The physician shortage, especially that of primary care physicians, is well documented in the United States. But even in specialties where there seem to be adequate numbers of doctors to service the citizens of the US, relative geographic shortages can occur. It turns out that this is not a problem specific to this country:
Doctors are distributed unequally across different regions in virtually all OECD countries, and this causes concern about how to continue to ensure access to health services everywhere. In particular access to services in rural regions is the focus of attention of policymakers, although in some countries, poor urban and sub-urban regions pose a challenge as well. Despite numerous efforts this maldistribution of physician supply persists. This working paper first examines the drivers of the location choice of physicians, and second, it examines policy responses in a number of OECD countries.
It’s not just that rural and sparse areas can be deficient in health services. Some urban, populated areas can suffer, too. Why?
Some of the reasons aren’t surprising. Some places are just more attractive to work and live than others. It’s not shocking that physicians, like everyone else, are attracted to some areas and not to others. Compensation can also be a factor. While doctors in dense urban areas often make less than those in rural areas, the increase in income may not be enough to entice many to move. It’s also sometimes more prestigious to work in denser areas, and less so to live in the middle of nowhere.
The most common method to try and reverse this trend is to use financial incentives. Those have often failed, though. What else can we do? The OECD report I highlighted above offers some ideas.
First, they suggest that we move some of the focus to medical students. Even before acceptance, we could identify students who are more likely to want to work in rural or underserved areas. While it’s very difficult to force physicians to hold these interests over long periods of time, there are ways to maximize the number of graduates with the most potential to want to work in such areas.
Second, they recommend a “carrot and stick” approach. We might consider continuing financial incentives to attract doctors to underserved areas. But we should also consider regulations that restrict the number of physicians in some areas while increasing them in others.
Third, we could redesign health services configurations to maximize productivity with a reduced workforce. These could include the increased use of mid-level providers, as well as technology to increase the ability to care for patients from a distance.
None of these are completely new ideas. But it’s interesting to see these issues presented in an international setting. There are many problems in the US health care system that we hoped can be fixed by financing reform. This does not appear to be one of them. Other countries’ health care systems come in many flavors, from socialized, to exchange-managed, to more privately run. But almost all of them seem to suffer this problem.
Recognizing that, we have to stop relying on insurance reform to fix the issue of physician shortages. We also have to stop blaming reform for this problem. It’s one that all kinds of health care systems face, and one we need to solve independent of our disagreements over the Affordable Care Act.