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Southeastern Geographer Vol. 22, No. 1, May 1982, pp. 68-86 COUNTY POPULATION/PHYSICIAN RATIOS IN KENTUCKY, 1847-1976 Gary W. Shannon The manner in which physicians are distributed relative to a population affects the behavior of people in relation to their illness. (1) Relatively few physicians available to a population, for example, may be associated with delay on the part of individuals in seeking treatment. Isolation from an adequate supply of physicians may also serve to reinforce alternate medical care behavior. And, insofar as alternate medical care behaviors influence the disease process, patterns of morbidity and mortality may be influenced. (2) The distribution of physicians relative to a population, therefore, is important to understanding medical care behavior and disease patterns. This relative distribution is not static, however, and evolves as a result of the growth, decline, and migration of the population as well as the physicians. (3) Understanding the underlying basis of physician distributions relative to populations remains one of the central issues of medical care research and planning. Among the many variables found to be associated with physicians' location decisions, the primary ones are economic development and stability, high per capita income, and urbanization. (4) The purpose of this paper is to present an historical inquiry of the changing relationship between the distribution of physicians and population of Kentucky. One indicator of physician availability, population/ physician ratio, is examined for counties in Kentucky for selected dates within a 130-year period. County population/physician ratios are presented for the earliest date that such data are known to exist, 1847, and for 1877, 1893, 1939, and 1976. The latter dates represent major periods of economic development and medical care. The distributions of ratios for these dates are assessed for their association with regional economic, demographic, and medical care development. METHODOLOGY. Data on physician locations were obtained from several sources, including state and national registries and directories of Dr. Shannon is Professor of Geography at the University of Kentucky in Lexington, KY 40506. Vol. XXII, No. 1 69 physicians. Data for 1847 were obtained from the first annual state register of physicians published for Kentucky. (5) Physicians' locations for 1877 were derived from a national registry of physicians (6) and, beginning with 1893, directly and indirectly from registers of the Kentucky Medical Licensure Board. (7) Intercensal population estimates were necessary in order to compute population/physician ratios for each study year. Using appropriate years of the federal census statistics for county populations, simple linear estimates of the county populations were obtained for each study year. For example, county populations were derived for 1847 by obtaining the difference in population for each county in 1840 and 1850. When there was a population increase, seven-tenths of the increase was added to the 1840 population. In cases where there was a population decrease, three-tenths of the difference was subtracted from the 1850 population. Subsequently, the estimated population of each county was divided by the total number of resident practicing physicians to obtain the population /physician ratio. The county population/physician ratios for each study year were then rank-ordered, divided into quartiles, and mapped. In 1847 there were 100 counties in Kentucky, in 1877 there were 117, in 1893 there were 119, and in 1939 there were 120 counties, the present number. Several considerations of Kentucky geography and history are especially pertinent to the changing patterns of county population/physician ratios. Particularly important are the ebb and flow of economic fortunes of Kentucky counties associated with changes in transportation, the development ofagriculture and mining, and, more recently, regional urban development based upon metropolitan as well as nonmetropolitan manufacturing. The history of medical education and public health within Kentucky has also had an impact on state and county population/ physician ratios. The economic development of Kentucky is closely associated with the major physiographic regions of the state (Fig. 1). The six major physiographic regions—The Mountains, The Knobs, Blue Grass, The Pennyroyal , Western Coal Basin, and Jackson Purchase—have demonstrated differential economic development throughout Kentucky's history. EARLY CONSIDERATIONS. Early economic development in Kentucky was associated with agriculture and centered in the Blue Grass. Lexington , founded in 1776, served as an early...

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Additional Information

ISSN
1549-6929
Print ISSN
0038-366X
Pages
pp. 68-86
Launched on MUSE
2013-07-03
Open Access
No
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