xt7ftt4fpj8z https://exploreuk.uky.edu/dips/xt7ftt4fpj8z/data/mets.xml Kentucky Agricultural Experiment Station. 1958 journals 069 English Lexington : Agricultural Experiment Station, University of Kentucky Contact the Special Collections Research Center for information regarding rights and use of this collection. Kentucky Agricultural Experiment Station Progress report (Kentucky Agricultural Experiment Station) n.69 text Progress report (Kentucky Agricultural Experiment Station) n.69 1958 2014 true xt7ftt4fpj8z section xt7ftt4fpj8z Progress Report 69 August I958
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JOHN R. CHRISTIANSEN and THOMAS R. FORD
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Population-Physician Ratios of Medical service areas 1:1
Kentuclq, BDC. Principal MGGJCBI CB11t9!’B S6I'V'1I1g Bach 5.1*99,,
UNIVERSITY OF KENTUCKY
AGRICULTURAL EXPERIMENT STATION
LEXINGTON
in cooperation with Agricultural Marketing Service
U.S. Department of Agriculture
Progress Report 69 ·’°»U€'¤~St l958
TRENDS IN THE NUMBER AND DISTRIBUTION OF MEDICAL
DOCTORS IN KENTUCKY
h John R. Christiansen .
l l and U
Thomas R. Ford _
Department of Rural Sociology `
<
University of Kentucky
Kentucky Agricultural Experiment Station
Lexington
t In Cooperation With
Agricultural Marketing Service
United States Department of Agriculture
TRENDS IN THE NUME R AND DISTRIBUTION OF MEDICAL DOCTORS IN KENTUCKY
by John R, Christiansenfand Thomas R. Ford
The number of physicians in Kentucky and their distribution within
the state have received attention in several recent studies.1 These studies,
although independently conducted and employing different sources of data,
have been in substantial agreement with respect to two findings: (1)
Kentucky has fewer doctors relative to the size of its population than most
states; (2) the distribution of physicians within the state is such that some
localities have an adequate or near adequate number of physicians while others
have shortages of varying degrees of seriousness.
This report, which presents data from the most recent (1956) edition
of the Amegigan Madical Djgeatogy,,offers_a sequel to the earlier studies with
regard to changes in the number and distribution of Kentucky physicians. In
addition, changes in selected characteristics of medical doctors are analyzed
to indicate trends in types of medical service available within the state.
Naabe; aaa Diatgibutqioat gi; ga Kaatuclg
The number of physicians practicing in Kentucky has declined steadily
during the past half century. The 1906 edition of the american Medigal u
Digaatogy listed 3,761 Kentucky physicians, The 1956 edition listed only
2,638, a slight increase over the number-registered in the 1950 volume.2 H ·
' 1Dickinson, Frank G., Distribution ag Phygigiang by_Madical Serviga
Araag, Bureau of Medical Economic Research Bulletin 9a. Chicagoé American'
Medical Association, 195h, Pennell, Maryland Y., and Altenderfer, Marion E.,
Health Maapower Source Book;'Sectioa»l,,Paysiciana, Public Health Service
Publication 263. 'Washington,`Ds C»¥‘ Government Printing Office, 1952. Re-
search Staff, Kentucky Legislative Research Commission, Mediaal Educatiga:
Does Kentucky Need a State-Supported Medical School? Research.Publication
No. 37, Frankfort, 1953. _ ` `
2Most of the data on physicians cited in this report were obtained
from the 1912, 1921, l93l,_1938, 1950,,and 1956 editions of the Amegigaa Madi-
£aL_Directory, published periodically by the American Medical Asaaciation. As
‘ to who are listed in the Directory,'the·l956‘edition states: ”[Those/ who
possess a degree of Doctor of Medicine or its equivalent from a bonaKfide
medical school and who are licensed to practice medicine; who possess a de-
gree of doctor of medicine or its equivalent from an approved medical school
and those who are engaged in scientific, educational or public health activi-
ties and those who have been licensed to practice medicine on the years of
practice provision of the law of the state in which they are licensed.“ (p.
