Distribution Of Family Physicians Research Articles

Geographic distribution of family physicians in Japan and the USA: a cross-sectional comparative study.

Solutions for geographic maldistribution of physicians is challenging around the world, but primary care specialists are expected to resolve this issue. This study compares the geographic distribution of family physicians in Japan and the USA, both of which are developed countries without a major system for physician allocation by the public sector; however, the two countries differ greatly in the maturity of family medicine (ie length of its history as part of the healthcare system and the population of qualified family medicine experts). This cross-sectional comparative study used publicly available online databases for Japan in 2018 and 2017 in the USA. The municipalities in Japan and counties in the USA were divided into quintile groups according to population density. The number of family physicians per unit population in each group of areas was calculated, and was evaluated with a residual analysis. The geographic distribution of all physicians in Japan was simulated assuming that the proportion of family physicians among all physicians in Japan (0.16%) was increased to match that in the USA (11.8%). Of 320 084 physicians in Japan and 899 244 in the USA, 519 (77.2%) family physicians in Japan and 105 999 (100%) in the USA were included. The distribution of family physicians in Japan was noticeably shifted to areas with the lowest population density. In contrast, family physicians in the USA were distributed equally across areas. The distribution of physicians of other specialties (general internists, pediatricians, surgeons and obstetricians/gynecologists) was shifted heavily to areas with the highest population densities in both countries. The simulation analysis showed the geographic maldistribution of the total number of physicians improved substantially if the proportion of family physicians in Japan is increased to match that in the USA. The distribution of family physicians is more equitable than that of other medical specialists; however, an immature family medicine system can lead to an aggregation of family physicians in rural areas. This aggregation supports equity due to the broader scope of practice required by family physicians in rural areas. In countries where family medicine has not yet matured as a specialty, provided that the equitable aggregation of family physicians in rural areas can be maintained, increasing the number of family physicians as a proportion of the total number of physicians may improve the geographic maldistribution of the total number of physicians.

Assessment and Optimization of a Spatial Model of Access to Family Physician Centers in Shiraz Using Geographic Information System

INTRODUCTION: The present study aimed to assess and optimize the spatial model of access to family physician centers in Shiraz using the Geographic Information System (GIS Software). METHODS: This descriptive-analytical cross-sectional study was performed in four stages in all family physician centers and clinics in Shiraz. In the first stage, a review study was performed to determine site selection criteria, and in the second stage, the criteria were prioritized and weighted using the method of Analytical Hierarchy Process (AHP). In the third stage, the data were recorded in GIS Software, and finally, in the last stage, the spatial data were assigned to databases. FINDINGS: Based on the results, the field of geography with a weight of 0.549 was the most important area, and the criterion of population age structure with a weight of 0.451 assumed the most critical importance in the selection of appropriate sites for the establishment of family physician centers. According to Moran’s index (MI = 0.055), family physicians are randomly distributed in Shiraz, and about 20% of the population do not have standard access to family physician centers. CONCLUSION: As evidenced by the results of the current study, people living in the suburbs of Shiraz had far less access to family physician centers, as compared to those residing in central parts. Moreover, the spatial distribution of family physicians in Shiraz does not follow a specific pattern. It is necessary to plan and take effective measures to establish new centers or redistribute existing centers in accordance with the priorities obtained from the results of this study in an attempt to increase healthcare access in suburban areas using GIS and other related techniques.

Family Physicians Working at Hospitals: A 20-Year Nationwide Trend Analysis in Taiwan

Family physicians play an essential role as gatekeepers in primary health care. However, most studies in the past focused on the geographic maldistribution of family physicians, and few studies focused on the distribution of family physicians between private practices and hospitals. This study aims to analyze the trends in practice locations of family physicians in Taiwan between 1999 and 2018, using the databases of the Taiwan Association of Family Medicine and Taiwan Medical Association. Although the annual number of physicians registered as family physicians had steadily increased from 1876 in 1999 to 3655 in 2018, the ratio of family physicians practicing in hospitals to total family physicians remained stable around 40% in the study period. Even after eliminating the trainees who were entirely registered at hospitals, the proportion of hospital-based family physicians still accounted for about one-third of the total in each year. In conclusion, family physicians had been continuously demanded by hospitals in Taiwan. If the supply of primary care-oriented family physicians is insufficient outside hospitals, health manpower planning would require urgent adjustments.

Human resources for health density and its associations with child and maternal mortality in the Islamic Republic of Iran.

The Family Physician and Social Protection Scheme for Iranian rural inhabitants was launched in June 2005 to improve physician density. To our knowledge, a comprehensive study of the impact of the Scheme on mortality-related health indicators has not been conducted. To investigate the effects of health workforce density on maternal, neonatal, infant and under-5 mortality rates in rural areas of the Islamic Republic of Iran between 2005 and 2011. We built mixed-effects Poisson regression models including mortality measures as response variables and physician and behvarz (community-based health worker) densities as independent variables, using data from the Iranian Vital Horoscope tool, annual Households Income and Expenditure Survey, and DTARH software. We also included population sizes, age of inhabitants, rate of urbanization, years of schooling, and wealth index in each district, as well as effect of time, as covariates. Physician density was significantly associated with child mortality rates (1.5%, 1.1% and 63.5% decrease in neonatal, under-5 and maternal mortality with a 1-unit increase in physician density per 1000 individuals). In the model built for infant mortality rate, physician density and behvarz densities were not significantly associated with this measure. Improving the distribution of family physicians was associated with lower child and maternal mortality. Improvements in behvarz densities were not associated with decrements in these rates, which probably calls for improvement in access to more professional health services and facilities.

