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Office
of Social and Economic Data Analysis March 2002 |
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CHANGES IN PHYSICIAN POPULATION, 1990 – 2000 The number of active physicians in Missouri increased 25.8 percent between 1990 and 2000, from 9,789 in 1990 to 12,316 in 2000. During this same decade, the population in Missouri increased by only 9.3 percent, resulting in a 17.3 percent increase in the physician population ratio. In 1990, Missouri had 19.1 active physicians per 10,000 populations, compared to the national rate of 23.0. In 2000, Missouri had 22.4 physicians per 10,000, still below the national rate of 22.9 in 1999.
While the overall supply of physicians increased in Missouri relative to the population, this growth did not occur uniformly throughout the state. As Map 1 shows, 37 counties experienced either no change or a decline in the ratio of physicians per 10,000 population during the 1990s. In addition, the rate of change could not be calculated for two counties because there were no physicians in those counties—one county lacked physicians in 1990, and the other one lacked physicians in 2000. However, while individual counties experienced decline, no change or increase when the counties are aggregated into regions within the state, all regions experienced increases in the physician population ratio.
As Map 2 shows, the physician supply in 2000 is not distributed evenly throughout the state—the ratio of physicians per 10,000 population ranged from 0.0 to 68.1 among the counties. While 28 counties had more than 10.5 physicians per 10,000, another 28 counties had fewer than 4.0 physicians per 10,000. The map also shows that there are clusters of counties with few physicians, increasing the geographic distance necessary for persons to access physician services. Supply of Rural Physicians The level of urbanization affects demographic, environmental, economic, and social characteristics of the population. Urbanization also affects availability of physician services. In general, the relative lack of physicians in non-metropolitan/rural areas has been attributed to the professional and personal isolation experienced by physicians and their families, the lack of hospitals and medical technologies in the local area, and differences in income. Another factor impacting availability of physicians in less populated areas is increased physician specialization. As physicians become more specialized, they require larger patient population bases to support that specialty. In 2000, Missouri had 93 counties classified as non-metropolitan. These 93 counties contained 82.4 percent of the state’s landmass, but only 32.2 percent of the population. In addition, only 16.0 percent of the active physicians in 2000 practiced in one of those counties. In the 93 non-metro counties there were 11.2 physicians per 10,000 population, compared with 27.7/10,000 in metropolitan Missouri. Of these 93 counties, 26 had fewer than 10,000 residents, with nine of these low-density counties having fewer than 4.0 physicians per 10,000 population. Specialization of Physicians As mentioned above, specialization of physicians is a major concomitant of the geographic distribution of physicians. Throughout most of the past century, the relative number of physicians electing to practice primary care has declined. As the medical profession became increasingly focused on specialty care, fewer physicians established practices in non-metropolitan areas, especially in the more sparsely populated rural areas. During the last decade, however, there has been a shift in the number of physicians entering primary care. In 1993, 46.0 percent of Missouri physicians were in the primary care specialties of family practice, general practice, general internal medicine, general pediatrics, obstetrics/gynecology, and general surgery. By 2000, that percentage had increased to 49.0 percent. The increased election to primary care specialists may have contributed to the increase in physicians practicing in non-metropolitan areas. During the 1990s, the number of physicians per 10,000 population increased 22.8 percent in non-metropolitan areas, compared to an increase of 16.4 percent in the metropolitan areas. While non-metropolitan areas still have fewer physicians per 10,000 populations (11.2) than the metropolitan areas of Missouri (27.7), the gap narrowed slightly during the 1990s. Summary The physician population ratio in Missouri is still below the national average, 22.4/10,000 compared to 22.9/10,000. In addition, there is still a wide discrepancy between the physician population ratio in rural areas, compared to urban areas; 11.2/10,000 compared to 27.7/10,000. When only primary care physicians are considered, the discrepancies still exist. In 2000, the metropolitan areas of Missouri had 12.7 primary care physicians per 10,000 population, compared with only 7.5 primary care physicians per 10,000 population in non-metropolitan areas. 1Data source: Missouri Department of Health, Center for Health Information Management and Epidemiology, licensing survey data.2Source for national data. AMA. Physician Characteristics and Distribution in the US, 2001-2002 edition. |
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