1) Physicians who obtain their degree during the year in which the data are
collected are excluded, Each Directory includes, essentially, the physician
population of the previous year. For example, the 1956 Directory provides
data for 1955. In this paper, the information is reported as of the year the
data were collected rather than as of the year the Directory was published.
*Former Social Science Analyst, Farm Population and Rural Life
Branch, Agricultural Marketing Service, United States Department of Agriculture.
Now assistant professor of Sociology Brigham Young University.
- L, - ` .
5,000,000
/(en/ucky Papu/afxbn [
I,000,000
500,000
U S Phys/bmns
I00,000
50,000
\ I _
I0,000
/(enfuc/ry Physxbmns
»
'·°°° /9/0 1920 xsao /940 /9:0
Fig. 1,--Kcmtuclq Population, Ember of United. States
Physicians, and Number of Kentucky Physicians, 1910-1955
... .,.
From 1905 to 1955, the number of Kentucky physicians dewreased 30 percent; in
the same period the total number of physicians in the United States increased
80 percent (Figure 1), To view these changes another way, of every 1,000
physicians in the nation in 1905, 31 practiced in Kentucky; in 1955 only l2 of '
every 1,000 practiced in the state, Since the Kentucky popmlation has increased
steadily, although not rapidly, while the number of physicians has declined,
the ratio of persons to physicians has risen substantially since the turn of
the century,
Although the adverse effects of the continued los: of professional
medical services cannot be discounted, it should be recegnized that several fac- ·
tors have served to mitigate their seriousness, There can be little doubt
that the professional quality of physicians today is, on the average, cona
siderably better than that of their counterparts of 50 years ago, many of
whom were the products of the “medical diploma millsm described in the famous
Flexner report of 1910, Not only is the physician of tedcy better trained,
but also he has at hand elaborate equipment and an imposing array of "miracle
drugs" which serve to reduce considerably the time required for the diagnosis ·
and treatment of disease, and hence make it possible for him to serve more
g patients, The shift in usual place of treatment from the patient“s home to
a hospital, clinic or doctor's office, while not without drawbacks, has made
it possible for the physician to see nmre patients and to enlist the aid of _ ·
` nurses, technicians, and other medical personnel in providing care and treat-
ment. Improvements in transportation and communication have also permitted -
the physician to make more efficient use of his time, Consequently, phys1~
cians can now care for more patients with greater effectiveness than has
hitherto been possible,
On the other hand, it may be argued with considerable suoporting
evidence that many of the same factors which make it possible for physicians
to render more efficient service operate simultaneously to create greater dea
mand for their services. As the educational level of the population rises,
as knowle ge of health care becomes more widespread and the associated values
more generally accepted, and as improved transpcwtaiion and comnunication in. ,
crease the accessibility of medical peL°%0?f3.1’1e1 and proportionately
more persons call upon the services of the physiciau, Firihermore, those who
utilize his services are more likely now than in former years to use them
frequently and routinely--for example, for perioilm physical examinations-~
rather than to limit their calls to emergencies, Other factors, such as the
A rise in per capita purchasing power and the phencmena2 dovelowment of voluntary
health insurance, are also generally credited with ralsiwi the demand for
medical services. In short, it is questionable whether inc gain in efficiency
has been sufficient to offset the increased demand itz service, particularly
when this increased demand has occurred while the numkey of p*ysicians was
declining, as has been the case in Kentucky,
Population»phvsician ratios,—»Even with the mos? modern equipment
and advanced techniques, there is a limit to the amount of service that can
be provided by a single physician, The question of Low many physicians are
_required to give adequate service to a population of a given size is not easily
answered, If the Humber of physicians required is computed on the basis of
economic demand (the number that a given populatiog will svpport at an accept-
able income level), the figure is likely to be quite different from one computed
on the basis of the number of physicians needed to give adequate medical care
to the population, Obviously the "economi; demani“ deoends cron the income
level of the population and how much of their income the people are able and
- 6 -
willing to expend on medical care, Measuring requirements on the basis of
"needed medical care" is probably more difficult than measuring "eccncmic ”
demand" requirements. As rough rules of thumb, some authorities have suggested
a maximum ratio of 1,500 persons per physician; others a maximum of 1,000 persons.
