United States General Accounting Office 

GAO Report to the Chairman, Committee on 

Health, Education, Labor, and 

Pensions, U.S. Senate 

October 2003 PHYSICIAN 

WORKFORCE 

Physician Supply 

Increased in 

Metropolitan and 

Nonmetropolitan 

Areas but Geographic 

Disparities Persisted 

GAO-04-124 

Highlights of GAO-04-124, a report to the 

Chairman, Committee on Health, 

Education, Labor, and Pensions, U.S. 

Senate 

Through a variety of programs, the 

federal government supports the 

training of physicians and 

encourages physicians to work in 

underserved areas or pursue 

primary care specialties. GAO was 

asked to provide information on 

the physician supply and the 

generalist and specialist mix of that 

supply in the United States and the 

changes in and geographic 

distribution of physician supply in 

metropolitan and nonmetropolitan 

areas. To address these objectives, 

GAO analyzed data on physician 

supply and geographic distribution 

from 1991 and 2001. 

October 2003 

PHYSICIAN WORKFORCE 

Physician Supply Increased in 

Metropolitan and Nonmetropolitan Areas 

but Geographic Disparities Persisted 

The U.S. physician population increased 26 percent, which was twice the rate of 

total population growth, between 1991 and 2001. During this period the average 

number of physicians per 100,000 people increased from 214 to 239 and the mix 

of generalists and specialists in the national physician workforce remained 

about one-third generalists and two-thirds specialists. Growth in physician 

supply per 100,000 people between 1991 and 2001 was seen in historically highsupply metropolitan areas as well as low-supply statewide nonmetropolitan 

areas. 

Between 1991 and 2001, all statewide nonmetropolitan areas and 301 out of the 

318 metropolitan areas gained physicians per 100,000 people. Of those 17 

metropolitan areas that experienced declines in the number of physicians per 

100,000 people, only 2 had fewer total physicians in 2001 than 1991. Overall, 

nonmetropolitan areas experienced higher proportional growth in physicians per 

100,000 people than metropolitan areas, but the disparity in the supply of 

physicians per 100,000 people between nonmetropolitan and metropolitan areas 

persisted. Nonmetropolitan counties with a large town (10,000 to 49,999 

residents) had the biggest increase in physicians per 100,000 people of all county 

categories but their supplies per 100,000 people were still less than large and 

small metropolitan counties’ supplies in 1991 and 2001. 

In written comments on a draft of this report, the Health Resources and Services 

Administration agreed with GAO findings of persisting disparities between 

metropolitan and nonmetropolitan areas. 

Physicians Per 100,000 people, 1991 and 2001 

www.gao.gov/cgi-bin/getrpt?GAO-04-124. 

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Laura A. 

Dummit at (202) 512-7119. 
Contents 


Letter 

Results in Brief 


Background


National Physician Supply Grew at Twice the Rate of the U.S. 


Population 

Physician Supply Per 100,000 People Increased in Most Areas but 

Geographic Disparities Persisted 

Agency Comments 

1 

2 

3 

7 

10 

15 

Appendix I Scope and Methodology 

Appendix II 	 HRSA Programs That Address Supply and 

Distribution of Health Professionals 

Appendix III 	 Physicians Per 100,000 People by State Metropolitan 

and Nonmetropolitan Areas, 1991 and 2001 

Appendix IV 	 Comments from the Health Resources and Services 

Administration 

Related GAO Products 

Tables 

Table 1: Physicians Per 100,000 People in the United States, 1991 

and 2001 7 

Table 2: Areas with Reductions in Physicians Per 100,000 People 

from 1991 to 2001 12 

Table 3: Physicians Per 100,000 People in Statewide 

Nonmetropolitan and Metropolitan Areas, 1991 and 2001 13 

Table 4: HRSA Programs’ Expenditures or Appropriations and 

Objectives 20 

Page i GAO-04-124 Physician Workforce 

17 

19 

23 

28 

31 
Figures 

Figure 1: Physicians Per 100,000 People in the United States by 

Metropolitan Areas and Statewide Nonmetropolitan 

Areas, 1991 8 

Figure 2: Physicians Per 100,000 People in the United States by 

Metropolitan Areas and Statewide Nonmetropolitan 

Areas, 2001 9 

Figure 3: Physicians Per 100,000 People by Metropolitan and 

Nonmetropolitan County Categories, 1991 and 2001 15 

Abbreviations 

AMA American Medical Association 


AOA American Osteopathic Association 


CMS Centers for Medicare & Medicaid Services 


COGME Council on Graduate Medical Education 


DO doctor of osteopathic medicine 


GMENAC Graduate Medical Education National Advisory Committee 


HHS Department of Health and Human Services 


HPSA health professional shortage area


HRSA Health Resources and Services Administration 


IOM Institute of Medicine 


MD medical doctor 


MSA metropolitan statistical area 


NECMA New England county metropolitan area 


NHSC National Health Service Corps 


PHSA Public Health Service Act 


PMSA primary metropolitan statistical area


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Page ii GAO-04-124 Physician Workforce 
United States General Accounting Office 

Washington, DC 20548 

October 31, 2003 


The Honorable Judd Gregg 


Chairman 


Committee on Health, Education, Labor, and Pensions 


United States Senate 


Dear Mr. Chairman: 


The federal government has had a long-standing interest in ensuring an 


adequate supply of physicians to meet the health care needs of the U.S. 


population. Several federal programs provide funding to train physicians


and encourage physicians to work in underserved areas. Other programs 


attempt to encourage physicians to train as general or primary care 


practitioners rather than specialists. 


In anticipation of the reauthorization of several programs administered by 


the Health Resources and Services Administration (HRSA) that fund 


physician education and encourage physicians to practice primary care in


underserved areas, you asked us to provide information on the physician


supply in the United States. We are providing information on (1) the 


national physician supply, supply per 100,000 people, and the generalist 


and specialist mix in 1991 and 2001 and (2) changes from 1991 to 2001 in 


physician supply, supply per 100,000 people, and the geographic 


distribution of that supply in metropolitan and statewide nonmetropolitan 


areas. 


To address these objectives, we analyzed physician supply data from 1991 


and 2001 for the nation, 318 individual metropolitan areas, 48 statewide 


nonmetropolitan areas, and county categories.1

 To provide information on 


1

Metropolitan areas are metropolitan statistical areas (MSA), primary metropolitan 

statistical areas (PMSA), or New England county metropolitan areas (NECMA) as of 2001. 

If a county was designated as metropolitan in 2001, we considered it a metropolitan area in 

1991. A statewide nonmetropolitan area encompasses all counties within a state that are 

not in an MSA, PMSA, or NECMA. The District of Columbia, New Jersey, and Rhode Island 

have no nonmetropolitan areas. 

