title: Geographic maldistribution of primary care for children.
abstract: OBJECTIVE
  This study examines growth in the primary care physician workforce for children and examines the geographic distribution of the workforce.
  
  
  METHODS
  National data were used to calculate the local per-capita supply of clinically active general pediatricians and family physicians, measured at the level of primary care service areas.
  
  
  RESULTS
  Between 1996 and 2006, the general pediatrician and family physician workforces expanded by 51% and 35%, respectively, whereas the child population increased by only 9%. The 2006 per-capita supply varied by >600% across local primary care markets. Nearly 15 million children (20% of the US child population) lived in local markets with <710 children per child physician (average of 141 child physicians per 100 000 children), whereas another 15 million lived in areas with >4400 children per child physician (average of 22 child physicians per 100 000 children). In addition, almost 1 million children lived in areas with no local child physician. Nearly all 50 states had evidence of similar extremes of physician maldistribution.
  
  
  CONCLUSIONS
  Undirected growth of the aggregate child physician workforce has resulted in profound maldistribution of physician resources. Accountability for public funding of physician training should include efforts to develop, to use, and to evaluate policies aimed at reducing disparities in geographic access to primary care physicians for children.
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Suite 202, Lebanon, NH 03766, USA. scott.shipman@dartmouth.edu
authors.forename: Scott A
authors.initials: SA
authors.lastname: Shipman
authors.forename: Jia
authors.initials: J
authors.lastname: Lan
authors.forename: Chiang-Hua
authors.initials: CH
authors.lastname: Chang
authors.forename: David C
authors.initials: DC
authors.lastname: Goodman
mesh_terms: D002648:Child; D002662:Child Health Services / Q000600:supply & distribution*; D005194:Family Practice; D006801:Humans; D010372:Pediatrics; D011320:Primary Health Care; D014481:United States; D000078329:Workforce