Actually, the figure depends on many factors and circumstances, and will undoubt-
edly vary from place to place and time to time. The national ratio of population
to physicians in 1955 was approximately 757 to 1, but of course there was no
uniform distribution of either population or physicians throughout the country.
The wide variation of population-physician ratios among states is shown in
Table 1, Kentucky, with 2,638 licensed physicians in 1955 (exclusive of those
in government service, but including those retired from active practice) to
serve a population of 3 million, ranked U0th among the states, with 1,139 per-
sons per physician, To equal the national ratio, Kentucky would have needed
more than 1,300 additional physicians in 1955, or nearly 50 percent more than
the actual number.
Distributigg gf_physicians by_county.--Physicians are unequally dis-
tributed within states as well as among states. Kentucky‘s shortage of phy-
sicians, relative to the national distribution, is much more severe in certain ‘
areas of the state than in others. In Kentucky, as in the remainder of the
nation, physicians are highly concentrated in urban areas, But most of
Kentucky's population, unlike that of the nation as a whole, still is in rural .
areas (defined as all places of less than 2,500 population), despite a marked
shift to the cities in recent years. Approximately 65 percent of the state's ,
population was classified as rural in the 1950 census, yet about half of the
state's physicians were located in the 5 most urban counties--Boyd, Campbell, -
Fayette, Jefferson, and Kenton——which contained about 28 percent of the
total state population. Seven of the 120 counties in the state had fewer
than 1,000 residents per physician in 1955 (Table 2), but only 2 counties,
Fayette and Jefferson, had population-physician ratios lower than the national
ratio. At the other extreme, in 21 counties there were 3,000 or more persons
per physician, and b counties had more than 6,000 persons per physician in
1955. As was to be expected, all of the counties with extremely high popur
A 1ation—physician ratios were predominantly rural.3 ·
Distribution gf_physicians by_size gf_place.——Further documenting
the unequal distribution of physicians throughout the state are data on the
location of physicians by size of place, shown in Table 3. Until about 1920,
when nearly threewfcurths of the state's residents lived in rural locales,
most Kentucky physicians were located in places with less than 2,500
inhabitants. Since that time there has been a rapidly increasing trend toward
the concentration of practice in larger urban centers. By 1955 fewer than
20 percent of the state‘s physicians were located in places with less than
2,500 population, while approximately a third of the state's medical doctors
were in the Louisville metropolitan area. ,
3It should not be assumed that county population-physician ratios
necessarily reveal the availability of medical service to county residents.
Distribution of physicians within a county and their availability outside
county lines strongly influence the actual utilization of their services.
See Olaf F. Larson and Donald G. Hay, "Differential Use of Health Resources
by Rural People," §eg_York State Journal gf_Medigine 52:1 (Jan, 1, 1952)
pp. ¤3—L+9.