Page 1 GAO-04-124 Physician Workforce 
the physician workforce2

 and its generalist-specialist mix,3 we analyzed 

data from the American Medical Association (AMA) Physician Masterfile 

and the American Osteopathic Association (AOA) Physician Masterfile. We 

used data from the Census Bureau for resident population estimates based 

on the 2000 Census. We aggregated county-level information to 

metropolitan and statewide nonmetropolitan areas. We used urban 

influence codes, a county categorization system developed by researchers 

with the Economic Research Service in the Department of Agriculture, to 

categorize metropolitan counties according to the size of the metropolitan 

area and nonmetropolitan counties according to the size of the county’s 

largest city and proximity to metropolitan areas.4

 We also reviewed 

relevant literature and interviewed experts on the U.S. physician 

workforce. For more information on our scope and methodology see 

appendix I. We performed our work from April through October 2003 in 

accordance with generally accepted government auditing standards. 

The number of physicians in the United States increased about 26 percent 

from 1991 to 2001, twice as much as the nation’s population. The average 

number of physicians per 100,000 people rose from 214 in 1991 to 239 in 

2001 and the mix of generalists and specialists in the national physician 

workforce remained about one-third generalists and two-thirds specialists. 

Growth occurred in areas with relatively low and high supplies of 

physicians per 100,000 people. The number of individual metropolitan and 

statewide nonmetropolitan areas with fewer than 100 physicians per 

100,000 people decreased and more areas had at least 300 physicians per 

100,000 people. 

Results in Brief 

2

We counted active, nonfederal, patient-care physicians with a known address. 

3

Generalists are physicians whose primary specialty is family practice, general practice, 

general internal medicine, or general pediatrics as reported in the American Medical 

Association or American Osteopathic Association Masterfiles. Other physicians are 

designated specialists. 

4

T.C. Ricketts, K.D. Johnson-Webb, P. Taylor, Definitions of Rural: A Handbook for Health 

Policy Makers and Researchers, Prepared for the Federal Office of Rural Health Policy, 

Health Resources and Services Administration, United States Department of Health and 

Human Services, June 1998. Downloaded from 

www.shepscenter.unc.edu/research_programs/rural_program/wp.html (downloaded April 

2003). 

Page 2 GAO-04-124 Physician Workforce 
Between 1991 and 2001, all but 17 areas gained physicians per 100,000 

people. Of the 48 statewide nonmetropolitan areas, all gained physicians 

per 100,000 people and fewer of these statewide nonmetropolitan areas 

were below 100 physicians per 100,000 people in 2001 than in 1991. Of the 

318 individual metropolitan areas, 17 experienced declines in the number 

of physicians per 100,000 people from 1991 to 2001, but only 2 had fewer 

total physicians in 2001 than in 1991. Overall, nonmetropolitan areas 

experienced larger proportional gains in physicians per 100,000 people 

than metropolitan areas, but the disparity in the supply of physicians per 

100,000 people between metropolitan and nonmetropolitan areas 

persisted. Nonmetropolitan counties that included a large town had the 

largest percentage increase in physicians per 100,000 people from 1991 to 

2001 of any type of metropolitan or nonmetropolitan county. Like 

metropolitan counties, nonmetropolitan counties with large towns had 

more specialists than generalists per 100,000 people, while 

nonmetropolitan counties without a large town and rural counties had 

more generalists per 100,000 people than specialists in 1991 and 2001. 

In written comments on a draft of this report, HRSA agreed with our 

findings of persisting disparities between metropolitan and 

nonmetropolitan areas. 

From the 1950s until the early 1970s, concerns about physician shortages 

prompted measures by the federal and state governments to increase 

physician supply. Federal and state governments supported the growth in 

the physician population by providing funds for constructing medical 

schools and increasing medical school class sizes, offering loans and 

scholarships to medical students, and paying hospitals through Medicare 

to subsidize residency training costs. Concurrent with these initiatives, the 

total physician supply and per-capita supply increased in the United 

States. 

By the 1980s and through the 1990s, however, concerns were raised about 

the adequacy of the physician supply. A 1981 study by the Graduate 

Medical Education National Advisory Committee (GMENAC) and a series 

of reports from 1992 to 1999 by the Council on Graduate Medical 

Background 

Page 3 GAO-04-124 Physician Workforce 
Education (COGME) forecast a national physician surplus.5,6

 COGME 

based these estimates on its determination that the appropriate target for 

physician supply ranged from 145 to 185 physicians per 100,000 people. 

These estimates were predicated in part on the belief that managed care, 

with its emphasis on preventive care and reliance on primary care 

gatekeepers exercising tight control over access to specialists, would 

become a more typical health care delivery model. COGME and others 

have noted that managed care has not become as dominant as predicted. 

By 2000, some research concluded that physician supply increased even 

more than these studies predicted.7

 Some researchers, however, 

questioned whether there was a national surplus of physicians.8 

A report from the Institute of Medicine (IOM) describes why studies of the 

physician workforce vary.9

 According to the IOM report, disagreement 

about the adequacy of physician supply arises because there is no single 

accepted approach to estimating physician supply or demand. Varying 

assumptions related to factors that may affect future supply or demand 

can lead to different conclusions about the adequacy of future physician 

supply. Projecting future physician supply depends on the approach used 

to count physicians, measure their productivity, and estimate the rate of 

entrance into and exit from the profession. Estimating demand for 

physicians’ services requires even more assumptions. Demand for 

physicians’ services can be estimated using current and projected service 

utilization patterns or by determining an ideal level of care to treat the 

projected incidence and prevalence of illness among the population. In 

addition, physician practice patterns, the use of new technology, the 

5

GMENAC, Summary Report to the Secretary, Department of Health and Human 

Services, Vol. 1, DHHS Pub. No. (HRA) 81-651 (Washington, D.C.: Health Resources 

Administration, Department of Health and Human Services, April 1981). 

6

For a complete list of COGME reports see the COGME Web site: 

http://www.cogme.gov/rptmail.htm. 

7

E.S. Salsberg and G.J. Forte, “Trends in the Physician Workforce, 1980-2000,” Health 

Affairs, vol. 21, no. 5 (2002). 

8

See for example, Salsberg and Forte, “Trends in the Physician Workforce, 1980-2000,” J.P. 

Weiner, “A Shortage of Physicians or a Surplus of Assumptions?” Health Affairs, vol. 21, 

no.1 (2002), and R.A. Cooper, “Perspectives on the Physician Workforce to the Year 2020,” 

JAMA, vol. 274, no. 19 (1995). 

9

IOM, The Nation’s Physician Workforce: Options for Balancing Supply and 

Requirements, K.N. Lohr, N.A. Vanselow, and D.E. Detmer, eds (Washington, D.C.: National 

Academy Press, 1996). 

