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October 8, 1982

Distribution of Physicians

JAMA. 1982;248(14):1711. doi:10.1001/jama.1982.03330140025021

To the Editor.—  The article "Where Have All The Doctors Gone" by Newhouse and colleagues (1982; 247:2392) and its predecessor article1 represent a major and formidable statement regarding the applicability of "trickle-down" or "smaller slice" models to explain physician manpower distribution.2 Such prominence at a time when other market-forces theories enjoy popularity in federal economic circles only serves to underscore the scrutiny to which both data and interpretations must be subjected.A review of the data presented leaves no question that physicians in 1979 were more broadly distributed and present in smaller communities than in 1970. The conclusion that "competitive forces play a major role in determining where physicians choose to practice" is, however, not supported by the data. In fact, the authors present no data at all that speak to mechanisms of deployment, only outcomes. Instead, this and related conclusions rest on a labyrinth of assumptions, many