1. NOBLE Analytics & Consulting
P.O. Box 1051 Brentwood, TN 37024 – 1051 | Office: 615-480-0023 | www.nobleanalytics.com
First Issue of 4 Part Series
The Physician-To-Population Ratio Model Is Limiting Access To Healthcare
At Noble Analytics, we believe that people should have access to healthcare based on their
true needs. Unfortunately, most hospital organizations use an ill equipped model based on
the physician-to-population ratio in determining physician needs for their community. This
article, the first in a four part series, will begin to explain the many flaws that occur when
healthcare leaders depend on the physician-to-population ratio to determine community
needs. This common approach assumes that all physicians are created equal and that every
community has the same health needs, regardless of demographics. In fact, due to
frustrations we had over these and other fundamental flaws of the current approach (that
we will begin to detail below), we’ve developed the Noble Community Utilization Model
which matches the level of physician activity in a community to the needs of the people
who live there.
Noble Analytics is legally counseled by a Stark expert from one of the nation’s largest
healthcare law firms. Recently, she stated, “our products, which include a specific
methodology, are used to assist providers in determining whether a need exists for
additional physicians in a given area. Because the methodology is based on more detailed
information that is specific to a geographic area than has previously been used to analyze
the situation, it can provide backup documentation and support the decision if the recruiting
ends up being challenged through the audit process or in court.”
As referenced, we believe the popular method used to assess a community’s healthcare
needs is highly inadequate. First, physicians often have multiple office locations, thus
making it difficult to determine how often a physician is serving inside a specific
community. Next, individual physicians will work more or less than an average rate based
on personal reasons not related to the health needs of a community (i.e. research work,
nearing retirement, etc.). In addition, the simple physician-to-population ratio ignores that
healthcare needs can vary greatly between different communities based on multiple factors,
including the average age of the population and other socioeconomic variances. Finally,
the standard approach does not account for people easily migrating into and out of a
specific community when seeking care.
The limitations of the common approach used in assessing healthcare needs can be
furthered viewed when looking at the impact of the Affordable Care Act (ACA). With the
passing of ACA, millions of low income people gained access to care coverage with the
expansion of the Medicaid provision. As a result, it can be reasonably assumed that people
who have this new coverage will consume to some extent, more healthcare than they did
previously. In using the current physician-to-population ratio however, healthcare needs
are not recognized as amplifying since the size of a state’s population does not actually
change.
Proponents of the current physician-to-population method point out that fluctuations (like
those caused by ACA) will eventually adjust based on natural market changes and more
physicians moving to that state due to increased needs. However, there are still two large
issues with this assumption. First, in the years it will take the market to adjust to an effect
that can be measured and potentially corrected, there is no relief for the people whose
access to healthcare is diminished because hospitals cannot recruit to meet the new need.

2. NOBLE Analytics & Consulting
P.O. Box 1051 Brentwood, TN 37024 – 1051 | Office: 615-480-0023 | www.nobleanalytics.com
First Issue of 4 Part Series
Secondly, new Medicaid enrollees will still not be evenly distributed throughout a state.
Instead, they will be clustered in communities that contain greater quantities of low income
populations; thus causing a great strain on the existing provider networks in those
communities.
The ACA impact is an example of a demand shock where healthcare usage will increase
suddenly, but the market can eventually react to such an event and adjust to blunt some of
the problems created. There are, however, examples of chronic problems a community
could face which will put it at a permanent disadvantage. For example, communities that
rely heavily on private wells or cisterns with high levels of contaminants are likely to face
additional health care challenges that communities with municipal water supplies do not
encounter. Again, issues of this nature are generally not accounted for with simple
physician-to-population ratios - thus resulting in an over worked physician population that
is likely to produce worse wait times for care and in general, worse healthcare outcomes
for the entire community.
This same problem can also be present in communities based on the types of industry
present. For example, industries such as utilities and manufacturing spend more on
healthcare than industries like telecommunications and publishing1
. As a result, this heavier
concentration of industries with higher healthcare costs can create a higher burden on the
physicians in the community.
All of these issues discussed exist because physician-to-population ratios only compare the
number of physicians in an area to the number of people living there. Since the number of
people doesn’t change with this method, there is no immediate adjustment to the number
of physicians the community requires. By contrast, a model that is based on the amount of
healthcare actually delivered in an area, can detect changes in activity in as little as a few
months. As such, communities will get the help they need much more quickly and the areas
with the greatest needs will get the most help.
Focusing on the amount of healthcare that is delivered in a community instead of simply
the number of people who live there, can correct for all of the problems we’ve referenced
and we hope that we can be of assistance in helping push this change. After all, people
shouldn’t be punished for their income level, the water they drink, the job they do, or for
the variety of other ways physician-to-population ratios disadvantage many communities.
People should have access to healthcare based on their true needs and not their number.
1
J.P. Farley Corporation (http://www.jpfarley.com/blog/bid/49843/Which-Industries-Pay-the-Highest-Health-Care-
Cost-Per-Employee)