Page 4 GAO-04-124 Physician Workforce 
supply and role of nonphysician providers,10 and rates and levels of 

insurance coverage also affect estimates of the demand for and supply of 

physicians’ services. 

In spite of the difficulty of determining whether the overall number of 

physicians is indeed the right number, there is little disagreement that 

physicians have been located disproportionately in metropolitan areas 

relative to the U.S. population. Geographic disparities in physician supply 

have persisted even as the national physician supply has increased 

steadily. Economic factors and professional preferences have all been 

offered as evidence to explain why physicians, and specialists in 

particular, locate in metropolitan areas.11 For example, physicians depend 

on the availability of hospitals, laboratories, and other technology, and 

metropolitan areas tend to have more of these facilities and equipment 

than nonmetropolitan areas. Small nonmetropolitan areas generally lack a 

large enough population or hospital resources to support a specialty 

practice, because specialists handle less prevalent but more complicated 

illnesses and require more specialized support facilities and technology.12 

To influence overall physician supply and address perceived physician 

shortages in certain areas, several federal programs fund efforts to address 

these issues. The bulk of federal dollars to support physician education is 

through Medicare’s graduate medical education (GME) payments to 

teaching hospitals, which totaled an estimated $7.8 billion in 2000, the 

latest year for which data were available. These GME payments are 

distributed based on the number of physicians being trained and 

Medicare’s share of patient days in the hospital. Medicare also pays 

physicians a 10 percent bonus above the usual payment amount for 

services they provide to beneficiaries in health professional shortage areas 

10Although this report describes the supply and geographic distribution of the physician 

workforce, other providers, such as physicians’ assistants and nurse practitioners, also 

provide many health care services that physicians provide. 

11H.K. Rabinowitz and N. P. Paynter, “The Rural vs. Urban Practice Decision,” JAMA, vol. 

287, no.1 (2002). 

12H.J. Jiang and J.W. Begun, “Dynamics of Change in Local Physician Supply: An Ecological 

Perspective,” Social Science & Medicine, vol. 24 (2002). 

Page 5 GAO-04-124 Physician Workforce 
(HPSAs).13 These Medicare Incentive Payments totaled $104 million in 14 2002. 

Programs intended to encourage health professionals to practice in 

underserved areas and to support the training and education of health 

professionals are administered by HRSA, within the Department of Health 

and Human Services (HHS). HRSA programs include the National Health 

Service Corps (NHSC) and grant and loan support programs for health 

professions education and training. Most of these programs address three 

objectives of improving the distribution of health professionals in 

underserved areas, increasing representation of minorities and individuals 

from disadvantaged backgrounds in health professions, and increasing the 

supply of health professionals. They also address other objectives such as 

improving the quality of education and training. In fiscal year 2001, 

spending for the NHSC was $70.8 million and spending for health 

professions education and training programs was $266 million. Funds for 

the NHSC and for health professions education and training programs 

support a range of health professions including medicine. See appendix II 

for more information about program spending or appropriations and 

program objectives. 

13The Department of Health and Human Services (HHS) designates areas having a critical 

shortage of primary care providers as HPSAs. A HPSA may be a distinct geographic area 

(such as a county), a specified population group within the area (such as migrant farm 

workers), or a public or nonprofit facility (such as a prison). 

14The number of physicians who received these payments in 2002 cannot be readily 

assessed from the Centers for Medicare & Medicaid Services (CMS) physician claims data. 

In 1999, we reported that specialists receive most of the Medicare Incentive Payment 

program dollars, even though primary care physicians have been identified as being in 

short supply. See U.S. General Accounting Office, Physician Shortage Areas: Medicare 

Incentive Payments Not an Effective Approach to Improve Access, GAO/HEHS-99-36 

(Washington, D.C.: Sept. 26, 1999). In 1994, the HHS Office of Inspector General found that 

the program may be paying physicians for providing care to Medicare beneficiaries who do 

not live in HPSAs. See HHS Office of Inspector General, Design Flaws in the Medicare 

Incentive Payment Program, OEI-01-93-00051 (Washington, D.C.: June 1994). 

Page 6 GAO-04-124 Physician Workforce 
National Physician 

Supply Grew at Twice 

the Rate of the U.S. 

Population 

The number of physicians in the United States increased about 26 percent, 

from about 541,000 to about 681,000 from 1991 to 2001. Physician growth 

was twice that of national population growth during this period. As a 

result, the total number of physicians per 100,000 people in the United 

States climbed 12 percent, from 214 in 1991 to 239 in 2001.15 The number of 

generalists per 100,000 people increased at about the same rate as the 

number of specialists per 100,000 people. (See table 1.) The national 

physician workforce maintained approximately a one-third generalist to 

two-thirds specialist composition between 1991 and 2001. 

Table 1: Physicians Per 100,000 People in the United States, 1991 and 2001 

Change from 

1991 to 2001 

1991 2001 (percentage) 

All physicians 214 239 

Generalists 78 87 

Specialists 133 150 

Sources: AMA, AOA, Bureau of Census, and Centers for Medicare & Medicaid Services (CMS). 

Notes: Physicians refer to active, nonfederal, patient-care physicians with a known address. We could 

not categorize some physicians as generalists or specialists because there was no information about 

their specialty in the AMA or AOA Masterfiles. Specifically, records for 7,185 physicians (1 percent) in 

1991 and 4,982 physicians (0.7 percent) in 2001 did not have information that would allow us to 

classify them as generalists or specialists. These physicians are included in the all physicians total 

but not in the generalist and specialist totals. The percentage change calculations are based on rates 

prior to rounding. 

Growth in physician supply reduced the number of metropolitan and 

nonmetropolitan areas with fewer than 100 physicians per 100,000 people 

and increased the number of areas with greater than 300 physicians per 

100,000 people. In 1991, 8 metropolitan areas and 27 statewide 

nonmetropolitan areas had fewer than 100 physicians per 100,000 people. 

By 2001, no metropolitan areas and 7 statewide nonmetropolitan areas had 

fewer than 100 physicians per 100,000 people. Twice as many metropolitan 

areas and statewide nonmetropolitan areas had at least 300 physicians per 

100,000 people in 2001 as in 1991. (See figs. 1 and 2.) In 1991, the 25 

percent of areas with the lowest physician supplies per 100,000 people had 

an average of 106 physicians per 100,000 people. By 2001, the 25 percent of 

areas with the lowest physician supplies per 100,000 people had an 

average of 132 physicians per 100,000 people. Similarly, the 25 percent of 

15The growth rate of physicians per 100,000 people was slightly higher (13 percent) from 

1996 to 2001 than from 1991 to 1996 (11 percent). 

