Vaccination coverage and physician distribution in the United States, 1997

Background. How many physicians are needed in the United States and how the y should be allocated geographically and among specialties has been the sub ject of intense debate, a debate that has often focused more on costs to th ird-party payers and government than on benefits to health. Child health is a central aspect of public health, and immunization is one of its most cos t-effective and easily measured interventions. Objective. To examine the association of immunization rates and delivery ch aracteristics with the distribution of child health physicians in the Unite d States in 1997. Design. Cross-sectional ecological study, using the state as the unit of an alysis, immunization rates and delivery characteristics (from the National Immunization Survey) as the main outcome measures, concentration of the pri ncipal physician specialties providing routine care to children (pediatric, family, and general physicians from the American Medical Association Maste rfile) as the main risk factor, while controlling for demographic and econo mic factors (from the Bureau of the Census and other sources). Results. Of the 96 689 physicians providing routine care to children, 37% w ere pediatric, 49% family, and 14% general physicians. Higher rates of vacc ination, private sector vaccination, and increased numbers of public and pr ivate vaccination sites were all associated with the concentration of pedia tricians but not of family or general physicians. The distribution of pedia tricians was strongly associated with the distribution of residency positio ns. Conclusions. Pediatrician distribution is a strong correlate to immunizatio n rates and delivery characteristics. Opportunities to affect pediatrician distribution may exist with allocation of residency positions.