Access to Healthcare

Access to Providers

As regards the distribution of providers, one of the long-standing issues in the quest to equitably distribute physicians across the country is determining whether a sufficient number of physicians are being trained to meet the needs of patients. Additionally, consideration must be given to whether these physicians can be encouraged to work in historically underserved geographic areas, such as inner-city and rural areas. In 2004, there were 884,974 practicing physicians in the United States, 81% of whom worked in metropolitan areas, while 19% worked in nonmetropolitan areas. The overall number of practicing physicians has increased during the past two decades: In 1980, there were 443,502 active physicians in the nation. The number of medical school graduates grew by 12% between 1982 and 1998, but the U.S. population increased by 24% during the same time period. The increase in the supply of physicians has not kept up with the nation's population.

Several government policies have been used since World War II to foster the equitable distribution of physicians across the nation. These policies include the federal government offering incentives to states to increase the number of medical students and reducing immigration barriers to international medical graduates, the development and use of a needs-based approach by the Graduate Medical Education National Advisory Committee (GMENAC) to manage the distribution of physicians, and the recruitment of medical specialists into managed-care organizations in the 1980s to match the expansion in the number of these organizations. Efforts to encourage physicians to practice in underserved areas have been recently complicated by declining healthcare reimbursement rates and increasing malpractice insurance rates. In terms of reimbursement rates, the federal government has traditionally reimbursed healthcare providers at a lower rate for services provided under the Medicaid program than that received from private health insurance companies. As a result, providers who practice in poor communities run the risk of receiving less payment per patient than those medical professionals who practice in other more affluent communities. Additionally, several malpractice insurance crises since the 1970s have discouraged providers from practicing in certain communities or in certain medical specialties, such as obstetrics.

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