- 7 - 7
Table 1.-—Population, Persons per Physician, and
Bank of States by Nu ber of Persons per Physician, 1955
i
Rank State Popu1ation* Persons per
{In Thousand;} Physician
1 . New York 16,124 518
2, Massachusetts 5.016 576
3, Connecticut 2,241 593
4. California 13,032 628
5, Colorado 1,549 649 ‘
6, Vermont .378 671
7, .Mary1and 2,669 687
8, Minnesota 3,174 715
9. New Hampshire .557 741
10. Illinois 9.361 747
11. Pennsylvania 11,159 758
1 2. Delaware 387 760
1 3. Utah ' 781 761
14, 1·1oI·1¤1a 3.452 762
. 15. Washington 2,570 794
16. Oregon 1,669 796
17, New Jersey 5,420 805
18, Rhode Island .845 816
19. Ohio 8.966 825
20, Missouri 4.128 842
21. Nebraska 1.381 873
22. Louisiana 2.927 889
23, Kansas 2,060 914
24. Michigan 7,236 916
25. Maine .905 919
26, Wisconsin 3.694 941
27. Iowa 2,692 952
28, Arizona .980 963
29. Tennessee 3,417 967
30. Oklahoma 2,168 974
31, Texas 8.563 978
32, Indiana 4,330 979
33, Virginia 3,579 _98O
5 34, Nevada 225 987
35, Montana .633 1,019
36. Georgia 3, 621 1,068
37, Idaho .609 1,072
38. North Carolina 4,285 1.095
39. Arkansas 1.789 1,100
40, KENTUCKY 3,005 1.139
41, Wyoming .306 1,163
42, West Virginia 2,002 1,180
43, New Mexico 795 1,258
44. South Dakota 677 1,268
45. North Dakota .642 1,300
1+6. Alabama 3.033 1.307
47. South Carolina 2,283 1,311
48. Mississippi 2,111 1,351
*Provisiona1 data, U. S, Bureau of the Census, Stat ;t_ce_
Abstract g§_the United States: 1956. Seve -:- -. · ··
1 3 1
Table 2,--Kentucky Population, Number of Active Physicians, and
Number of Persons per Active Physician,
by Counties, 1955
:::::::::::::::::::::::::::::::::::;:::::::2;::: :2:::::;::::::::::::::::::::
_ Number Persons Number Persons
County Popula» of per County Popu1a» of _ per
tion V Physi- Physi— tion Physi- Physi-
cians cian cians cian
Total 3,001,330 2,486 1,207 _
Ada1r 14,652 7 2,093 Edmonson 7,689 2 3,845
Allen 13,066 6 2,178 Elliott 6,852 1 6,852
Anderson 7,898 5 1,580 Estill 11,576 5 2,315
Ba11ard 10,637 7 1,520 Fayette 116,728 226 516
Barren 29,817 18 1,657 Fleming 10,431 8 1,304 _
Bath 9,485 4 2,371 Floyd 43,680 20 2,184
Be11 38 ,105 24 1,588 1@‘ra,nk11n 26 ,173 19 1 , 378
Boone 16,348 7 2,335 mzon 12,377 12 1,031
Bourbon 17,619 17 1,036 Gallatin 3,736 l 3,736 _
Boyd 56,474 57 991 Garrard 11 ,919 7 1 ,703
Boyle 21,637 26 A 832 Grant 10 ,331 5 2,066
Bracken 9,231 7 1,319 Graves 32,981 17 1,940
Breathitt 18,151 2 9,075 Grayson 16,358 8 2,045
Breckinridge 14,459 4 3,615 Green 9,092 4 2,273
Bullitt 13,586 3 4,529 Greenu 28,365 10 2,837
Butler 9.509 3 3,135 Hancock 5,097 2 2,549
Caldwell 13,881 8 1 .735 Hardin 59,873 29 2,065
Calloway 16,545 17 973 Harlan 67,991 46 1,478
Cemp`¤e11 83,952 59 1,55*+ Harrison 15,303 10 1,530
Carlisle 6,105 4 1,526 Hart 13,086 6 2,181
Carre 11 8 , 6L|·1 5 1 ,728 Henderson 33,967 27 1 , 258
carter 24,088 9 2,676 Henry 11,156 10 1,116
Casey 19,660 5 2,932 Hickman 6,921 2 3,461
Christian 63,893 37 1,727 Hopkins 41,627 29 1,435
Clark 20,656 16 1,291 Jackson 11,000 2 5,500
Clay 20,063 4 5,016 Jefferson 559,587 846 661
C1 1nt on 7 , 990 3 2 , 663 Jessamine 14 ,053 7 2 , 008 *
Crittenden 8,877 4 2,219 Johnson 18,944 14 1,353
Cumberland 8,193 3 2,731 Kenton 114,243 107 1,068
