Physicians are not practicing where their time and efforts will be most effective. While residents of rural areas are more likely to be older, lower-income, and in worse health than those in urban areas, health professionals continue to flock to cities. The most effective distribution, in terms of addressing suffering, would be to have more physicians living where there is greater demand for them. Unfortunately, the opposite is the case. While 20% of the population in the United States lives in rural areas, only 9% of physicians practice in those areas.
But what is the real effect on suffering? Those who live in rural areas, far from primary care physicians, are more likely to have waited longer and be in worse health at the time of care. This results in increased medical costs and more overall suffering among a population that is, on average, more disadvantaged. All in all, many of those who are most disadvantaged are geographically isolated from basic medical care, limiting the efficiency and efficacy of the medical system within the U.S.
While these numbers are obvious within the United States, they are surprisingly worse on a global scale. Over 50 countries have a shortage of over two million health professionals which limits the ability to diagnose and treat even the most basic of health problems. Most health professionals (and most training programs for health professionals) are disproportionately located within the most developed countries (mainly in the United States and in Europe), while the need for basic health care and health professionals is greatest within the least developed countries, among populations struggling with highly treatable “diseases of poverty.” While low income and lack of resources are a major cause of disease that should be addressed, the care of those whom are already ill is a necessary step in reducing suffering and preventing the mortality of treatable diseases.
The suffering that exists due to shortages and ineffective distribution of physicians is a major problem, albeit a solvable one. Mexico historically addressed the rural/urban physician gap by instituting policies that required physicians to spend a year practicing in rural areas. This program, though not completely solving the problem, issued in a new era of improved care in rural corners of the country, and may serve as an example to other countries. Additionally, physicians should be incentivized to provide care in countries suffering a shortage of health professionals. This could be implemented in a variety of ways: medical schools or governments could offer reduced tuition cost as an incentive for providing future care in rural areas, nonprofits could focus on areas experiencing the greatest need, and more medical teaching programs could be created in areas with shortages of health professionals. Ideally, the implementation of training programs for health professionals should be focused on areas with the greatest need for them.