Rural Health Research Gateway

Physicians

Publications

Listed by publication date. You can also view these publications alphabetically.

2007

  • 2005 Physician Supply and Distribution in Rural Areas of the United States (Project Summary)
    Author(s): Meredith A. Fordyce, Frederick M. Chen, Mark P. Doescher, L. Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: International Medical Graduates (IMGs), Physicians, Workforce
    Date: 11 / 2007
    This study describes the 2005 supply and distribution of physicians (including osteopathic physicians and international medical graduates) with particular emphasis on generalists in rural areas. Results indicate variability in the rural-urban distribution of physicians, with generalist physicians playing prominent roles in rural areas.
  • 2005 Physician Supply and Distribution in Rural Areas of the United States (Full Report)
    Author(s): Meredith A. Fordyce, Frederick M. Chen, Mark P. Doescher, L. Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: International Medical Graduates (IMGs), Physicians, Workforce
    Date: 11 / 2007
    This study describes the 2005 supply and distribution of physicians (including osteopathic physicians and international medical graduates) with particular emphasis on generalists in rural areas. Results indicate variability in the rural-urban distribution of physicians, with generalist physicians playing prominent roles in rural areas.
  • Urban-Rural Flows of Physicians
    Author(s): Thomas C. Ricketts, Randy Randolph
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Physicians, Workforce
    Citation: Journal of Rural Health, 23(4), 277–285
    Date: 2007
    Reports findings from a study to determine whether there was a significant flow of physicians from urban to rural areas in recent years when the overall supply of physicians has been considered in balance with needs.

