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William B. Schwartz, MD; Albert P. Williams, PhD; Joseph P. Newhouse, PhD; Christina Witsberger, MPH

JAMA. 1988;259(2):233-239.

Abstract
As of 1983,10% to 40% of cities with a population of 200 000 to 500 000 lacked a board-certified physician in one or more medical subspecialties, and many additional cities of this size had only one certified representative in many of the subspecialties. Somewhat smaller cities (population, 125 000 to 200 000) had far less complete coverage. Even when one includes board-certified internists who declared themselves subspecialists but lacked certification, there were many relatively large cities without complete coverage. Between now and 2000, an appreciable portion of the projected larger pool of board-certified subspecialists will be required to deal with a growing population and an increase in per capita demand for care. Others will locate in unserved or underserved cities, but our data suggest that even in 2000, many relatively large cities will have a deficit of most types of subspecialists.

(JAMA 1988;259:233-239)

Author Affiliations
From the Department of Medicine, Tufts University School of Medicine, and the Medical Service, New England Medical Center Hospitals, Boston (Dr Schwartz); and the Health Sciences Program, The RAND Corporation, Santa Monica, Calif (Drs Williams and Newhouse and Ms Witsberger).

Footnotes
The opinions and conclusions expressed herein are solely those of the authors and should not be construed as representing the opinions or policy of The Commonwealth Fund, New York; The Robert Wood Johnson Foundation, Princeton, NJ; or The RAND Corporation, Santa Monica, Calif.

Reprint requests to Tufts University School of Medicine, 136 Harrison Ave, Boston, MA 02111 (Dr Schwartz).

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