Page 7 GAO-04-124 Physician Workforce 

12 

13 

13 
Figure 1: Physicians Per 100,000 People in the United States by Metropolitan Areas and Statewide Nonmetropolitan Areas, 

1991 

Notes: Physicians refer to active, nonfederal, patient-care physicians with a known address. The 

District of Columbia, New Jersey, and Rhode Island do not have nonmetropolitan areas. 

Page 8 GAO-04-124 Physician Workforce 
Figure 2: Physicians Per 100,000 People in the United States by Metropolitan Areas and Statewide Nonmetropolitan Areas, 

2001 

Notes: Physicians refer to active, nonfederal, patient-care physicians with a known address. The 

District of Columbia, New Jersey, and Rhode Island do not have nonmetropolitan areas. 

Page 9 GAO-04-124 Physician Workforce 
Physician Supply Per 

100,000 People 

Increased in Most 

Areas but Geographic 

Disparities Persisted 

areas with the highest physician supplies per 100,000 people had an 

average of 319 physicians in 1991 and 362 physicians in 2001. See appendix 

III for information on physician supply by state metropolitan and 

nonmetropolitan areas in 1991 and 2001. 

All 48 statewide nonmetropolitan areas experienced an increase in the 

number of physicians per 100,000 people from 1991 to 2001 and 301 of 318 

metropolitan areas experienced an increase in physicians per 100,000 

people. Overall, the nonmetropolitan areas had higher proportional growth 

in physicians per 100,000 people than the metropolitan areas, but the 

disparity in the supply of physicians per 100,000 people between the 

metropolitan and nonmetropolitan areas persisted. Rates of growth in the 

number of physicians per 100,000 people, the supply of physicians per 

100,000 people, and the mix of generalists and specialists among 

categories of metropolitan and nonmetropolitan counties varied. Among 

the five county categories we analyzed, nonmetropolitan counties with a 

large town had the biggest increase in physicians per 100,000 people from 

1991 to 2001 and more physicians per 100,000 people than either 

nonmetropolitan counties without a large town or rural counties, but still 

fewer than metropolitan counties. Like metropolitan counties, 

nonmetropolitan counties with large towns had more specialists than 

generalists, while other nonmetropolitan counties had more generalists 

than specialists. 

Almost All Areas Gained 

Physicians Per 100,000 

People 

The 48 statewide nonmetropolitan areas, including those with the lowest 

supplies of physicians per 100,000 people in 1991, registered gains in 

physicians per 100,000 people between 1991 and 2001. However, this 

growth rate was not even across all statewide nonmetropolitan areas and 7 

areas remained below 100 physicians per 100,000 people. Five of these 7 

statewide nonmetropolitan areas—Iowa, Indiana, Louisiana, Oklahoma, 

and Texas—that remained below 100 physicians per 100,000 people, had 

average increases in physicians per 100,000 people that were less than the 

23 percent average increase for the nonmetropolitan United States. The 

remaining 2—statewide nonmetropolitan Alabama and Tennessee—had 

increases in physicians per 100,000 people that exceeded the national 

nonmetropolitan area average, but the number of physicians in these areas 

was so low in 1991 that this growth was not enough to elevate their 

physician supply above 100 per 100,000 people in 2001. 

Page 10 GAO-04-124 Physician Workforce 
In the aggregate, the 318 metropolitan areas of the United States 

experienced an increase in physicians per 100,000 people between 1991 

and 2001. However, 17 (5 percent) metropolitan areas experienced 

declines in the number of physicians per 100,000 people during this period. 

(See table 2.) In 2001, 11 of these areas had physician supplies per 100,000 

people that were below the national average of 239 physicians per 100,000 

people. Only 2 individual metropolitan areas, however—the Topeka, 

Kansas and Enid, Oklahoma MSAs—experienced an actual decrease in 

their physician populations between 1991 and 2001. While the remaining 

15 areas had more physicians in 2001 than in 1991, the population increase 

for all of them was large enough that they still experienced a decline over 

that decade in the number of physicians per 100,000 people. Five of these 

areas had physician population growth in excess of the national average of 

26 percent. However, in these areas the higher-than-average growth in 

physician supply was exceeded by population growth that was also above 

the national average of 13 percent, resulting in a decline in physicians per 

100,000 people.16 

16Other areas with higher-than-average population growth experienced increases in their 

physician populations per 100,000 people. For example, the physician supply in the Las 

Vegas, Nevada-Arizona MSA outpaced the area’s very high population growth during this 

period, resulting in a 20 percent increase in the number of physicians per 100,000 people. 

Page 11 GAO-04-124 Physician Workforce 
Table 2: Areas with Reductions in Physicians Per 100,000 People from 1991 to 2001 

Change in Change in 

physician Population physicians 

population, increase, Physicians per 100,000, 

1991-2001 1991-2001 per 100,000, 1991-2001 

(percentage) (percentage) 2001 (percentage) 

Phoenix-Mesa, Ariz. MSA 41 46 197 

Yuma, Ariz. MSA 38 47 100 

Greeley, Colo. PMSA 38 45 136 

Raleigh-Durham-Chapel 

Hill, N.C. MSA 33 38 398 

Denver, Colo. PMSA 27 29 265 

Tucson, Ariz. MSA 25 27 285 

Riverside-San 

Bernardino, Calif. PMSA 18 24 138 

Modesto, Calif. MSA 17 21 144 

Merced, Calif. MSA 15 18 101 

Stockton-Lodi, Calif. MSA 13 21 134 

Miami, Fla. PMSA 13 16 303 

Reading, Pa. MSA 9 10 180 

Iowa City, Iowa MSA 5 14 1004 

Los Angeles-Long Beach, 

Calif. PMSA 4 8 238 

Jersey City, N.J. PMSA 1 9 171 

Topeka, Kans. MSA -1 4 252 

Enid, Okla. MSA -4 1 212 

Sources: AMA, AOA, Bureau of Census, and CMS. 

Note: Physicians refer to active, nonfederal, patient-care physicians with a known address. 