2006

  • Wyoming Physicians Are Significant Providers of Safety Net Care
    Author(s): Sharon A. Dobie, Amy Hagopian, Beth A. Kirlin, L. Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Physicians, Workforce
    Citation: Journal of the American Board of Family Practice, 18(6), 470-477
    Date: 11 / 2006
    Describes the contributions of family and general practice physicians from Wyoming to the health care safety net.
  • Medicare Physician Payment: Impacts of Changes on Rural Physicians
    Author(s): Keith J. Mueller, A. Clinton MacKinney, Timothy D. McBride
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare, Physicians
    Report Number: Rural Policy Brief Vol. 11, No. 2 (PB2006-2 )
    Date: 09 / 2006
    Overview of the effects of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 on physician payment rates in rural areas. Discusses the impact of creating a floor of 1.00 in the geographic practice cost index (GPCI) for work expense and the effects of the Medicare incentive payment (MIP) for providing services in shortage areas and of the bonus for practicing in a physician scarcity area.
  • Clearing the Path to Medical School for American Indians and Alaska Natives: New Strategies
    Author(s): Walter B. Hollow, Apanakhi Buckley, Davis G. Patterson, Polly M. Olsen, Joycelyn Dorscher, Rustem Medora, Lori Morin, R. Steven Padilla, Jerry Tahsequah, Laura-Mae Baldwin
    Research center: WWAMI Rural Health Research Center
    Topics: American Indians and Alaska Natives, Physicians, Workforce
    Report Number: Working Paper No. 101
    Date: 01 / 2006
    Two recent studies examining recruitment and retention of American Indians and Alaska Natives (AI/ANs) in medical school identified significant challenges in the pursuit of a medical career by AI/AN students: the academic rigor of medical school, the needs of their communities and families, financial concerns, feelings that their perspectives on healing and spirituality were excluded from medical school, and the paucity of role models and mentors, especially those who shared their culture. Using the results of this research and their experience conducting programs to support AI/ANs pursuing health professions, the authors recommend several strategies for improving recruitment and retention of AI/AN medical students. These strategies include: 1. providing role models, advisors, and mentors; 2. providing early research opportunities by involving AI/AN communities in research on Native health issues; 3. anticipating students' traditional Native spiritual practices; 4. providing professional socialization opportunities for faculty and AI/AN medical students; 5. creating and implementing rigorous curricula that include indigenous perspectives; and 6. developing a pro-diversity institutional mission statement to inform admissions policies. The authors identify governmental and nongovernmental organizations in a position to fund and implement these strategies, as well as a list of resources. Collaboration with AI/AN individuals, organizations, and communities is critical to this effort but not a familiar role for most academic medical centers; suggestions for cross-cultural outreach and collaboration are provided.
  • How Adults' Access to Outpatient Physician Services Relates to the Local Supply of Primary Care Physicians in the Rural Southeast
    Author(s): Donald E. Pathman, Thomas C. Ricketts, Thomas R. Konrad
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health services, Physicians
    Citation: Health Services Research, 41(1), 79-102
    Date: 2006
    For adults as a whole in the rural South and for the elderly there, low local primary care physician densities are associated with travel inconvenience but not convincingly with other aspects of access to outpatient care. Access for those insured under Medicaid and the uninsured, however, is in more ways sensitive to local physician densities.
  • Shortages of Medical Personnel At Community Health Centers: Implications for Planned Expansion
    Author(s): Roger A. Rosenblatt; C. Holly A. Andrilla; Thomas Curtin; L. Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Federally Qualified Health Centers (FQHCs), Physicians, Workforce
    Citation: JAMA, 295(9), 1042-1049
    Date: 2006
    To examine the status of workforce shortages that may limit Community Health Center (CHC) expansion, the authors surveyed all 846 federally funded US CHCs that directly provide clinical services and are within the 50 states and the District of Columbia. Analysis of the results showed that CHCs face substantial challenges in recruitment of clinical staff, particularly in rural areas. The largest numbers of unfilled positions were for family physicians at a time of declining interest in family medicine among graduating US medical students.
  • Geographic Access to Health Care for Rural Medicare Beneficiaries
    Author(s): Leighton Chan, L. Gary Hart, David C. Goodman
    Research center: WWAMI Rural Health Research Center
    Topics: Health services, Medicare, Physicians
    Citation: Journal of Rural Health 22(2),140-146
    Date: 2006
    Describes the results of a study comparing the travel times, distances, and physician specialty mix of all Medicare patients living in Alaska, Idaho, North Carolina, South Carolina, and Washington.
  • Will Rural Family Medicine Residency Training Survive?
    Author(s): Roger A. Rosenblatt, Amy Hagopian, C. Holly A. Andrilla, L. Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
    Citation: Family Medicine, 38(10), 706-711
    Date: 2006
    Reports the results of a study examining the recent performance of rural residencies in the National Resident Matching Program as an indicator of their viability.
  • Professional Liability Issues and Practice Patterns of Obstetrical Providers in Washington State
    Author(s): Thomas J. Benedetti, Laura-Mae Baldwin, Susan M. Skillman, C. Holly A. Andrilla, Elise Bowditch, Katherine Camacho Carr, Susan J. Myers
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Physicians, Women
    Citation: Obstetrics & Gynecology, 107, 1238-1246
    Date: 2006
    Objective: To describe recent changes in obstetric practice patterns and liability insurance premium costs and their consequences to Washington State obstetric providers (obstetrician–gynecologists, family physicians, certified nurse midwives, licensed midwives).
    Methods: All obstetrician–gynecologists, rural family physicians, certified nurse midwives, licensed midwives, and a simple random sample of urban family physicians were surveyed about demographic and practice characteristics, liability insurance characteristics, practice changes and limitations due to liability insurance issues, obstetric practices, and obstetric practice environment changes.
    Results: Fewer family physicians provide obstetric services than obstetrician–gynecologists, certified nurse midwives, and licensed midwives. Mean liability insurance premiums for obstetric providers increased by 61% for obstetrician–gynecologists, 75% for family physicians, 84% for certified nurse midwives, and 34% for licensed midwives from 2002 to 2004. Providers’ most common monetary responses to liability insurance issues were to reduce compensation and to raise cash through loans and liquidating assets. In the 2 years of markedly increased premiums, obstetrician–gynecologists reported increasing their cesarean rates, their obstetric consultation rates, and the number of deliveries. They reported decreasing high-risk obstetric procedures during that same period.
    Conclusion: Liability insurance premiums rose dramatically from 2002 to 2004 for Washington’s obstetric providers, leading many to make difficult financial decisions. Many obstetric providers reported a variety of practice changes during that interval. Although this study’s results do not document an impending exodus of providers from obstetric practice, rural areas are most vulnerable because family physicians provide the majority of rural obstetric care and are less likely to practice obstetrics.

2005

  • Family Physician Vacancies in Federally Funded Health Centers
    Research center: WWAMI Rural Health Research Center
    Topics: Federally Qualified Health Centers (FQHCs), Physicians, Workforce
    Date: 11 / 2005
    Presents results for family physicians from a study of staffing needs at Federally Qualified Health Centers (FQHCs). Provides information on family physician vacancy rates by rural and urban location. Compares family physician vacancies to other physician vacancies at FQHCs.
  • Is Large Really Beautiful? Physician Practice in Small versus Large Scale Communities
    Author(s): George E. Wright, Ira Moscovice
    Research center: Minnesota Rural Health Research Center
    Topics: Health services, Physicians
    Report Number: Working Paper No. 56
    Date: 09 / 2005
    Examines the effect of community size on how physicians view their practices as reported by respondents to two waves (1996-97 and 1998-1999) of a national sample survey conducted as part of the Community Tracking Study (CTS). Results suggest that bigger is not necessarily better when it comes to physicians' perceptions of their practice. A key challenge is whether larger urban-based practices can be decomposed into smaller clinical microsystems that can benefit from the strengths of physician practices in small city or rural settings yet retain the presumed benefits of larger scale organizations.
  • Pathways to Rural Practice: A Chartbook of Family Medicine Residency Training Locations and Characteristics
    Author(s): L. Gary Hart, Denise M. Lishner, Eric H. Larson, Frederick M. Chen, C. Holly A. Andrilla, Thomas E. Norris, Ronald Schneeweiss, Tim M. Henderson, Roger A. Rosenblatt
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
    Citation: Seattle, WA: WWAMI Rural Health Research Center, University of Washington.
    Date: 08 / 2005
    Discusses characteristics and geographic locations of family medicine residency programs' rural locations, types of rural family medicine training by location, and rural mission of family medicine residencies.
  • WWAMI Physician Workforce 2005
    Author(s): Frederick M. Chen, Meredith A. Fordyce, L. Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
    Report Number: Working Paper No. 98
    Date: 05 / 2005
    Data on physician supply, demand, and need in the WWAMI region have not been routinely collected or reported. This report responds to a request by the University of Washington School of Medicine (UWSOM) Primary Care Steering Committee to examine the current supply and distribution of physicians in the WWAMI region. These data can help inform and guide the UWSOM in the production of physicians for the WWAMI region. The analysis utilizes the 2005 AMA Masterfile to determine the population-based supply of physicians at the state and county level, analyzed by the discipline of physician, and whether they had graduated from, or trained at the University of Washington, which is the only medical school for the five-state WWAMI region. The emphasis on primary care is important as over one-third of the WWAMI population lives in rural areas and tends to be medically underserved, relying on primary care physicians for the majority of their medical needs.
  • Workforce Issues in Rural Areas: A Focus on Policy Equity
    Author(s): Thomas C. Ricketts
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: Health policy, Nurses, Pharmacy and prescription drugs, Physicians, Workforce
    Citation: American Journal of Public Health, 95(1), 42-48
    Date: 01 / 2005
    Reviews the geographic distribution of 6 classes of health professionals: physicians, nurses, dentists, pharmacists, mental health professionals, and public health professionals. Describes the government and private policies and programs intended to affect the geographic distribution of these health professionals.
  • Characterizing the General Surgery Workforce in Rural America
    Author(s): Matthew J. Thompson, Dana Christian Lynge, Eric H. Larson, Pantipa Tachawachira, L. Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
    Citation: Archives of Surgery, 140(1), 74-79
    Date: 01 / 2005
    Describes the rural general surgical workforce. Discusses the potential impact of its demographic characteristics on rural access to surgical services in the future.
  • More May Be Better: Evidence of a Negative Relationship Between Physician Supply and Hospitalization for Ambulatory Care Sensitive Conditions
    Author(s): James N. Laditka, Sarah B. Laditka, Janice C. Probst
    Research center: South Carolina Rural Health Research Center
    Topics: Chronic diseases and conditions, Health services, Physicians
    Citation: Health Services Research, 40(4), 1148-1166
    Date: 2005
    The authors conducted an empirical test of the relationship between physician supply and hospitalization for ambulatory care sensitive conditions (ACSH). Principal findings showed that in the urban models for ages 0-17 physician supply has the largest negative adjusted relationship with ACSH. For ages 18-39 and 40-64, physician supply has the second largest negative adjusted relationship with ACSH. Physician supply was not associated with ACSH in rural areas. The authors conclude that physician supply is positively associated with the overall performance of the primary health care system in a large sample of urban counties of the United States.
  • Impact of U.S. Medical Students' Debt On Their Choice of Primary Care Careers: An Analysis of Data from the 2002 Medical School Graduation Questionnaire
    Author(s): Roger A. Rosenblatt, C. Holly A. Andrilla
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
    Citation: Academic Medicine, 80(9), 815-819
    Date: 2005
    The authors used results from questions on the Association of American Medical Colleges' 2002 Medical School Graduation Questionnaire that focused on students' debt and career choices to examine the hypothesis that medical students' rising total educational debt is one of the factors that explains the recent decline in students' interest in family medicine and primary care. Students reported that higher levels of debt influenced their future career choices, and there was an inverse relationship between the level of total educational debt and the intention to enter primary care, with the most marked effect noted for students owing more than $150,000 at graduation. Total debt was associated with a lower likelihood of choosing a primary care career, but factors such as gender and race appeared to have more explanatory power. Female students were much more interested in primary care-and especially pediatrics-than were male students; African American students were more interested in inner-city practice than was any other identified racial or ethnic group.
  • Flight of Physicians From West Africa: Views of African Physicians and Implications for Policy
    Author(s): Amy Hagopian, Anthony Ofosub, Adesegun Fatusic, Richard Biritwumd, Ama Essele, L. Gary Hart, Carolyn Watts
    Research center: WWAMI Rural Health Research Center
    Topics: International Medical Graduates (IMGs), Physicians
    Citation: Social Science and Medicine, 61, 1750-1760
    Date: 2005
    West African-trained physicians have been migrating from the sub-continent to rich countries, primarily the US and the UK, since medical education began in Nigeria and Ghana in the 1960s. In 2003, we visited six medical schools in West Africa to investigate the magnitude, causes and consequences of the migration. We conducted interviews and focus groups with faculty, administrators (deans and provosts), students and post-graduate residents in six medical schools in Ghana and Nigeria. In addition to the migration push and pull factors documented in previous literature, we learned that there is now a well-developed culture of medical migration. This culture is firmly rooted, and does not simply fail to discourage medical migration but actually encourages it. Medical school faculty are role models for the benefits of migration (and subsequent return), and they are proud of their students who successfully emigrate.

