Abstract
BackgroundIn many countries, there is a surplus of physicians in some communities and a shortage in others. Population size is known to be correlated with the number of physicians in a community, and is conventionally considered to represent the power of communities to attract physicians. However, associations between other demographic/economic variables and the number of physicians in a community have not been fully evaluated. This study seeks other parameters that correlate with the physician population and show which characteristics of a community determine its "attractiveness" to physicians.MethodsAssociations between the number of physicians and selected demographic/economic/life-related variables of all of Japan's 3132 municipalities were examined. In order to exclude the confounding effect of community size, correlations between the physician-to-population ratio and other variable-to-population ratios or variable-to-area ratios were evaluated with simple correlation and multiple regression analyses. The equity of physician distribution against each variable was evaluated by the orenz curve and Gini index.ResultsAmong the 21 variables selected, the service industry workers-to-population ratio (0.543), commercial land price (0.527), sales of goods per person (0.472), and daytime population density (0.451) were better correlated with the physician-to-population ratio than was population density (0.409). Multiple regression analysis showed that the service industry worker-to-population ratio, the daytime population density, and the elderly rate were each independently correlated with the physician-to-population ratio (standardized regression coefficient 0.393, 0.355, 0.089 respectively; each p < 0.001). Equity of physician distribution was higher against service industry population (Gini index = 0.26) and daytime population (0.28) than against population (0.33).ConclusionDaytime population and service industry population in a municipality are better parameters of community attractiveness to physicians than population. Because attractiveness is supposed to consist of medical demand and the amenities of urban life, the two parameters may represent the amount of medical demand and/or the extent of urban amenities of the community more precisely than population does. The conventional demand-supply analysis based solely on population as the demand parameter may overestimate the inequity of the physician distribution among communities.
Highlights
In many countries, there is a surplus of physicians in some communities and a shortage in others
The service industry workers-to-population ratio showed the strongest correlation with the physician-to-popula
The service industry workers/population ratio, the daytime population density and elderly rate were each independently correlated with the physician-to-population ratio
Summary
There is a surplus of physicians in some communities and a shortage in others. Population size is known to be correlated with the number of physicians in a community, and is conventionally considered to represent the power of communities to attract physicians. This study seeks other parameters that correlate with the physician population and show which characteristics of a community determine its "attractiveness" to physicians. In reality, the unequal distribution of physicians is a serious problem in many countries. In Japan, where medical practice is financially based on a feefor-service reimbursement system and there is no restriction on practice location, physician distribution is determined largely by the market and by physicians' individual preferences. Physicians are highly concentrated in communities that are financially and geographically attractive to them, which results in their socalled maldistribution
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