Statewide The number of physicians per 100,000 people in nonmetropolitan areas, in 

Nonmetropolitan Areas which 19 percent of the U.S. population resided in 2001, increased 23 

Had Greater Proportional percent from 1991 to 2001. During this same time, the number of 

physicians per 100,000 people in metropolitan areas, in which 81 percent Increases in Physicians Per of the U.S. population resided in 2001, increased 10 percent. (See table 3.) 100,000 People Than The higher growth rate in physicians per 100,000 people in Metropolitan Areas but nonmetropolitan areas over the decade did not translate into a reduction 

Geographic Disparities in the gap in the supply of physicians per 100,000 people in metropolitan 

Persisted versus nonmetropolitan areas. The disparity in the supply of physicians 

per 100,000 people between nonmetropolitan and metropolitan areas 

Page 12 GAO-04-124 Physician Workforce 

-4 

-7 

-5 

-4 

-2 

-1 

-5 

-4 

-3 

-6 

-2 

-1 

-8 

-3 

-7 

-5 

-5 
persisted because physicians continued to disproportionately locate in 

metropolitan areas. On net, about 17,000 physicians (12 percent of the 

physician population increase) went to nonmetropolitan areas between 

1991 and 2001, while about 123,000 (88 percent of the physician population 

increase) went to metropolitan areas. The difference in physician supply 

between metropolitan and nonmetropolitan areas remained relatively 

unchanged from 1991, when the difference in supply was 143 per 100,000 

people, to 2001 when the difference was 145 per 100,000 people. 

Table 3: Physicians Per 100,000 People in Statewide Nonmetropolitan and 

Metropolitan Areas, 1991 and 2001 

Change from 1991 to 2001 

1991 2001 (percentage) 

Nonmetropolitan 

All physicians 99 122 

Generalists 49 59 

Specialists 49 63 

Metropolitan 

All physicians 242 267 

Generalists 85 94 

Specialists 154 171 

Sources: AMA, AOA, Bureau of Census, and CMS. 

Notes: Physicians refer to active, nonfederal, patient-care physicians with a known address. We could 

not categorize some physicians as generalists or specialists because there was no information about 

their specialty in the AMA or AOA Masterfiles. Specifically, records for 7,185 physicians (1 percent) in 

1991 and 4,982 physicians (0.7 percent) in 2001 did not have information that would allow us to 

classify them as generalists or specialists. These physicians are included in the all physicians total, 

but not in the generalist and specialist totals. The percentage change calculations are based on rates 

prior to rounding. 

In nonmetropolitan areas, the number of specialists per 100,000 people 

increased faster than the number of generalists per 100,000 people. As a 

result, the generalist and specialist composition shifted from an even mix 

of generalists and specialists in 1991 to 48 percent generalists and 52 

percent specialists in 2001. In metropolitan areas, generalists and 

specialists per 100,000 people increased at approximately the same rate, 

shifting the composition less than 1 percent from 36 percent generalists 

and 64 percent specialists in 1991 to 35 percent generalists and 65 percent 

specialists in 2001. 

Page 13 GAO-04-124 Physician Workforce 

23 

19 

28 

10 

11 

11 
Rates of Growth in 

Physician Supply Differed 

Among Categories of 

Nonmetropolitan and 

Metropolitan Counties 

To obtain additional information about physician supply within 

nonmetropolitan and metropolitan areas, we aggregated county physician 

and population data into five categories defined by a county’s 

nonmetropolitan or metropolitan status and the presence and size of a 

town within the county. All five county categories had an increase in 

physicians per 100,000 people from 1991 to 2001. (See fig. 3.) But the rates 

of growth in physician supply per 100,000 people, supply of physicians per 

100,000 people, and mix of generalists and specialists varied by county 

category. While nonmetropolitan counties with a large town (10,000 to 

49,999 residents) had the biggest percentage increase in physicians per 

100,000 people of all county categories, their supplies per 100,000 people 

were still less than large and small metropolitan counties’ supplies in 1991 

and 2001. Among nonmetropolitan counties, however, those with a large 

town had more physicians per 100,000 people than those without a large 

town or rural counties in 1991 and 2001. Like metropolitan counties, 

nonmetropolitan counties that are more urbanized—those with a large 

town—had more specialists than generalists per 100,000 people. Less 

urbanized nonmetropolitan counties—those without a large town—and 

rural counties had more generalists than specialists per 100,000 people in 

1991 and 2001. 

Page 14 GAO-04-124 Physician Workforce 
Figure 3: Physicians Per 100,000 People by Metropolitan and Nonmetropolitan 

County Categories, 1991 and 2001 

Notes: Counties without urban influence codes are not included in these figures. Physicians refer to 

active, nonfederal, patient-care physicians with a known address. 

a

Large metropolitan areas have at least one million residents. 

b

Small metropolitan areas have 50,000 to 999,999 residents. 

c

Large towns have 10,000 to 49,999 residents. 

d

Counties without large towns include those with or without a town of 2,500 to 9,999 residents. 

e

Rural counties have fewer than 2,500 residents. 

Agency Comments 	 We provided a draft of this report to HRSA for comment. HRSA said that 

the study supports the conclusion that the disparity in the distribution of 

physicians in rural and urban areas persists and has narrowed. HRSA also 

agreed with our assessment of the difficulties and variation associated 

with determining an appropriate supply for any given geographic area. 

However, HRSA noted that the report should draw conclusions to make 

the report more complete. 

Page 15 GAO-04-124 Physician Workforce 
HRSA also commented that rural citizens are still grossly underserved, 

noting that physician supply can be a rough measure of access to 

physician services in a given area and that even in areas with a large 

number of physicians many people still lack access due to a number of 

factors. HRSA’s comments are reprinted in appendix IV. 

Although we found that a geographic disparity persists, we did not find 

that the disparity in the distribution between metropolitan and 

nonmetropolitan areas has narrowed. Physician supply grew faster in 

nonmetropolitan than metropolitan areas, on a national basis, but this did 

not reduce the disparity because there are so many physicians in 

metropolitan areas. As we stated in the draft report that HRSA reviewed, 

while nonmetropolitan areas experienced higher growth rates in 

physicians per 100,000 people, the difference in physician supply per 

100,000 people remained relatively unchanged from 1991 to 2001. 

HRSA noted that physician supply is only one of several factors affecting 

the accessibility of health care in an area. However, assessing the 

adequacy of access to physicians was beyond the scope of our work. 

HRSA also provided technical comments that we incorporated as 

appropriate. 

We are sending copies of this report to the Administrator of the Health 


Resources Services Administration and other interested parties. We will 


also provide copies to others upon request. In addition, the report will be 


available at no charge on the GAO Web site at http://www.gao.gov. If you 


or your staff have any questions about this report, please call me at (202) 


512-7119 or Christine Brudevold at (202) 512-2669. Major contributors to 


this report were Kathryn Linehan and Ann Tynan. 


Sincerely yours, 


Laura A. Dummit 


Director, Health Care—Medicare Payment Issues 


Page 16 GAO-04-124 Physician Workforce 
Appendix I: Scope and Methodology 


To conduct this work, we counted active, nonfederal, patient care 

physicians with a known address, including interns and residents, in the 

United States. We used individual physician-level data on medical doctors 

(MD) from the 1991 and 2001 American Medical Association (AMA) 

Physicians’ Professional Data, also known as the AMA Masterfile and 1991 

and 2001 data on doctors of osteopathic medicine (DO) from the American 

Osteopathic Association (AOA) Masterfile. These data are widely used in 

studies of physician supply because they are a comprehensive list of U.S. 

physicians and their characteristics. 

