Chang R K, Halfon N
Department of Pediatrics, UCLA School of Medicine, Los Angeles, California, USA.
Pediatrics. 1997 Aug;100(2 Pt 1):172-9. doi: 10.1542/peds.100.2.172.
To determine current geographic distribution of pediatricians in the United States, to assess the changes in the geographic distribution of pediatricians between 1982 and 1992, and to identify factors associated with the distribution of pediatricians among the 50 states.
A data set was constructed using several published data sources including the American Medical Association Physician Masterfile as the principal source for physician information. The pediatrician-to-child population ratio (PCPR, the number of pediatricians per 100 000 people under 18 years of age) was calculated to compare the distribution of pediatricians among states and the distributional changes between 1982 and 1992. Lorenz curves and Gini indices were used to describe distributions and to compare distributions across time periods. Linear regression analysis was performed to assess the relationship between PCPR (dependent variable) with 9 predictor variables.
Between 1982 and 1992, there was a 5.4% increase in the United States (US) child population and a 46.1% increase in the number of pediatricians in patient care. During that time period, the PCPR increased by 38.6% from 35.1 per 100 000 to 48.6 per 100 000. There was a more than 4-fold difference in the PCPRs of the highest state (Maryland, 84.3) and the lowest state (Idaho, 18.5) in 1992. The PCPR increased in all 50 states, but varied from a 4.1% increase in Wyoming to a 63.4% increase in Massachusetts. The Lorenz curve showed that pediatricians were less evenly distributed than all physicians, but more evenly distributed than pediatric cardiologists. Between 1982 to 1992 the Gini index decreased 9.8% for all physicians and 10.2% for pediatric cardiologists, but only 1. 9% for pediatricians. Since a decrease in the Gini index signifies better overall distribution, these changes are relatively modest for pediatricians as a whole, especially when compared to other physicians. Regression analysis showed that a higher PCPR was associated with a greater number of residency positions per 100 000 children and with the per capita income of the state (R = .93).
The distribution of pediatricians does not parallel the distribution of the child population in the US, nor has this distribution changed substantially in spite of a 38.6% increase in the PCPR. Pediatricians tend to concentrate in states with high per capita income and in states with a larger number of residency training positions. The failure of market forces to improve the geographic distribution may require manpower policy changes designed to improve distribution in underrepresented states. The uncertain impact of market changes due to increased use of managed care could affect distributional requirements of pediatricians in the future.
确定美国儿科医生的当前地理分布，评估1982年至1992年间儿科医生地理分布的变化，并确定与50个州儿科医生分布相关的因素。
使用多个已发表的数据源构建数据集，其中美国医学协会医生主文件作为医生信息的主要来源。计算儿科医生与儿童人口比例（PCPR，每10万名18岁以下儿童中的儿科医生数量），以比较各州之间儿科医生的分布以及1982年至1992年间的分布变化。使用洛伦兹曲线和基尼系数来描述分布并比较不同时间段的分布。进行线性回归分析以评估PCPR（因变量）与9个预测变量之间的关系。
1982年至1992年间，美国儿童人口增加了5.4%，从事患者护理的儿科医生数量增加了46.1%。在此期间，PCPR从每10万人口35.1名增加到48.6名，增长了38.6%。1992年，PCPR最高的州（马里兰州，84.3）与最低的州（爱达荷州，18.5）之间存在超过4倍的差异。所有50个州的PCPR均有所增加，但增幅从怀俄明州的4.1%到马萨诸塞州的63.4%不等。洛伦兹曲线显示，儿科医生的分布不如所有医生均匀，但比儿科心脏病专家均匀。1982年至l992年间，所有医生的基尼系数下降了9.8%，儿科心脏病专家的基尼系数下降了10.2%，而儿科医生的基尼系数仅下降了1.9%。由于基尼系数下降表示总体分布更好，因此对于整个儿科医生群体而言这些变化相对较小，尤其是与其他医生相比。回归分析表明，较高的PCPR与每10万名儿童中更多的住院医师职位以及该州的人均收入相关（R = 0.93）。
美国儿科医生的分布与儿童人口的分布不平行，尽管PCPR增加了38.6%，但这种分布也没有实质性变化。儿科医生倾向于集中在人均收入高的州以及住院医师培训职位较多的州。市场力量未能改善地理分布，可能需要改变人力政策以改善在代表性不足的州的分布。由于管理式医疗使用增加导致的市场变化的不确定影响，可能会影响未来儿科医生的分布需求。
