services, the American Osteopathic College of Ophthalmology, and the American Medical Association data sets. DOs and MDs were then analyzed by determining where each ophthalmologist practiced, identifying the size and type of community in which they practiced, and finally by comparing the percentage of DOs and MDs who practiced in various community sizes and each community type as defined by the US Census Bureau. A χ2 analysis was used to determine whether a difference existed in practice locations.
A total of 643 ophthalmologists practiced in Michigan in 2018, including 85 DOs and 558 MDs. A greater proportion of DOs worked in rural areas and urban clusters (57 [67%]), whereas a greater proportion of MDs worked in urbanized areas (368 [66%]). Of DOs, 28 (33%) practiced in cities with a population of at least 50,000 vs 371 MDs (66%). Fourteen DOs (16%) practiced in communities with a population of at least 100,000 vs 207 MDs (37%). χ2 analysis showed a significant difference in the geographic distribution of ophthalmologist DOs and MDs (P<.01).
Higher proportions of DOs practice ophthalmology in smaller, more rural Michigan communities compared with MDs, implying that a subgroup exists that tends to serve underserved areas.
虽然现有数据表明，从事初级保健的整骨疗法医生（即DO）比全科医生（即MD）更有可能在农村地区执业，但关于整骨外科专科医生（如眼科医生）的执业模式尚无数据。密歇根州的整骨疗法医生数量相对较多，而且以前是美国整骨眼科住院医师培训项目最多的州。分析密歇根州眼科医生的分布情况，可能会揭示整骨外科专科医生在全国地理分布的模式并预测趋势。
比较密歇根州整骨疗法和全科眼科医生的地理分布，并确定其执业的社区规模和类型（如城市化地区、城市集群或农村地区）的差异。
利用医疗保险和医疗补助服务中心、美国整骨眼科医学院和美国医学协会的数据集，编制了一份2018年在密歇根州执业的眼科医生名单。然后，通过确定每位眼科医生的执业地点、确定他们执业的社区规模和类型，最后比较在不同社区规模和美国人口普查局定义的每种社区类型中执业的整骨疗法医生和全科医生的百分比，对整骨疗法医生和全科医生进行分析。采用χ2分析来确定执业地点是否存在差异。
2018年共有643名眼科医生在密歇根州执业，其中包括85名整骨疗法医生和558名全科医生。更大比例的整骨疗法医生在农村地区和城市集群工作（57名[67%]），而更大比例的全科医生在城市化地区工作（368名[66%]）。在整骨疗法医生中，28名（33%）在人口至少5万的城市执业，而全科医生有371名（66%）。14名整骨疗法医生（16%）在人口至少10万的社区执业，而全科医生有207名（37%）。χ2分析显示，整骨疗法眼科医生和全科眼科医生的地理分布存在显著差异（P<.01）。
与全科医生相比，在密歇根州较小、更偏远的社区从事眼科工作的整骨疗法医生比例更高，这意味着存在一个倾向于服务未得到充分服务地区的亚群体。