Geographical distribution of family physicians in Japan: a nationwide cross-sectional study

BackgroundGeographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem.MethodsWe obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists.ResultsFive hundred nineteen JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p < 0.001).ConclusionsFamily physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan.

Distributional Differences between Family Physicians and General Internists.

While differences in practice style and costs between family medicine and internal medicine are relatively well known, the differences in geographic distribution between the two remain underexplored. This study aims to examine differences in distribution of family physicians and general internists by geographic and demographic characteristics. Data sources are the 2016 American Medical Association Physician Master File and 2015 American Community Survey. Results show that internists are more dominant in urban areas, especially in the Northeast; they are also more likely to practice in the West and South. Family physicians are more likely to practice in rural areas and primary care Health Professional Shortage Areas than internists; their distribution also varies significantly with respect to areas whose residents are members of racial/ethnic minority groups, live in poverty, and are uninsured. Such differences should be a consideration for planning to address regional and national primary care workforce shortages.

The role of distributed education in recruitment and retention of family physicians

BackgroundDistributed medical education (DME) programmes, in which training occurs in underserviced areas, have been established as a strategy to increase recruitment and retention of new physicians following graduation to these...

Unequal socioeconomic distribution of the primary care workforce: whole-population small area longitudinal study

ObjectiveTo measure changes in socioeconomic inequality in the distribution of family physicians (general practitioners (GPs)) relative to need in England from 2004/2005 to 2013/2014.DesignWhole-population small area longitudinal data linkage study.SettingEngland...

Vínculos empregatícios de Médicos de Família e Comunidade no Brasil, 2004

O Programa Saúde da Família (PSF) constitui, desde a sua implantação em 1994, a principal estratégia para a reestruturação da Atenção Básica em Saúde no Brasil, sendo a atuação do Médico de Família e Comunidade (MFC) fundamental para o sucesso do programa. Este estudo descreve a distribuição geográfica dos vínculos de trabalho em MFC no Brasil, presentes no Cadastro Nacional de Estabelecimentos de Saúde, e sua relação com o Índice de Desenvolvimento Humano (IDH), coeficiente de mortalidade infantil, anos de estudo, PIB e rendimento mensal em 2004. Trata-se de estudo ecológico, com apresentação geográfica dos indicadores em relação às microrregiões brasileiras. Os coeficientes de correlação entre os vínculos de trabalho e o coeficiente de mortalidade infantil, o IDH e o PIB foram 0,17, 0,18 e 0,74, respectivamente. Presentes na quase totalidade das microrregiões, em menos de 12% delas havia três ou mais vínculos descritos, conforme preconiza o PSF. Após dez anos de implantação da Estratégia de Saúde na Família no Brasil, a distribuição dos vínculos em MFC ainda era irregular e, na maioria das microrregiões, insuficiente.

The use of provisionally licensed international medical graduates in Canada

Many communities in Canada, particularly those in rural areas, suffer from a shortage of physicians because the distribution of family physicians is inadequate and inequitable. For example, in 2000 there was an average of 94 family physicians per 100 000 Canadians. Some communities (typically urban

Current Distribution and Trends in the Location Pattern of Pediatricians, Family Physicians, and General Practitioners Between 1976 and 1979

The literature suggests that pediatricians in the United States are concentrated in the more densely populated regions and states, whereas family physicians and general practitioners are more likely to settle in rural areas. The rapidly increasing supply of all child health physicians had led many to hypothesize that the traditional geographic preferences of pediatricians would expand to include smaller communities. Data for 1976 to 1979 confirm the urban concentration of pediatricians and the more even distribution of family physicians and general practitioners. These data also demonstrate a marked imbalance of pediatricians within county groups, resulting in some areas of shortage even within highly metropolitan communities. Evidence of a trend toward increased dispersion of pediatricians into urban shortage areas is presented, but there is no indication that enough pediatricians will settle in rural areas to meet the needs of children in those small communities.

MEDICAL DEMOBILIZATION

<h3>Objective</h3> To measure changes in socioeconomic inequality in the distribution of family physicians (general practitioners (GPs)) relative to need in England from 2004/2005 to 2013/2014. <h3>Design</h3> Whole-population small area longitudinal data linkage study. <h3>Setting</h3> England from 2004/2005 to 2013/2014. <h3>Participants</h3> 32 482 lower layer super output areas (neighbourhoods of 1500 people on average). <h3>Main outcome measures</h3> Slope index of inequality (SII) between the most and least deprived small areas in annual full-time equivalent GPs (FTE GPs) per 100 000 need adjusted population. <h3>Results</h3> In 2004/2005, inequality in primary care supply as measured by the SII in FTE GPs was 4.2 (95% CI 3.1 to 5.3) GPs per 100 000. By 2013/2014, this SII had fallen to −0.7 (95% CI −2.5 to 1.1) GPs per 100 000. The number of FTE GPs per 100 000 serving the most deprived fifth of small areas increased over this period from 54.0 to 60.5, while increasing from 57.2 to 59.9 in the least deprived fifth, so that by the end of the study period there were more GPs per 100 000 need adjusted population in the most deprived areas than in the least deprived. The increase in GP supply in the most deprived fifth of neighbourhoods was larger in areas that received targeted investment for establishing new practices under the ‘Equitable Access to Primary Medical Care’. <h3>Conclusions</h3> There was a substantial reduction in socioeconomic inequality in family physician supply associated with national policy. This policy may not have completely eliminated socioeconomic inequality in family physician supply since existing need adjustment formulae do not fully capture the additional burden of multimorbidity in deprived neighbourhoods. The small area approach introduced in this study can be used routinely to monitor socioeconomic inequality of access to primary care and to indicate workforce shortages in particular neighbourhoods. http://creativecommons.org/licenses/by/4.0