Physician Office Locations Within Charlotte, North Carolina

Southeastern Geographer Vol. XXIX, No. 2, November 1989, pp. 118-135 PHYSICIAN OFFICE LOCATIONS WITHIN CHARLOTTE, NORTH CAROLINA Gerald F. PyIe There have been geographical differences in the distribution of physicians in the United States for decades. Referred to as inequalities or maldistributions, these differences can be quite pronounced regionally and within cities. Many have suggested that they result because there simply are not enough physicians to go around; i.e., it has been a supply problem. Even though many more physicians have been trained, however , medical offices still are not equitably distributed in cities. The parts of urban areas that seem to attract physicians are either close to hospitals, near central business districts, or adjacent to higher income neighborhoods. But as our cities shift from monocentric to polycentric forms of urbanization, there are, presumably, increasingly more attractive sites for physicians to locate offices as the supply of doctors increases . The purposes of this study are to determine the extent to which physician office locations are clustered within Charlotte, North Carolina , and to offer some possible explanations for these geographical patterns . FACTORS IN PHYSICIAN DISTRIBUTIONS. During the 1930s, 40s, and 50s, the physician-to-population ratio in the United States varied little, ranging from 125 to 130 physicians per 100,000 persons. (J) By the mid-1980s, this rose to 220 physicians per 100,000 persons. The Southeastern United States lags behind the remainder of the nation in both total number of physicians and number per 100,000 persons in spite of recent growth trends. The main reasons for this are that the region is poorer and areas with higher ratios of physicians to population tend to attract even more physicians as the supply increases. Dozens of studies have demonstrated that the most successful methods of statistical comparison in physician location studies are forms of linear (the most common) and curvilinear regression. (2) Analyses of reasons for physician shifts from one part of the United States to another Dr. PyIe is Professor of Geography at the University of North Carolina at Charlotte in Charlotte, NC 28223. Vol. XXIX, No. 2 119 have suggested various forms of income gravitation, degrees of urbanization , and population mass as leading explanatory variables. (3) By the early 1960s, it was clear that as physician-population ratios began to improve with increasing prosperity, rural areas and smaller towns continued to suffer from inadequate medical care due to physician shortages. By 1970 the largely rural South could claim only four states near the national average: Virginia, Louisiana, Tennessee, and Florida. As urban-rural differences in the geographical distribution of physicians became more pronounced, researchers continued to investigate the problem. One study utilized an urban ecological context to explain how a third of the U.S. population and half of the nation's physicians were located in the 22 largest metropolitan areas. (4) With that number of observations, a correlation coefficient of .984 between numbers of physicians and population size using a simple linear regression equation was not surprising. Interestingly, income correlations were not as strong as population in the analysis. A related analysis of socioeconomic status of medical school graduates in Southern Appalachia during the mid-1960s found that even within physician shortage areas in the South graduates of higher socioeconomic background tended to establish practices in urban areas and to become specialists. (5) A 1966 study utilized a human ecological context to explain how metropolitan physician distributions in 1960 were heavily influenced by city size, population composition, and "medical environment," i.e., hospitals and other specialized medical support facilities. (6) It was the first to indicate the importance of proximity to urban hospitals in physician office location analysis, and it also found that black areas tended to repel physicians. A more geographically oriented examination of physician distributions also found the size of urban places to be a strong indicator variable for predicting numbers of physicians. (7) In the early 1970s, there were nearly 300,000 non-federal practicing physicians in the United States. (8) In spite of a 50% increase in the number of doctors from 1960 to 1970, the national distribution remained unchanged with a continued heavy concentration of doctors in the Northeast and California...