Daviess 60,916 61 999 Knott 16,935 2 8,468
- 9 -
Table 2 (Continued)
Number Persons _ Number Persons
County Popule» of per County Popula» of ner
tion Phys1— Physi- ltion Physi- Physi-
cians clan clans clan
Knox 26, 543 6 4,424 Nlenolae 6,874 3 2 , 291
Lerue 11,193 1+ 2,798 Gino 17,558 5 3.512
Laurel 24,439 13 1 ,880 Oldham 1 2,149 6 2, 025
1.n».n·enoe 15,219 8 1,902 Gwen 8,756 4 2,189
Lee 7.749 1+ 1,937 Owsley 6,321 2 3,161
Leslie 15,846 2 7.923 Pendleton 9,684 4 2,421
Let ober 31,247 14 2,232 Perzy 36 ,523 20 1,826
Lewae 12,909 5 2.582 Pike 69.388 32 2,168
Lincoln 18,958 9 2,106 Powell 6,637 2 3,319
Llvingston 7,129 6 1,188 Pulaski 33,711 32 1,053 '
Logan 23,440 12 1,953 Robertson 2,738 1 2,738 ·
Lyon 7,450 5 1,490 Bockoastle 11,420 7 1,631
McCracken 70,461+ 66 1,068 Rowan 11,721 1+ 2,930 —
MoCreary 13,567 3 4,522 Russell 10,749 5 2,150
Motean 11,837 5 2,367 Scott 15,1+38 12 1,287
Menneon 33,801+ 32 1.056 Shelby 20.765 8 2.596
Magoffin 11,61+1+ 4 2,911 Simpson 12,998 9 1,444
Marion 14,836 8 1,851+ Spencer 5,537 5 1,107
Marshall 15,605 9 1,734 Taylor 14,313 12 1,193
Martin 10,773 2 5,387 Todd 12,295 5 2,459
Mason 20,008 13 1,539 Trigg 8,047 3 2,682
Meade 11,319 3 3,773 Trimble 5,766 2 2,883
Menifee 3,641 1 3,641 Union 13,215 10 1,322
Mercer 13,881 17 ,817 Warren 1+4,312 35 1,266
Menoalfe 6,744 4 1,686 Washington 11,316 3 3,772
Monroe 11,457 5 2,291 Wayne 14,824 8 1,853
Montgomery 12,198 10 1,220 Webster 14,126 9 1,570
- Morgan 9, 592 6 1 , 599 Whitley 26 ,562 17 1 , 562
Molnenbeng 29,606 11 2,691 Wolfe 5,848 2 2,924
Nelson 19,985 11 1,817 Woodford 11,566 10 1,157
Sources: Pgpulgtion E§t;mgte§ {gg §gg;gggy_Qggn;;gg, June 30, 1255, J
Kentucky Agricultural Experiment Station Progress Report 31,
July 1955. @22122:. 1:1.o.Q-.1cg Qizmtnm. 1956 9<111¤1<>¤·
— 10 - _
Table 3.-4Distribution of Kentucky Population and Physicians »
by Size of Place 1920-1950
......l.92£L..... .......L93Q.... _.......1..9’+Q....... _....1.950.........
Size of Popu1a» Physi- P0pu1a» Physi— P0pu1a» Physi— Populap Physi-
Place tion cians tion cians tion cians tion cians
100,000 & over 23*1,891 593 307.795 659 319.077 655 369.129 739
25,000 to 100,000 127.972 285 203.3*+7 377 235.500 370 288.690 *138 A
10,000 to 25,000 69,057 11+8 89.511 179 73.772 172 106,378 175 A
5,000 to 10,000 100,317 2Ul ll2,¤51 215 123,263 235 1Ml,065 197
2,500 to 5,000 101,306 336 85,972 226 97.715 ZL8 ,120,527 252 V
Under 2.500 1.783.0871.538 1.815.563 1.081 1.996.300 9*+9 1.959.067 595
.Al1P1aces 2,}+16,630 3,11+1 2,6111,589 2,737 2,8}+5,627 2,599 2,901+,806 2,396 3
Sources: Population distribution from United States census of population for p
indicated years, Data on physicians were taken from volumes of the
gggg;gan_Mediga1 Directory for the years nearest the census years (1921,
1931, 1938, 1951). In some few cases, physicians whose place of practice
was unknown have been omitted from the tabulation. Although census data
on the distribution of the population by size of place are not available
later than 1950, the distribution of active physicians by reported size
of place listed in the 1956 Agegican Medicgg Directgry was as follows:
Size gf_P1a&g Number_gf Physicians
100,000 & over 806
25,000 to 100,000 525 .
