Over the past two decades, there has been a notable improvement of geographic access to physicians in most parts of the world. However, most parts of rural and sub-urban regions pose a few challenges which result in unequal distribution of doctors in some countries. Despite the fact that adequacy of physicians labor force is subject to vary and fluctuate often, most researchers agree with the view that physicians are unequally distributed with the geographical aspect being the underlying factor. For instance, COGME (1998) states that: Geographic maldistribution of health care providers and service is one of the most persistent characteristics of the American health care system. In spite of numerous policies put in place to ensure equal distribution of doctors across the globe, maldistribution by geographical location persists (Newhouse et al, 2005). This paper critically examines the drivers creating geographic maldistribution of physician workforce despite the availability of numerous doctors in most parts of the world.
Attractiveness of Location of Practice
Arguably, the choice of location of practice by most physicians and medical students is the root factor that has indeed contributed to the unequal distribution of physician in most countries. First, in most rural regions the attractiveness of residential areas and workplaces are not very conducive a factor that deters most doctors from working in such conditions. This shortage of doctors is a big concern to the patient healthcare of people residing in rural regions particularly considering the absence of primary care physician. Most physicians prefer to work in the urban areas citing the high standards of the living conditions and working premises, though the general income is less compared to those doctors working in rural regions (Buchan et al, 2014).
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In fact, most patient care professionals prefer to work in the urban areas which provide chances for career development, education and other essential amenities for their families. Understandably, most professional healthcare prefers to work in urban areas as they offer career opportunities for the family members and personal safety as well as security is guaranteed compared to rural and remote regions particularly in developing countries. Lastly, urban areas have various leisure opportunities making it more attractive to physicians in comparison to rural and remote areas (Buchan et al, 2014).
Mode of Employment and Income Potential
Also, the terms of employment and mode of payments play a crucial role in determining the choice of location of practice by the physicians. Notably, the general income of medical practitioners in rural regions is quite high though this does not guarantee the adequacy of physicians in healthcare facilities located in rural and suburban areas. In as much as the total incomes are relatively high, they may not be sufficient to compensate for upkeep owing the fact they work for more extended hours in a moderately severe working conditions. Hence, the perception remains that the net income is limited in rural regions in spite of the fact that most countries offer relatively higher gross income for general medical practitioners in the rural areas compared to the urban areas. Besides, such regions do not provide opportunities for private practice to healthcare professionals a factor which deters them from working in such areas (Newhouse et al, 2005).
The dual practice opportunities offered in the urban regions attracts most healthcare professionals to work in such areas. Likewise, urban areas are associated with an attractive prestigious setting which provides opportunities for professional development and education thus most physicians tend to concentrate in such regions leaving rural and the remote regions adversely deprived of healthcare specialties just by default (Buchan et al, 2014).
Origin and Experience
Categorically, most young of physicians prefer to work in developed countries such as the United States and Australia citing prospects of working in a better experience as the most influential factor. For instance, in Indonesia distribution of patient care professionals is of great concern considering its large size and complex geographical nature. The complex topology which includes remote islands, dense mountainous forest nature presents tremendous challenges in the delivery of healthcare services in the country. It is viewed by most physicians that expectation of healthcare practice in such regions is to be more poorly than reality citing the numerous underlying challenges. Such areas are dominated by few essential amenities as well poor communication networks making it difficult to deploy primary care physicians in those regions (Buchan et al, 2014).
Arguably, in the recent times, studies indicate that young and female medical practitioners prefer teamwork and working in urban regions. A rural healthcare facility where there is only one doctor on duty at all times does not offer collaboration which is a preference for most young generation doctors. Notably, rural origin and experience are key factors that make physicians from remote regions to be ones who are likely to practice in remote healthcare facilities compared to those who have been nurtured in an urban setting. The initial experience of medical students during training predicts the future expectations of practice in such regions and they may decide either to work or not to depend on whether their experience was positive or negative. Accordingly, one of the settings, i.e., urban or rural is rendered less attractive to general medical practitioners by default (Shi & Singh, 2004)
Working Conditions
Following the inadequate supply of healthcare professionals in rural and remote regions, physicians in those are subjected to more extended working hours. The primary concern which makes such areas unattractive is on- call for doctors. The perception of the presence of a single doctor on duty at all times creates a somewhat tricky working condition in rural areas, particularly in developing countries. Doctors in such regions end up being overworked a factor which deters them from working in the rural areas of most countries. Also, working conditions in rural healthcare facilities, especially in developing countries, are relatively severe compared to those in urban regions (Buchan et al, 2014).
Stressful working conditions in remote and rural areas also include language problems, difficulties interacting with individuals of different cultural origin, and security concerns. For instance, studies indicate that in the recent times France has recorded most cases of physical harassments against foreign medical doctors. This factor has deterred physicians from working in locations with the above traits (Newhouse et al, 2005).
Unequal distribution of physicians is quite rampant in most countries of the world, with rural and remote areas being most affected regions. It is, therefore, a significant concern to ensure that distribution of healthcare workforce is equal irrespective of the location of practice. Despite multiple efforts by most countries to enforce policies aimed at providing better distribution of medical doctors, there is still an alarming rate of inadequate supply of physicians in rural and remote regions. However, to a certain extent, geographical access to physicians have dramatically improved in most countries following implementations of policies meant to curb the challenges outlined in this paper.
References
Buchan, J., Schoenstein, M., & Ono, T., (2014). Geographic Imbalances in Doctor Supply and Policy Responses. Retrieved from http://pnhp.org/blog/2014/04/16/maldistribution-of-the-physician-supply/
Council on Graduate Medical Education ( COGME) , Tenth Report (1998). Physician Distribution and Health Care Challenges in Rural and Inner-City Areas. Washington, DC: U.S. Department of Health and Human Services, Health Resources and Services Administration.
Newhouse, J., Zaslavsky, A., & Rosenthal, M., (2005). The Geographic Distribution of Physicians Revisited. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361233/
Shi, L., & Singh, A., (2015). Delivering Health Care in America : A Systems Approach. Boston: Jones & Bartlett Learning.
