Skip to main content

Health inequalities and regional specific scarcity in primary care physicians: ethical issues and criteria



A substantial body of evidence supports the beneficial health impact of an increase in primary care physicians for underserved populations. However, given that in many countries primary care physician shortages persist, what options are available to distribute physicians and how can these be seen from an ethical perspective?


A literature review was performed on the topic of primary care physician distribution. An ethical discussion of conceivable options for decision makers that applied prominent theories of ethics was held.


Examples of distributing primary care physicians were categorised into five levels depending upon levels of incentive or coercion. When analysing these options through theories of ethics, contrasting, and even controversial, moral issues were identified. However, the different morally salient criteria identified are of prima facie value for decision makers.


The discussion provides clear criteria for decision makers to consider when addressing primary care physician shortages. Yet, decision makers will still need to assess specific situations by these criteria to ensure that any decisions they make are morally justifiable.

This is a preview of subscription content, access via your institution.


Download references


The authors would like to extend their gratitude to the participants of “Explaining Health Inequalities: The Role of Space and Time” conference for their valuable comments and insight (Centre for Interdisciplinary Research, Bielefeld: Germany, 25–27 June 2012).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Peter Schröder-Bäck.

Additional information

This article is part of the special issue “Explaining Health Inequalities: The Role of Space and Time”.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Stapleton, G., Schröder-Bäck, P., Brand, H. et al. Health inequalities and regional specific scarcity in primary care physicians: ethical issues and criteria. Int J Public Health 59, 449–455 (2014).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: