I thank Drs Althouse, Stockman, and Lister for their letter, in which they make several important points. I am pleased that they generally concur with the assessment that too little has been done to overcome long-standing problems with geographic distribution of physicians. Evidence is abundant that the child physician workforce has grown, and continues to grow, far beyond the rate of growth of the child population. This growth may represent an opportunity for primary care physicians to better meet the needs of children. However, for physicians to succeed in meeting children's needs, it helps if they are geographically accessible.

Our study demonstrates that workforce expansion has been accompanied by a profound maldistribution of physicians. Furthermore, the areas most likely to have a paucity of child physicians are those in which the needs of children are greatest, as measured by population demographics. This multifactorial problem will not abate until policy-makers and...

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