2004

  • Access to Specialty Health Care for Rural American Indians: Provider Perceptions in Two States
    Author(s): Laura-Mae Baldwin, Waler B. Hollow, Susan Casey, L. Gary Hart, Eric H. Larson, Kelly Moore, Ervin Lewis, David C. Grossman
    Research center: WWAMI Rural Health Research Center
    Topics: American Indians and Alaska Natives, Health services, Minority health, Physicians
    Report Number: Working Paper No. 78
    Date: 10 / 2004
    Examines access to specialty services among rural Indian populations in Montana and New Mexico, based on a survey sent to primary care providers addressing access to specialty physicians, perceived barriers to access, and access to nonphysician clinical services. Report available upon request by contacting rhrc@fammed.washington.edu.
  • Rural Physicians' Acceptance Of New Medicare Patients
    Author(s): Keith J. Mueller, A. Clinton MacKinney, Timothy D. McBride, Jane L. Meza, Liyan Xu
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare, Physicians
    Report Number: Rural Policy Brief Vol. 9, No. 5 (PB2004-5 )
    Date: 08 / 2004
    Findings from analyses of national survey data of urban and rural respondents, published studies, and results of a survey of state organizations representing physicians indicate that: 1) The trend among all physicians is to not accept new Medicare patients, 2) The percentage of physicians in both urban and rural areas who are accepting new Medicare patients is declining, 3) Physicians practicing in rural areas not adjacent to urban areas are the most likely to accept new Medicare patients, and 4) Findings also indicate that the negative implications of not taking the necessary steps to reverse the small but important decline in physician willingness to take new Medicare patients may be most serious in rural communities.
  • Characterizing the General Surgery Workforce in Rural America
    Author(s): Matthew J. Thompson, Dana Christian Lynge, Eric H. Larson, Pantipa Tachawachira, L. Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
    Report Number: Working Paper No. 77
    Date: 05 / 2004
    General surgeons form a crucial component of the medical workforce in rural areas of the United States. Analysis of the data suggests that the general surgical workforce has not kept pace with the rising population, and that the number of general surgeons in most rural areas of the U.S. will decline further. Report available upon request by contacting rhrc@fammed.washington.edu.
  • American Indians and Alaska Natives: How Do They Find Their Path to Medical School?
    Author(s): Walter B. Hollow, Davis G. Patterson, Polly M. Olsen, Laura-Mae Baldwin
    Research center: WWAMI Rural Health Research Center
    Topics: American Indians and Alaska Natives, Physicians, Workforce
    Report Number: Working Paper No. 86
    Date: 01 / 2004
    Describes the findings of a study to understand the paths of American Indian and Alaska Native (AI/AN) students who successfully entered medical school.
  • Analysis of Medicare's Incentive Payment Program for Physicians in Health Professional Shortage Areas
    Author(s): Leighton Chan, L. Gary Hart, Thomas C. Ricketts III, Shelli K. Beaver
    Research center: WWAMI Rural Health Research Center
    Topics: Medicare, Physicians
    Citation: Journal of Rural Health, 20(2), 109-117
    Date: 2004
    The Medicare Incentive Payment (MIP) program provides a 10 percent bonus payment to physicians who treat patients in Health Professional Shortage Areas (HPSAs). This paper examines the experience of five states (Alaska, Idaho, North Carolina, South Carolina, and Washington) with the Medicare Incentive Payment (MIP) program. This study determines the program's expenditures, utilizations, and which types of physicians received payments. Results show that physicians eligible for the bonus payments often did not claim them, and physicians who likely did not work in approved HPSA sites, claimed the bonus payments and received them.
  • Productivity of Washington State’s Obstetrician–Gynecologist Workforce: Does Gender Make a Difference?