10,000 to 25,000 180
5,000 to 10,000 26M
2,500 to 5,000 221
Under 2,500 @79
,.IL-
Most seriously affected by this shift of physicians to the larger
urban centers have been the most rural areas of the state. In 1920 more than
1,500 doctors were located in rural areas of the state; by 1950 there were
fewer than 600, Yet the population living in rural areas increased by nearly
176,000 from 1920 to 1950 {Table 3}, The shifts in percentage distribution of
population and physicians by size of place from 1920 to 1950 are shown in Figure
2. The percentage of physicians practicing in places of less than 2,500
population declined sharply during the period; the percentage practicing in
towns of 2,500 to 10,000 remained relatively stable; places of 10,000 and over
had a somewhat larger share of the total population in 1950 and a considerably
larger share of the supply of physicians, Et must be borne in mind, however,
that the total supply diminished by approximately eco physicians during the
30—year period, Consequently, even the larger towns there were substantial
increases in the ratio of population to medical doctors,
Distribution g;_physicigns by_medical service areas,-—The county
despite its convenience for statistical analyses, has severe limitations as a
unit for measuring medical facilities and services, Individuals in need of
medical care are not restricted to their county boundaries in seeking it. Nor, ,
realistically, is it to be expected that each of the 120 Kentucky counties,
many of which are quite small in area and population, should have a complete
complement of medical facilities, These considerations suggest the need for
a more meaningful unit, which has been met in part by the delineation of
medical service areas, Essentially, the medical service area is a special
type of trade areas-a territory whose residents usually depend upon the
facilities available within the defined area for needed medical care, Such
an area may embrace several counties and even cross state lines, depending
upon the habits of the residents with respect to securing medical servicec
The medical service areas utilized in this study {shown in Figure 3)
were ad&pted from those delineated by the Bureau of Medical Economic Research
of the American Medical Association,+ As defined by the Bureau of Medical
Economic Research, medical service areas are "areas in which populations depend
V upon physicians located in these circumscribed territories for most of their
physician services,"? The chief difference between the areas shown in Figure
3 and those delineated by the Bureau of Medical Economic Research is that
counties were not divided in this study as they sometimes were in the earlier
investigations V
uDickinson, Frank G,, Distribgj;pp_g;_Phvsicians_by_Mediqal_§g;3;ge
Areas, Bureau of Medical Economic Research Bulletin 9M, Chicago: American
Medical Association, l95@, Dickinson. Frank G. and Bradley, Charles E.,
Map_Suno1ement tg_Bulle;ip_9Q, Bureau of Medical Economic Research Bulletin
9MA, Chicago: American Medical Association, 1953,
5Dickinson,_gp. git,, p, 13,
- 12 -
SIZE OF PLACE
?r>???¥2§2:?Fi$ aoopoo me Q{i·J£·£{$·_»,·{J¤.(. J.; MJF U
` over
25,000 as ·\'=·,·%\‘·'$1'»»¤ »·=· 1
l00,000
POPULATION PHYSICIANS
- :;;a»:w=<=· ‘ ‘.5Q*#~%; Z 5-LZ :;¤;:;.;.
