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ARTICLE |

Distribution of Physicians FREE

Frederic W. Hafferty, PhD
JAMA. 1982;248(14):1711-1711. doi:10.1001/jama.1982.03330140025021
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To the Editor.—  The article "Where Have All The Doctors Gone" by Newhouse and colleagues (1982; 247:2392) and its predecessor article1 represent a major and formidable statement regarding the applicability of "trickle-down" or "smaller slice" models to explain physician manpower distribution.2 Such prominence at a time when other market-forces theories enjoy popularity in federal economic circles only serves to underscore the scrutiny to which both data and interpretations must be subjected.A review of the data presented leaves no question that physicians in 1979 were more broadly distributed and present in smaller communities than in 1970. The conclusion that "competitive forces play a major role in determining where physicians choose to practice" is, however, not supported by the data. In fact, the authors present no data at all that speak to mechanisms of deployment, only outcomes. Instead, this and related conclusions rest on a labyrinth of assumptions, many

REFERENCES

Schwartz WB, Newhouse JP, Bennett BW, et al:  The changing geographic distribution of board certified physicians . N Engl J Med 1980;;303:1032-1038.
Schwartz WB, et al:  Reply to correspondence . N Engl J Med 1981;;304:917-918.
Report of the Graduate Medical Education National Advisory Committee to the Secretary, Department of Health and Human Services: Geographic Distribution Technical Panel , Dept of Health and Human Services publication (HRA) 81-653, vol 3, 1981;.
Social and Psychological Characteristics in Medical Specialty and Geographic Decisions , Graduate Medical Education National Advisory Committee staff paper 4, US Dept of Health, Education, and Welfare publication (HRA) 78-13, 1978;.
Parker R, Sorenson A:  The tides of rural physicians: The ebb and flow, or why physicians move out of and into small communities . Med Care 1978;;16:152-166.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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Schwartz WB, Newhouse JP, Bennett BW, et al:  The changing geographic distribution of board certified physicians . N Engl J Med 1980;;303:1032-1038.
Schwartz WB, et al:  Reply to correspondence . N Engl J Med 1981;;304:917-918.
Report of the Graduate Medical Education National Advisory Committee to the Secretary, Department of Health and Human Services: Geographic Distribution Technical Panel , Dept of Health and Human Services publication (HRA) 81-653, vol 3, 1981;.
Social and Psychological Characteristics in Medical Specialty and Geographic Decisions , Graduate Medical Education National Advisory Committee staff paper 4, US Dept of Health, Education, and Welfare publication (HRA) 78-13, 1978;.
Parker R, Sorenson A:  The tides of rural physicians: The ebb and flow, or why physicians move out of and into small communities . Med Care 1978;;16:152-166.
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