To determine physician supply per 100,000 people, we obtained countylevel resident population data for 1991 and 2001 from the U.S. Census 

Bureau Web site.1

 We used data from the Department of Agriculture Web 

site to determine urban influence codes for each county.2

 For additional 

information about physician supply in the United States, we reviewed 

relevant literature and interviewed academic researchers on the topic of 

the U.S. physician workforce. 

To obtain federal program information, we interviewed officials from the 

Health Resources and Services Administrative (HRSA) and officials at the 

Centers for Medicare & Medicaid Services (CMS). HRSA officials provided 

information on the scope and expenditures of health professions training 

and education programs and the National Health Service Corps. CMS 

officials provided information on the Medicare Incentive Payments to 

physicians providing services in health professional shortage areas. 

We combined counts of MDs and DOs to determine the total number of 

physicians in each of our study years. Each physician was counted without 

adjustment for hours worked. To determine physicians per 100,000 people, 

we divided the physician population in a given area by the total population 

in the area in that same year. To count generalists and specialists we used 

each physician’s specialty information in the AMA and AOA data files to 

categorize physicians as generalists or specialists. Physicians whose 

specialty information was listed as family practice, general practice, 

1

Data for 1991 were from http://eire.census.gov/popest/data/counties/tables/CO-EST2001­

12.php (downloaded on July 3, 2003). Data for 2001 were from 

http://eire.census.gov/popest/estimates_dataset.php (downloaded on March 13, 2003). 

2

Data on urban influence codes from the Department of Agriculture were from 

http://www.ers.usda.gov/briefing/Rurality/UrbanInf/Urbinfl.xls (downloaded on March 12, 

2003). 

Page 17 GAO-04-124 Physician Workforce 
Appendix I: Scope and Methodology 

general internal medicine, and general pediatrics were categorized as 

generalists. All other physicians with specialty information available were 

categorized as specialists. 

To assign physicians to a geographic area in the United States, we used 

address information in the AMA and AOA data files. The address 

information in these files does not specify whether the address refers to 

the physician’s home, office, or some other location and it is possible that 

some physicians live and work in different counties. Because of this 

limitation, we did not analyze the data at the individual county level. We 

combined multiple, adjacent counties into larger geographic units. We 

assigned counties to a metropolitan statistical area (MSA), primary 

metropolitan statistical areas (PMSA), or New England county 

metropolitan area (NECMA). We grouped data from all areas within a state 

that were not in a MSA, PMSA, or NECMA into one statewide 

nonmetropolitan area for each state. We used 2001 MSA, PMSA, and 

NECMA classifications for the 2001 and 1991 data. 

For analysis by county categories, we used urban influence codes, which 

group metropolitan and nonmetropolitan counties according to the official 

metropolitan status announced by the Office of Management and Budget 

in 1993, based on 1990 Census data. Urban influence codes group counties, 

county equivalents, and independent cities into nine categories.3 

Metropolitan counties are grouped into two categories (1 and 2) by the 

size of the metropolitan area. Nonmetropolitan counties are grouped into 

seven groups (3 through 9) by their adjacency to metropolitan areas and 

the size of their own city. For this analysis of physician supply, we 

maintained categories 1, 2, and 9 and collapsed the remaining six 

categories into two, for a total of five categories. This analysis combines 

codes 3, 5, and 7 into one category (i.e., nonmetropolitan with a large 

town) and 4, 6, and 8 into one category (i.e., nonmetropolitan without a 

large town). 

3

For more information about urban influence codes see T.C. Ricketts, K.D. Johnson-Webb, 

P. Taylor, Definitions of Rural: A Handbook for Health Policy Makers and Researchers, 

Prepared for the Federal Office of Rural Health Policy, Health Resources and Services 

Administration, United States Department of Health and Human Services, June 1998. 

Downloaded from www.shepscenter.unc.edu/research_programs/rural_program/wp.html 

(downloaded April 2003). 

Page 18 GAO-04-124 Physician Workforce 
Appendix II: HRSA Programs That Address 

Supply and Distribution of Health 

Professionals 

HRSA administers programs that encourage health professionals to 

practice in underserved areas and support health professions education 

and training. The National Health Service Corps and the State Loan 

Repayment Program, authorized by Title III of the Public Health Service 

Act, offer scholarships and loan repayments to health professionals in 

exchange for a commitment to practice in health professional shortage 

areas.1

 Grant and loan support programs that support health professions 

education and training, authorized by Title VII of the Public Health Service 

Act, have diverse objectives.2

 Generally, these programs support education 

and training for a range of health professions including medicine, 

chiropractics, dentistry, optometry, pharmacy, physician assistants, allied 

health, and public health. While most of the Title VII programs address 

three objectives of improving the distribution of health professionals in 

underserved areas, increasing representation of minorities and individuals 

from disadvantaged backgrounds in health professions, and increasing the 

supply of health professionals, they also address other objectives such as 

improving the quality of education and training. Table 4 provides 

information on Title III and Title VII program spending or appropriations 

and objectives. 

1

Public Health Service Act (PHSA), July 1, 1944, ch. 373, 58 stat. 682 (classified to 42 U.S.C. 

§§ 201 et seq.) Title III of the PHSA is classified to 42 U.S.C. §§ 241 et seq. 

2

Title VII of the PHSA is classified to 42 U.S.C. §§ 292 et seq. 

