A lot of pediatricians, but in the wrong places

NEW YORK (Reuters Health) - The number of doctors who treat children has expanded in recent years, but they are not evenly distributed, leaving millions of U.S. kids without good access to medical care, a new study finds.

Specifically, the authors found that the number of pediatricians in the U.S. has increased by 50 percent since 1996, but 15 million children live in regions where there are more than 4,000 children for each child doctor.

Furthermore, nearly 1 million children live in a region with no local physician who treats children.

The findings illustrate that simply training more doctors won't ensure that everyone gets better access to care, study author Dr. Scott Shipman told Reuters Health. "We've had a lot of growth in the workforce, but what we've gotten is extreme maldistribution."

The danger, of course, said Shipman, is that children with conditions that require regular doctors' visits -- such as asthma or diabetes -- will fare worse if they have less access to medical care. "We've got to take this seriously," said the researcher, based at the Dartmouth Institute for Health Policy and Clinical Practice. "It isn't going away."

To investigate the distribution of doctors available to treat children, Shipman and his team reviewed geographic data from pediatricians and from family-practice physicians, who tend to dedicate about 15 percent of their time to children.

On average, the authors found that in 2006 there were nearly 39,000 general pediatricians and 83,000 family physicians, representing one doctor for every 1,420 children in the U.S. There was wide variation within every state, however -- 18 percent of regions showed the equivalent of one full-time child physician for every 1,000 children or fewer, and 15 percent of regions with one full-time doctor serving more than 3,000 children. An additional 1.3 percent of kids lived in an area with no child physician.

Regions with more than 3,000 people per doctor may be designated as official "shortage areas."

Places with fewer doctors tended to be rural, lower income and have a higher percentage of kids living in poverty, the authors report in the journal Pediatrics.

This can be a hard trend to tackle, Shipman said in an interview, since where a doctor chooses to practice is a very personal decision. However, there are some steps officials can take, he said.

For one, medical schools could accept more students who come from rural areas and other under-served regions, since studies show they are more likely to return there. "People who come from rural areas are more likely to go back to rural areas," he said.

Doctors who are part of underrepresented minorities, such as African-Americans or Latinos, are also more likely to choose to serve underrepresented communities, Shipman added.

Furthermore, medical schools are primarily located in urban areas, so many doctors graduate without any sense of what it's like to practice elsewhere. "I think we need to do more to expose trainees to these underserved areas." Incentives, such as scholarships or loan repayments, could also help entice doctors to settle in these regions, Shipman added.

Clearly, a laissez-faire attitude to geographic distribution doesn't work, he noted, since many doctors likely hesitate to settle in regions without as much support from other doctors or specialists, or where it may be harder to find work for their spouse, who is often also a professional.

Experts frequently voice concern that the country is facing a shortage of doctors, though there likely is no overall shortage of doctors who treat children, Shipman said. But this doesn't mean much to the parents who live in an underserved area, he added. "What matters is, 'do I have someone nearby who I can see?' And what we've shown is that millions of kids likely don't."

SOURCE: link.reuters.com/baq23r Pediatrics, online December 20, 2010.