Miller A E, Miller M G, Adelman J
Med Care. 1978 Oct;16(10):799-818. doi: 10.1097/00005650-197810000-00001.
The twenty largest multi-county SMSAs in the U. S. were studied for trends in the suburbanization of medical practice from 1959 to 1974. Fifteen of them allowed a distinction between suburbs and central city on the county level according to criteria developed from a New York City pilot study. In all SMSAs, the density of hospital-based physicians was higher in central cities than in suburbs and still increasing more rapidly there, though hospital practice is also starting to grow in the suburbs at an appreciable rate. The same trends were found for physicians in non-patient care activities. Office based specialists in large Northeastern SMSAs increased much more rapidly in the urbanized suburbs than in the central cities. In the Southern and Western SMSAs, on the contrary, office-based specialists continued to increase rapidly in the central cities despite concentrations already far greater than in the Northeast. Suburban desities were growing more slowly in these areas. General practitioners declined uniformly everywhere, apparently simply by attrition. Implications of these trends for health care are discussed.
对美国最大的20个多县标准都市统计区进行了研究，以了解1959年至1974年医疗业务郊区化的趋势。其中15个地区根据纽约市试点研究制定的标准，在县一级能够区分郊区和中心城市。在所有标准都市统计区中，以医院为基础的医生密度在中心城市高于郊区，且在中心城市仍在以更快的速度增长，不过郊区的医院业务也开始以可观的速度增长。非患者护理活动中的医生也呈现出同样的趋势。在东北部大型标准都市统计区，城市化郊区的门诊专科医生增长速度比中心城市快得多。相反，在南部和西部标准都市统计区，尽管中心城市的专科医生集中度已经远远高于东北部，但门诊专科医生仍在中心城市快速增加。这些地区的郊区密度增长较为缓慢。全科医生在各地都呈普遍下降趋势，显然只是由于人员自然损耗。文中讨论了这些趋势对医疗保健的影响。