Page 19 GAO-04-124 Physician Workforce 
Appendix II: HRSA Programs That Address 

Supply and Distribution of Health 

Professionals 

Table 4: HRSA Programs’ Expenditures or Appropriations and Objectives 

Program expenditures 

or appropriationsa 

(in millions of dollars) Program objectives 

Program FY 1991 FY 2001 

Improving 

distribution of 

health 

professionals in 

underserved 

areas 

Increasing 

representation 

of minorities 

and individuals 

from 

disadvantaged 

backgrounds in 

health 

professions 

Increasing 

supply of 

health 

professionals 

Improving training 

for health 

professionals in 

geriatrics and in 

public health 

Programs authorized by 

Title III of the Public 

Health Service Act 

Scholarships and loan 

repayments to individuals 

in exchange for 

commitments to practice in 

underserved areas 

National Health Service $42.5 $70.8 X 

Corps 

State Loan Repayment 6.0 7.2 X 

Title III Total $48.5 $78.0 

Programs authorized by 

Title VII of the Public 

Health Service Act 

Scholarships and loans to 

individuals in exchange for 

commitment to train in and 

practice primary care 

medicine 

Exceptional Financial $9.6 $1.0 X X 

Need Scholarships 

Financial Assistance for 6.1 .6 X X 

Disadvantaged Health 

Professions 

Primary Care Loanb,c, d N.A. 9.9 X 

Page 20 GAO-04-124 Physician Workforce 
Appendix II: HRSA Programs That Address 

Supply and Distribution of Health 

Professionals 

Program expenditures 

or appropriationsa 

(in millions of dollars) Program objectives 

Improving 

distribution of 

health 

professionals in 

underserved 

areas 

Increasing 

representation 

of minorities 

and individuals 

from 

disadvantaged 

backgrounds in 

health 

professions 

Increasing 

supply of 

health 

professionals 

Improving training 

for health 

professionals in 

geriatrics and in 

Program FY 1991 FY 2001 public health

Scholarships, loans, and 

loan repayments to 

individuals in health 

professions training 

Health Professions 3.5 1.2 X 

Student Loanb, c 

Loans for 2.8 .2 X 

Disadvantaged 

Studentsc 

Scholarships for 8.2 41.0 X X 

Disadvantaged Students 

Faculty Loan .5 1.0 X 

Repayment Program 

Grants to institutions or 

individuals for health 

professions education and 

training 

Quentin N. Burdick 3.8 6.0 X 

Program for Rural 

Interdisciplinary Training 

Training in Primary Care 70.4 91.1 X X X 

Medicine and Dentistry 

Area Health Education 19.2 33.4 X X X 

Centers 

Geriatric Training for 3.9 2.9 X X 

Physicians, Dentists, 

and Behavioral and 

Mental Health 

Professionals 

Page 21 GAO-04-124 Physician Workforce 
Appendix II: HRSA Programs That Address 

Supply and Distribution of Health 

Professionals 

Program expenditures 

or appropriationsa 

(in millions of dollars) Program objectives 

Improving 

distribution of 

health 

professionals in 

underserved 

areas 

Increasing 

representation 

of minorities 

and individuals 

from 

disadvantaged 

backgrounds in 

health 

professions 

Increasing 

supply of 

health 

professionals 

Improving training 

for health 

professionals in 

geriatrics and in 

Program FY 1991 FY 2001 public health

Geriatric Academic N.A. .8 X 

Career Awards 

Geriatric Education 9.5 7.5 X 

Center Program 

Centers of Excellence 14.5 30.6 X 

Health Careers 24.2 32.0 X 

Opportunity Program 

Preventive Medicine U.A. 2.1 X X X 

Residency Grant 

Program 

Public Health Training N.A. 4.7 X 

Center Program 

Title VII Total $176.2 $266.0 

Source: HRSA. 

Legend: NA = not applicable because program not operational this year 

UA = data not available 

Notes: All programs provide support for a range of health professions including medicine, 

chiropractics, dentistry, optometry, pharmacy, physician assistants, allied health, and public health, 

except as noted. 

a

For Title III programs, expenditures are given. For Title VII programs, appropriations are given. 

b

Program provides support for medical students, residents, and physicians. 

c

Loan programs financed by revolving loan fund. 

d

The Primary Care Loan Program replaced Health Professions Student Loan Program in 1993 for 

allopathic and osteopathic medicine programs. 

Page 22 GAO-04-124 Physician Workforce 
Appendix III: Physicians Per 100,000 People 

