The Changing Geographic Distribution of Board-Certified Physicians

We studied the recent distribution of board-certified specialists among cities and towns of different sizes. Between 1960 and 1977, diplomates of the eight specialty boards that we studied appeared for the first time in many small nonmetropolitan towns. The percentage increase in numbers of specialists in small towns significantly exceeded that in cities, but the absolute increase in specialists per 100,000 persons was greater in metropolitan areas. Our findings suggest that the increased supply of specialists activated market forces that caused the observed changes in distribution. It is also possible that a new preference for small-town living has contributed to this evolving pattern. If an increase in physician supply has been the major force responsible for the movement into nonmetropolitan areas, this trend implies that smaller and smaller towns will acquire board-certified specialists as the number of physicians increases. (N Engl J Med. 1980; 303:1032–8.) THE geographic distribution of physicians continues to be a major concern of public policy. The high degree of specialization among recent graduates has accentuated the fear that areas outside urban centers will remain underserved despite the large increase in the number of physicians. 1 2 3 It is said that specialists prefer the metropolis and can locate there in excessive numbers because they are less subject to economic competition than are providers of other types of goods and services. 4 5 6 7 8 9 10 We undertook this study to record the distribution of board-certified specialists in recent years and to learn what forces have influenced their choice of . . .