5;;::5 =·=·'·===&§§`:;€;E;E _ =· ' " `·—·»·
VA-
ILL
`\, :-5-:·=;r‘ 5.; ‘‘:‘ ¥¤*·¢§2i2¥*2"° *
°<•\_ _ ' '·
x. :----_·_ ;.;:;. VA_
M0. 5:5:5:5 5:5:5:5:5:5:¤ -,£..;_;_;_:____H ____ __~Tm *‘**=*"f“=‘*“ *"""=··» B R -·-·-----—-- 5
: §2i2%2§2§z§2 °
Hg, 3,--Population-Physician Ratios of Medical service areas in
Kentucky, and Principal Medical Centers Serving each Area, 1955
~ lb -
Table Q.-—Number of Persons per Active Physician,
by Medical Service Area, 1937, 19U9, 1955
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
Medical Service Area
Number, and Name of Number of Persons per Active Physician
Principal Medical
Service Center 1955 l9M9& 1937b
1. Lexington 9*+5 995 .91+5
2. Ashland 1,5¤l 1,52U 1,375
3, Maysville 1,765 1,470 1,227
M. Louisville 937 899 765
5, Paducah Q 1,366 1,32M 1,150 »
6, Hopkinsville 1,789 1,500 1,099 ·
7, Bowling Green, Glasgow 1,79Q 1,891 1,b35 U
8, Somerset 1,6}+9 2,161 2,259 ·
9, Middlesboro, Harlan 1,732 1,976 1,658
10. Hazard 2,901 2,297 l,96LI»
ll. Pikeville 2,316 2,587 2,361
12. Cincinnati, Ohio 737 69iI- 661
13. Evansville, Indiana 4
Owensboro, Kentucky 1,182 1,109 l,0¤8 F
aRatios computed using 1950 population.
bliatios computed using l9L|·0 population, E
- 15 -
Of the 13 medical service areas shown in Figure 3, 3 of which include
parts of bordering states, only the Cincinnati area had a better ratio than
the 1955 national ratio of 757 persons per active physician (Table U), This
area, of course, serves many more Ohioans than KentuckiansQ The Louisville
and Lexington areas were the only others with fewer than 1,000 persons per
active physician. The Pikeville area, with 2,316 persons per active physician
in 1955, and the Hazard area, with 2,901 persons per physician, had the highest
ratios, that of the latter area being almost four times the national ratio.
' Since 1937, ratios have become less favorable in all but three of the
areas, Lexington, Pikeville, and Somerset. However, five areas had better
ratios in 1955 than in l9¤9, indicative of some improvement in the relative
supply of physicians' services in the most recent years, either because of
additional physicians on especially in Eastern Kentucky, because of population
decreases through migration, Despite these signs of betterment, most areas
of the state still have physician shortages of varying degrees of seriousness,
measured either against national popu1ation—physician ratios or conventional
standards of adequacy.
Chshacteristics g§_Ksntuchy Physicians
Data available in the various editions of the hherican Medical
Director make it possible to analyze certain characteristics of physicians
practicing in Kentucky at various periods during the past four decades. On
the basis of this, certain inferences can be made about changes in the type of
medical services available in various parts of the state.
hss gg_physigians.--Knowledge of the ages of physicians practicing in
a given area is useful for estimating the rates of loss and replacement of I
doctors in the area, for gauging the service capacity of practicing physicians,
and for determining when physicians received their basic medical training.
Kentucky physicians have generally been somewhat older, on the average, than
those of the nation as a whole. In 1955, however, the median age of active
physicians in Kentucky listed in the Amegigan Mediggl Digsctory was at the
lowest point in about forty years (Table 5). More than half of the active
medical doctors listed in the most recent Directohy·were under U6 years of
age. This represented a lowering of the average age by more than U years
» since l9¤9, and more than 8 years since 1937,
There are some indications, though, that the average age of Kentucky
physicians may rise again in the near future, In l9¤9, more than l0 percent
of the state's medical doctors were less than 30 years of age; in 1955. only
5,5 percent were under 30 (Figure Q). .The percentage of physicians 65 years of
age and over decreased from nearly 27 percent in l9U9 to less than 21 percent
in 1955, but in 1930 only 15 percent of the state"s active physicians were
65 or over, and in 1920, less than ll percent.
In general, physicians practicing in larger urban centers of Kentucky
are younger than those practicing in small towns and rural areas (Table 6).
