Evashwick C J
Med Care. 1976 Oct;14(10):808-23. doi: 10.1097/00005650-197610000-00002.
The geographic maldistribution of physicians persists as a major obstacle to improving the availability of health services in rural areas. This study looks at group practice as a potential factor in the location of physicians in nonmetropolitan areas. The basic assumptions are 1) the expected conditions of practice are critical to a physician's decision about where to locate, and 2) a group practice form of organization alleviates many of the deterrents to rural practice. The sample for the study is 287 nonmetropolitan trade areas in eight geographic regions of the U.S. Stepwise multiple regression is used to evaluate the relationship of demographic and health system variables, including group practice, to the physician/population ratio. Analyses are done for 1960 and 1970 and then for the change over the ten-year time period. The regression outcomes show that income, population over age 64, and urbanization are most helpful in explaining physician distribution in 1960. In 1970, hospital facilities also contribute. However, the percentage change in the physician/population ratio between 1960 and 1970 is explained by the 1960 physician/population ratio and the per cent of physicians in group practice in 1960. The findings suggest that attractive practice arrangements may be one way to alter the geographic maldistribution of physicians.
医生的地理分布不均仍然是改善农村地区医疗服务可及性的主要障碍。本研究将团体医疗视为影响医生在非都市地区选址的一个潜在因素。基本假设为：1）预期的执业条件对医生的选址决策至关重要；2）团体医疗组织形式可减轻许多农村执业的阻碍因素。该研究的样本是美国八个地理区域的287个非都市贸易区。采用逐步多元回归分析来评估人口统计学和卫生系统变量（包括团体医疗）与医生/人口比率之间的关系。分别对1960年和1970年进行分析，然后分析这十年间的变化情况。回归结果表明，收入、64岁以上人口以及城市化程度对解释1960年的医生分布情况最有帮助。1970年，医院设施也有影响。然而，1960年至1970年间医生/人口比率的变化百分比可由1960年的医生/人口比率和1960年团体医疗中医生的百分比来解释。研究结果表明，有吸引力的执业安排可能是改变医生地理分布不均的一种方式。