    Author(s): Thomas J. Benedetti, Laura-Mae Baldwin, C. Holly A. Andrilla, L. Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Women
    Citation: Obstetrics and Gynecology, 103(3), 499-505
    Date: 2004
    Objective: To compare the practice productivity of female and male obstetrician–gynecologists in Washington State.
    Methods: The primary data collection tool was a practice survey that accompanied each licensed practitioner’s license renewal in 1998–1999. Washington State birth certificate data were linked with the licensure data to obtain objective information regarding obstetric births.
    Results: Of the 541 obstetrician–gynecologists identified, two thirds were men and one third were women. Women were significantly younger than men (mean age 43.3 years versus 51.7 years). Ten practice variables were evaluated: total weeks worked per year, total professional hours per week, direct patient care hours per week, nondirect patient care hours per week, outpatient visits per week, inpatient visits per week, percent practicing obstetrics, number of obstetrical deliveries per year, percentage working less than 32 hours per week, and percentage working 60 or more hours per week. Of these, only 2 variables showed significant differences: inpatient visits per week (women 10.1 per week, men 12.8 per week, P <= .01) and working 60 or more hours per week (women 22.1% versus men 31.5%, P <= .05). After controlling for age, analysis of covariance and multiple logistic regression confirmed these findings and in addition showed that women worked 4.1 fewer hours per week than men (P < .01). When examining the ratio of female-to-male practice productivity in 10-year age increments from the 30–39 through the 50–59 age groups, a pattern emerged suggesting lower productivity in many variables in the women in the 40–49 age group.
    Conclusion: Only small differences in practice productivity between men and women were demonstrated in a survey of nearly all obstetrician–gynecologists in Washington State. Changing demographics and behaviors of the obstetrician–gynecologist workforce will require ongoing longitudinal studies to confirm these findings and determine whether they are generalizable to the rest of the United States.
  • Migration of Physicians From Sub-Saharan Africa to the United States of America: Measures of the African Brain Drain
    Author(s): Amy Hagopian, Matthew J Thompson, Meredith Fordyce, Karin E Johnson, L Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: International Medical Graduates (IMGs), Physicians
    Citation: Human Resources for Health, 2(1):17
    Date: 2004
    The objective of this paper is to describe the numbers, characteristics, and trends in the migration to the United States of physicians trained in sub-Saharan Africa.
    Methods: We used the American Medical Association 2002 Masterfile to identify and describe physicians who received their medical training in sub-Saharan Africa and are currently practicing in the USA.
    Results: More than 23% of America's 771 491 physicians received their medical training outside the USA, the majority (64%) in low-income or lower middle-income countries. A total of 5334 physicians from sub-Saharan Africa are in that group, a number that represents more than 6% of the physicians practicing in sub-Saharan Africa now. Nearly 86% of these Africans practicing in the USA originate from only three countries: Nigeria, South Africa and Ghana. Furthermore, 79% were trained at only 10 medical schools.
    Conclusions: Physician migration from poor countries to rich ones contributes to worldwide health workforce imbalances that may be detrimental to the health systems of source countries. The migration of over 5000 doctors from sub-Saharan Africa to the USA has had a significantly negative effect on the doctor-to-population ratio of Africa. The finding that the bulk of migration occurs from only a few countries and medical schools suggests policy interventions in only a few locations could be effective in stemming the brain drain.