Especially significant is the fact that since 1930 the average age of physicians
6Dickinson, Frank G., "The Ages of Physicians in the United States,'
19bO and l9M8," Journal gf hhs Americsh Medicsl Association, 130: 1 (Jan. 1,
1999), D. si. 7 T y
h Q. 16 ..
Table 5.·-Median Age and Percentage Distribution of Active Kentucky
Physicians by Age, Specified Years, 1911-1955
Age .............
1955 19L|·9 1937 1930 1920 1911
25.34 21.8 21.5 18.8 12.1+ 10.7 26.0
35.1+*+ 26.*+ 22.3 15.5 1*+.Ll- 31.3 31.8 .
7+5-5*-|· 20.0 16.3 17.1 30.8 29.9 20.5 ‘
55-67+ 11.2 12.7 28.3 26.9 17.3 11.7 1
65—7'+ 1.1.1 16.1 15.5 11.7 7.6 6.6
75 & over 9.5 8.8 L|·.LI» 3.’·|» 3.0 1.7
Total _]_O0,0 “J_;=Q_0_,_Q_ 100,0 100,0 100,0 100,0
Source: Q{\_§;1j’__1_;Qg.[_1__ Med; gg Directory
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P E R C E N T
Fig. 4.--Percentage Distribution of Active Kentuclq
Physicians by Aga, 1930, 19***9, 1955
-33 -
has decreased in towns of all sizes except those with populations of less than
1,000. As the nu ber of physicians practicing in these smallest towns decreased
from 755 in 1930 to 203 in 1955, their average age increased from 55.7 years to
62.3 years. These figures indicate that the country doctor is rapidly vanishing
from the Kentucky scene as he has disappeared from the rural areas of most of
the remainder of the nation
Table 6.--Average (Median) Age of Active Physicians in Kentucky by Size
of Place, 1911, 1930, and 1955
:::::::::::::::::::::::::::::::::::::::::::::::::::::;:::::::::::::::::::::::
5126 of place Average Age of Physicians
1955 1930 1911 .
100,000 or above 02.5 08,3 39.9
50.000 — 99.999 03.0 09,6 1+1.7 A
25,000 - 1+9,999 1+5,5 09,1 1+2.,6
10,000 - 20,999 05,0 50,1 02,3
5,000 - 9,999 1+7.,8 1+8,7 1+1.1+
2,500 — 0,999 07,8 50.0 1+3,1
1,000 - 2.099 1+6.9 52,,8 1+1+.2
Under 1,000 62,3 55,7 01,1
All Places 05,8 52,7 01,8
Source: American Medigal Directory
Specialization gg medical practice,~-One of the outstanding develop- I
ments in recent medical history has been the growth of medical specialization.
In 1923 only one physician in ten practicing in the United States limited
his practice to a special field, In 1955, one of every three physicians
was a full specialist. If part-time specialists are included, at least half
of the physicians in the nation can be considered specialists.
The trend toward specialization of medical practice has also charac~
terized Kentucky‘s physicians, although the proportion of specialists among
the state's medical doctors has tended to be lower than for the nation as a
whole. Approximately 05 percent of the active Kentucky physicians listed
in the 1956 American Medical Directory were either full-time or part-time
specialists, compared to only 1 percent of those listed in the 1912 Directory
(Table 7). Two~thirds of the Kentucky physicians reporting a specialty in 1955
— 19 - ,
Table 7,--Number and Percentage of Active Kentucky Physicians
Listed as Specialists, l9ll~1955
Year Number of _ Percent of
Specialists all active Ky.
Physicians
1911 U1 1,2
1920 532 16.,6
1930 668 2}+.2
1937 780 29.9 y
1999 892 37.1+ o
1955 1,112, la.?
K 4
Sources American Medical Directggy. Specialists include both full-
time and part-time specialists as reported by the physicians
themselves to the American Medical Association,
restricted their practice to their specialty. Forty percent of the
specialists, full-time and part~time, had been certified by the examining
boards of their specialty fields, By comparison, 75 percent of the nation‘s
specialists in 1955 limited their practices to their specialty, and 55 percent `
were board certified, Kentucky"s specialist