Primary care versus specialists - Numeric Characteristics alist-Dominated Statesof Speci

An authority on primary care remarked to me the other day that the states most top-heavy with specialists and with the greatest shortage of primary care physicians were the northern tier of states - Massachusetts, Connecticut, New York, and New Jersey. I cannot verify the accuracy of his remark, but it fits my impression of the state of the physician workforce.

I’ve always maintained a region’s demographics and culture dictates and shapes its health care. You can express demographics in numbers, and the cultural response follows.

1. The four states - Massachusetts, Connecticut, New York, and New Jersey - have more physicians per capita and a much high population density than other states. This may be because these states have many teaching centers geared to specialty care. Crowded states tend to have more specialists and fewer primary care physicians.

`1) Physicians/capital Rank among 50 states

Massachusetts, 453/100,000 #2
Connecticut, 368,000 #5
New York, 400,000 #3
New Jersey, 332,000 #8

Average rank #4.5

Population Density/sq mi Rank among 50 states

Massachusetts, 822.7 #3
Connecticut, 722.9 #4
New York, 408.7 #7
New Jersey, 1171.1 #1

Average Rank # 3.8

2) The four states have a high per capita income. Well-off citizens tend to visit specialists more often, particularly for elective procedures. Also specialists tend to congregate in high income regions.

Per capita income Rank among 50 states

Massachusetts $49,467 #4
Connecticut, $53,296 #2
New York, $46,424 #7
New Jersey, $47,705 #6

Average Rank #4.8

3) The four states have older populations than 42 other states. According to Medicare, the typical Medicare patients with chronic illness is seen by 6 specialists. In 42 states, the median age is younger than in these four states
Median age Rank among 50 states

Massachusetts, 38.3 #10
Connecticut, 39.1 #8
New York, 37.4 #18
New Jersey, 38.2 #11

Average rank # 11.8

4) Public education expenditures per pupil

The four states rank at the top in public education. Well educated people may gravitate towards specialists, though I have no solid evidence of this.

Expenditure per pupil Rank among 50 states

Massachusetts, $11,267 #5
Connecticut, $11, 572 #4
New York, #14,419 #1
New Jersey, $13,800n #2

Average rank #3.0

5) Population without health insurance. The significance of this is unclear to me, except perhaps to observe that 33 states have high numbers of uninsured and five southern and western states have much larger numbers of immigrants have much higher uninsured rates – Texas 24%, New Mexico 22%, Florida 21%m Arizona 20%, and Louisiana 20%. I might also note specialists are flocking to Texas because of malpractice caps.

Massachusetts, 10% #5
Connecticut, 10% #9
New York, 14% #22
New Jersey, 15% #30

Average rank, #16.5

If you are interested in the demographic and cultural characteristics of the state in which you practice, I recommend Sate by State: A Panoramic Portrait of America (Ecco, a HarperCollins imprint, 2008)