title: Does the insufficient supply of physicians worsen their urban-rural distribution? A Hiroshima-Nagasaki comparison.
abstract: BACKGROUND
  Studies have suggested that a rapid increase in physicians does not necessarily change an urban-rural inequity in their distribution. However, it is unknown whether an insufficient supply of physicians worsens an inequity. Spatial competition and attraction-repulsion hypotheses were applied to the geographic distribution of physicians during a time of insufficient physician supply in Japan.
  
  
  METHODS
  Trends of physician distribution as well as urban-rural physician flow were compared using Hiroshima Prefecture which had the lowest increase in physician-to-population ratios between 2002 and 2008 (2.7%), and Nagasaki Prefecture where the increase was one of the highest (12.0%) among the 47 Japanese prefectures.
  
  
  RESULTS
  The Gini coefficient of physicians compared with population in Hiroshima increased by 4.1%. Movement toward inequity was greater in Hiroshima compared with Nagasaki where the increase was 2.5%. Approximately 245 physicians or 18.8% moved from rural to urban locations in Hiroshima compared with 143 (14.6%) for Nagasaki (p=0.01). In contrast, 228 (7.6%) urban physicians moved to rural areas in Hiroshima compared with 175 (11.6%) in Nagasaki (p<0.001).
  
  
  CONCLUSIONS
  In a time of insufficient supply of physicians, a region with a smaller increase in physicians may experience worsening of the urban-rural distribution of physicians compared with a region where there is a more rapid increase in physicians. One strategy for achieving a more equitable distribution of physicians is to increase in the physician supply relative to demand in order to stimulate competition among urban physicians and maintain the power equilibrium between attraction-to and repulsion-from urban areas.
authors.affiliation: Department of Community-Based Medical System, Faculty of Medicine, Hiroshima University, Hiroshima, Japan. matmo10@jb3.so-net.ne.jp
authors.forename: M
authors.initials: M
authors.lastname: Matsumoto
authors.forename: K
authors.initials: K
authors.lastname: Inoue
authors.forename: S
authors.initials: S
authors.lastname: Kashima
authors.forename: K
authors.initials: K
authors.lastname: Takeuchi
mesh_terms: D054625:Healthcare Disparities; D006801:Humans; D007564:Japan; D010820:Physicians / Q000600:supply & distribution* / Q000639:trends*; D019035:Rural Health Services; D012424:Rural Population; D019037:Urban Health Services; D014505:Urban Population; D000078329:Workforce