This research brief describes work documented in "HMO Growth and the Geographical Distribution of Generalist and Specialist Physicians, 1987-1997", by Escarce, J. J., D. Polsky, G. D. Wozniak, and P. R. Kletke. Published in HSR: Health Services Research 35(4):825-848; "Health Maintenance Organization Penetration and the Practice Location Choices of New Physicians: A Study of Large Metropolitan Areas in the United States", by Escarce, J. J., D. Polsky, G. D. Wozniak, M. V. Pauly, and P. R. Kletke. Published in Medical Care 36(11):1555-1566; "The Effect of HMO Penetration on Physician Retirement", by Kletke, P. R., D. Polsky, G. D. Wozniak, and J. J. Escarce. Published in HSR: Health Services Research 35(5 pt. 3):17-31; "HMO Penetration and the Geographic Mobility of Practicing Physicians", by Polsky, D., P. R. Kletke, G. D. Wozniak, and J. J. Escarce. Published in Journal of Health Economics 19(5):793-809.

Excerpt: The composition of the U.S. physician workforce and its geographical distribution are critical to the efficient functioning of the health care system and the provision of quality health care. Many analysts believe that the growth of managed care in recent years has decreased earning opportunities for specialists while not affecting, or even increasing, earning opportunities for generalists. Moreover, managed care is thought to have reduced physicians' professional autonomy and the appeal of medical practice. Thus far, however, the influence of managed care on the geographical distribution of physicians has not been considered.

This report is part of the RAND Corporation research brief series. RAND research briefs present policy-oriented summaries of individual published, peer-reviewed documents or of a body of published work.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.