County-level location decisions of physicians: evidence from 2010 through 2018 in Texas

Patient accessibility to health care is directly correlated with proximity to actively practicing health care providers and inversely proportional to the number of patients competing for the same care. However, since the effective number of actively practicing health care providers available to patients is limited by patient travel constraints, physician location choices significantly impact patient accessibility to health care.

This paper presents a model of county-level physician location choice given state-level aggregate physician supply. We model physician location choice as a function of patient population density, overall income of the county, expected physician compensation, proximity to schools, hospitals, and other services, and the number of physicians of the same specialty that are already practicing in the area.

We estimate the model using monthly emergency medicine (EM) physician data from the 2010 – 2018 Texas Medical Board physician licensure files. The model performs very well in predicting county level location choices of EM physicians in Texas, and is subsequently used to generate county-level projections of EM physician supply in Texas.

The model results indicate that physicians, particularly younger physicians continue to prefer larger cities, where there is a relative abundance of services needed for young families. In fact, after controlling for physician compensation and overall income levels, the data indicate that physicians still show preference to urban centers as compared to rural counties due to the other location-based factors.