GEOGRAPHIC-DISTRIBUTION OF PEDIATRICIANS IN THE UNITED-STATES - AN ANALYSIS OF THE 50 STATES AND WASHINGTON, DC

Objectives. To determine current geographic distribution of pediatrici ans in the United States, to assess the changes in the geographic dist ribution of pediatricians between 1982 and 1992, and to identify facto rs associated with the distribution of pediatricians among the 50 stat es. Methods. A data set was constructed using several published data s ources including the American Medical Association Physician Masterfile as the principal source for physician information. The pediatrician-t o-child population ratio (PCPR, the number of pediatricians per 100 00 0 people under 18 years of age) was calculated to compare the distribu tion of pediatricians among states and the distributional changes betw een 1982 and 1992. Lorenz curves and Gini indices were used to describ e distributions and to compare distributions across time periods. Line ar regression analysis was performed to assess the relationship betwee n PCPR (dependent variable) with 9 predictor variables. Results. Betwe en 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 i n patient care. During that time period, the PCPR increased by 38.6% f rom 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 stat es, but varied from a 4.1% increase in Wyoming to a 63.4% increase in Massachusetts. The Lorenz curve showed that pediatricians were less ev enly distributed than all physicians, but more evenly distributed than pediatric cardiologists. Between 1982 to 1992 the Gini index decrease d 9.8% for all physicians and 10.2% for pediatric cardiologists, but o nly 1.9% for pediatricians. Since a decrease in the Gini index signifi es better overall distribution, these changes are relatively modest fo r pediatricians as a whole, especially when compared to other physicia ns. 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 (A = .93). Conclusions. The distrib ution 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 conce ntrate in states with high per capita income and in states with a larg er number of residency training positions. The failure of market force s to improve the geographic distribution may require manpower policy c hanges designed to improve distribution in underrepresented states. Th e uncertain impact of market changes due to increased use of managed c are could affect distributional requirements of pediatricians in the f uture.