Diffusion of Physicians and Access to Primary Care: The Role of Person, Program, and Place (2014-15)


Author: Thomas C. Ricketts, PhD, MPH

Background: Federal and state policies try to influence physician location choices using a combination of programmatic or extrinsic factors (e.g. bonus payments, subsidized loans) and personal or intrinsic factors (e.g. promoting volunteerism, orienting trainees to underserved populations and selecting motivated students) to encourage physicians to practice in communities where the population has difficulty accessing medical care. Unfortunately, there has not been a combined evaluation of these policies, making it difficult to assess the actual effects. The central hypothesis of this project is that physician diffusion can be estimated based on the characteristics of the places physicians go to and come from. The focus of this report is on locations that are eligible for placement incentives from the federal government based on their designation as Health Profession Shortage Areas (HPSAs), but which may or may not have physicians recruited to them, as well as those places that could become HPSA

Conclusions and Policy Relevance:

1) It is not currently possible to generate models that predict who will move into or out of a rural HPSA or which rural HPSAs are more or less likely to attract physicians.

2) Federal programs and incentives that seek to promote practice in underserved communities are only one of a number of factors that influence a physician’s choice of practice location.

3) We have seen an overall steady and relatively well-distributed pattern of growth in physician supply. At the same time we have seen an overall increase in the number of areas designated as HPSAs despite growth in provider supply.

4) Analyses need to be conducted over a longer time period at a more fine-grained level to better understand the role of physicians serving in underserved places.

5) The cumulative effect of federal policies in reducing or eliminating geographic shortages is not known. A comprehensive evaluation is needed to judge the effects of current policies and factors that influence choice of location or the potential for emerging underservice.

Methods:This analysis makes use of multiple years of the American Medical Association’s (AMA) Physician Masterfile® that have been linked by the unique identifier for each physician in the files. The individual-level data sets included all physicians in the Masterfile at the end of calendar years 2006 and 2013.


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