National physician distribution: Past, present and future

Background: Geographic disparities in physician supply persist despite a continuous physician workforce expansion in the U.S. over the last fifty years. This made access to care even more difficult for certain vulnerable populations. Many programs and studies have already been in place to examine physician recruitment and retention in underserved areas. However, there has been a lack of systematic review of what have been done and what have worked or not worked. Purpose: This study was to conduct a comprehensive literature review to identify and evaluate predictors and programs that influence the practice location of physicians(such as NHSC/state scholarships, loan repayments, preferential admission policies, training/education exposures, and etc.). Conceptual Framework: Our framework was that the final decision to practice in an underserved area is determined by endogenous as well as exogenous factors including individual, medical education/residency training, practice setting and community. Methods: Pubmed database was searched from 1995 to 2006. We used key search terms “physician, distribution, recruitment, retention”. The search was limited to English articles published in US journals only. The initial search yielded 50 articles. Bibliography review yielded additional references. Results/Policy implications: Increasing physician supply alone did not fully address the geographic mal-distribution of physicians in the nation. The literature review helped better understand the effectiveness of potential strategies to improve physician geographic distribution. Recommendations were made to guide future research work based on the status of current research.