by State Metropolitan and Nonmetropolitan 

Areas, 1991 and 2001 

Physicians per 100,000 

people 

Generalists per 100,000 

people 

Specialists per 100,000 

people 

Areas 1991 2001 1991 2001 1991 2001 

Alabama 

Metropolitan Alabama 201 238 69 82 129 

Nonmetropolitan Alabama 61 78 36 45 25 

Alaska 

Metropolitan Alaska 176 246 60 91 115 

Nonmetropolitan Alaska 97 134 54 76 42 

Arizona 

Metropolitan Arizona 214 207 73 73 138 

Nonmetropolitan Arizona 90 111 52 56 38 

Arkansas 

Metropolitan Arkansas 231 265 78 91 148 

Nonmetropolitan Arkansas 85 101 48 55 35 

California 

Metropolitan California 225 229 78 83 144 

Nonmetropolitan California 112 129 52 59 58 

Colorado 

Metropolitan Colorado 231 240 81 85 147 

Nonmetropolitan Colorado 112 154 58 71 53 83 

Connecticut 

Metropolitan Connecticut 288 324 96 108 188 214 

Nonmetropolitan Connecticut 125 133 53 60 72 72 

Delaware 

Metropolitan Delaware 217 249 80 93 135 154 

Nonmetropolitan Delaware 153 194 53 66 99 128 

District of Columbia 

Metropolitan District of Columbia 544 554 169 171 363 373 

Florida 

Metropolitan Florida 214 237 71 82 141 154 

Nonmetropolitan Florida 98 117 40 49 57 68 

Georgia 

Metropolitan Georgia 208 228 64 77 140 150 

Nonmetropolitan Georgia 97 117 43 52 54 64 

Page 23 GAO-04-124 Physician Workforce 

154 

33 

156 

58 

133 

55 

172 

45 

143 

69 

154 
Appendix III: Physicians Per 100,000 People 

by State Metropolitan and Nonmetropolitan 

Areas, 1991 and 2001 

Physicians per 100,000 

people 

Generalists per 100,000 

people 

Specialists per 100,000 

people 

Areas 1991 2001 1991 2001 1991 2001 

Hawaii 

Metropolitan Hawaii 252 284 91 101 154 

Nonmetropolitan Hawaii 157 190 70 80 87 

Idaho 

Metropolitan Idaho 162 198 55 69 106 

Nonmetropolitan Idaho 108 129 49 54 56 

Illinois 

Metropolitan Illinois 240 270 91 102 145 

Nonmetropolitan Illinois 89 108 46 54 42 

Indiana 

Metropolitan Indiana 190 234 69 82 118 

Nonmetropolitan Indiana 83 99 43 49 39 

Iowa 

Metropolitan Iowa 261 288 92 102 165 

Nonmetropolitan Iowa 88 100 50 58 37 

Kansas 

Metropolitan Kansas 253 278 88 100 162 

Nonmetropolitan Kansas 93 114 54 61 38 53 

Kentucky 

Metropolitan Kentucky 252 285 84 91 166 191 

Nonmetropolitan Kentucky 93 121 45 56 47 64 

Louisiana 

Metropolitan Louisiana 226 283 65 86 157 194 

Nonmetropolitan Louisiana 68 78 39 43 28 34 

Maine 

Metropolitan Maine 229 300 88 115 140 183 

Nonmetropolitan Maine 151 195 74 90 76 103 

Maryland 

Metropolitan Maryland 311 335 105 112 199 217 

Nonmetropolitan Maryland 144 181 53 66 91 114 

Massachusetts 

Metropolitan Massachusetts 308 362 105 118 199 240 

Nonmetropolitan Massachusetts 134 150 63 67 71 83 

Page 24 GAO-04-124 Physician Workforce 

181 

109 

128 

73 

166 

53 

151 

50 

183 

42 

176 
Appendix III: Physicians Per 100,000 People 

by State Metropolitan and Nonmetropolitan 

Areas, 1991 and 2001 

Physicians per 100,000 

people 

Generalists per 100,000 

people 

Specialists per 100,000 

people 

Areas 1991 2001 1991 2001 1991 2001 

Michigan 

Metropolitan Michigan 237 273 88 104 145 

Nonmetropolitan Michigan 106 129 52 60 53 

Minnesota 

Metropolitan Minnesota 274 296 102 108 169 

Nonmetropolitan Minnesota 91 114 58 70 31 

Mississippi 

Metropolitan Mississippi 224 261 73 76 148 

Nonmetropolitan Mississippi 83 107 40 49 42 

Missouri 

Metropolitan Missouri 270 292 92 99 174 

Nonmetropolitan Missouri 90 111 50 60 39 

Montana 

Metropolitan Montana 236 302 52 82 183 

Nonmetropolitan Montana 124 157 63 73 59 

Nebraska 

Metropolitan Nebraska 262 300 88 106 171 

Nonmetropolitan Nebraska 83 115 49 63 34 52 

Nevada 

Metropolitan Nevada 161 180 53 63 106 116 

Nonmetropolitan Nevada 44 125 27 60 16 65 

New Hampshire 

Metropolitan New Hampshire 161 192 56 72 105 119 

Nonmetropolitan New Hampshire 287 353 103 119 180 230 

New Jersey 

Metropolitan New Jersey 256 296 97 110 156 184 

New Mexico 

Metropolitan New Mexico 247 264 84 97 161 166 

Nonmetropolitan New Mexico 99 114 51 55 48 59 

New York 

Metropolitan New York 318 357 115 127 200 228 

Nonmetropolitan New York 121 149 51 62 67 85 

Page 25 GAO-04-124 Physician Workforce 

167 

68 

185 

43 

183 

58 

192 

51 

219 

83 

192 
Appendix III: Physicians Per 100,000 People 

by State Metropolitan and Nonmetropolitan 

Areas, 1991 and 2001 

Physicians per 100,000 

people 

Generalists per 100,000 

people 

Specialists per 100,000 

people 

Areas 1991 2001 1991 2001 1991 2001 

North Carolina 

Metropolitan North Carolina 221 257 73 86 145 

Nonmetropolitan North Carolina 96 125 41 54 54 

North Dakota 

Metropolitan North Dakota 283 321 95 114 184 

Nonmetropolitan North Dakota 100 124 55 67 43 

Ohio 

Metropolitan Ohio 239 274 87 101 149 

Nonmetropolitan Ohio 92 114 44 57 47 

Oklahoma 

Metropolitan Oklahoma 220 236 79 87 138 

Nonmetropolitan Oklahoma 87 96 50 54 36 

Oregon 

Metropolitan Oregon 234 249 82 92 150 

Nonmetropolitan Oregon 128 156 58 70 69 

Pennsylvania 

Metropolitan Pennsylvania 277 317 100 114 173 

Nonmetropolitan Pennsylvania 133 152 55 66 77 86 

Rhode Island 

Metropolitan Rhode Island 250 313 98 115 149 196 

South Carolina 

Metropolitan South Carolina 192 241 65 80 124 159 

Nonmetropolitan South Carolina 88 120 44 55 43 65 

South Dakota 

Metropolitan South Dakota 257 315 84 100 160 212 

Nonmetropolitan South Dakota 93 122 54 65 38 54 

Tennessee 

Metropolitan Tennessee 255 290 83 95 168 193 

Nonmetropolitan Tennessee 77 98 42 52 35 45 

Texas 

Metropolitan Texas 195 213 65 73 127 139 

Nonmetropolitan Texas 72 81 42 45 29 36 

Page 26 GAO-04-124 Physician Workforce 

170 

70 

203 

54 

172 

57 

147 

41 

156 

84 

202 
Appendix III: Physicians Per 100,000 People 

by State Metropolitan and Nonmetropolitan 

Areas, 1991 and 2001 

Physicians per 100,000 

people 

Generalists per 100,000 

people 

Specialists per 100,000 

people 

Areas 1991 2001 1991 2001 1991 2001 

Utah 

Metropolitan Utah 203 208 64 70 137 

Nonmetropolitan Utah 85 115 40 50 43 

Vermont 

Metropolitan Vermont 388 487 142 179 240 

Nonmetropolitan Vermont 174 223 76 96 97 

Virginia 

Metropolitan Virginia 224 257 76 90 144 

Nonmetropolitan Virginia 112 135 51 62 60 

Washington 

Metropolitan Washington 222 245 82 90 137 

Nonmetropolitan Washington 128 152 63 73 63 

West Virginia 

Metropolitan West Virginia 214 273 78 106 133 

Nonmetropolitan West Virginia 156 186 67 80 88 

Wisconsin 

Metropolitan Wisconsin 225 268 78 95 143 

Nonmetropolitan Wisconsin 107 131 56 68 50 62 

Wyoming 

Metropolitan Wyoming 190 223 87 87 103 134 

Nonmetropolitan Wyoming 112 150 55 65 57 85 

Sources: AMA, AOA, Bureau of Census, and CMS. 

Note: Physicians refer to active, nonfederal, patient-care physicians with a known address. The 

District of Columbia, New Jersey, and Rhode Island do not have nonmetropolitan counties. We could 

not categorize some physicians as generalists or specialists because there was no information about 

their specialty in the AMA or AOA Masterfiles. Specifically, records for 7,185 physicians (1 percent) in 

1991 and 4,982 physicians (0.7 percent) in 2001 did not have information that would allow us to 

classify them as generalists or specialists. These physicians are included in the all physicians total 

but not in the generalist and specialist totals. 

Page 27 GAO-04-124 Physician Workforce 

137 

64 

300 

126 

165 

72 

153 

78 

164 

103 

171 
Appendix IV: Comments from the Health 

Resources and Services Administration 

Page 28 GAO-04-124 Physician Workforce 
Appendix IV: Comments from the Health Resources and Services Administration 

Page 29 GAO-04-124 Physician Workforce 
Appendix IV: Comments from the Health Resources and Services Administration 

Page 30 GAO-04-124 Physician Workforce 
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(290260) Page 31 GAO-04-124 Physician Workforce 
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