2003

  • Medicare Physician Payment: Practice Expense
    Author(s): A. Clinton MacKinney, Timothy D. McBride, Michael D. Shambaugh-Miller, Keith J. Mueller
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare, Physicians
    Report Number: Rural Policy Brief Vol. 8, No. 9 (PB2003-9)
    Date: 10 / 2003
    Examines the physician practice expense component of Medicare payment, which proportionately results in greater geographic physician payment variation than does the physician work payment. The practice expense adjustment methodology warrants careful validation to demonstrate that the index measures actual geographic practice cost differences. A complete understanding of the reasons for different payments will inform both physicians who want to know why the same procedure results in less reimbursement in one place than it does in another and policymakers who want to address that concern.
  • Medicare Payment Policies
    Author(s): Keith J. Mueller
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Hospitals and clinics, Medicare, Physicians
    Date: 08 / 2003
    Overview of the policy issues related to Medicare payment to physicians and hospitals. Presented at the All Programs Meeting, Federal Office of Rural Health Policy, 8/21/03.
  • Who is Caring for the Underserved? A Comparison of Primary Care Physicians and Nonphysician Clinicians in California and Washington
    Author(s): Kevin Grumbach, L. Gary Hart, Elizabeth Mertz, Janet Coffman, and Lorella Palazzo
    Research center: WWAMI Rural Health Research Center
    Topics: Mid-level practitioners, Physicians
    Citation: Annals of Family Medicine, 1(2), 97-104
    Date: 07 / 2003
    Compares the geographic distribution and patient populations of physician and nonphysician primary care clinicians. Includes the proportion of clinicians within each discipline practicing in rural areas, Health Professional Shortage Areas (HPSAs), and areas with vulnerable populations.
  • Attitudes of Family Physicians in Washington State Toward Physician-Assisted Suicide
    Author(s): L Gary Hart , Tom E Norris, Denise M Lishner
    Research center: WWAMI Rural Health Research Center
    Topic: Physicians
    Citation: Journal of Rural Health, 19(4), 461-9
    Date: 02 / 2003
    Context: The topic of physician-assisted suicide is difficult and controversial. With recent laws allowing physicians to assist in a terminally ill patient's suicide under certain circumstances, the debate concerning the appropriate and ethical role for physicians has intensified.
    Purpose: This paper utilizes data from a 1997 survey of family physicians (FPs) in Washington State to test two hypotheses: (1) older respondents will indicate greater opposition to physician-assisted suicide than their younger colleagues, and (2) male and rural physicians will have more negative attitudes toward physician-assisted suicide than their female and urban counterparts.
    Methods: A questionnaire administered to all active FPs obtained a 68% response rate, with 1074 respondents found to be eligible in this study. A ZIP code system based on generalist Health Service Areas was used to designate those practicing in rural versus urban areas.
    Findings: One-fourth of the respondents overall indicated support for physician-assisted suicide. When asked whether this practice should be legalized, 39% said yes, 44% said no, and 18% indicated that they did not know. Fifty-eight percent of the study sample reported that they would not include physician-assisted suicide in their practices even if it were legal. Responses disaggregated by age-groups closely paralleled the group overall. There was a significant pattern of opposition on the part of rural male respondents compared to urban female respondents. Even among those reporting support for physician-assisted suicide, many expressed reluctance about including it in their practices.
    Conclusions: These findings highlight the systematic differences in FP attitudes toward one aspect of health care by gender, rural-urban practice location, and other factors.
  • Medicare Physician Payment
    Author(s): A. Clinton MacKinney, Michael D. Shambaugh-Miller, Keith Mueller
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: Medicare, Physicians
    Date: 01 / 2003
    Resource-Based Relative Value Scale (RBRVS) has replaced the 25 year-old Medicare CPR charge system.
  • Effects of the 1997 Balanced Budget Act on Family Practice Residency Training Programs
    Author(s): Ronald Schneeweiss, Roger A. Rosenblatt, Susan Dovey, L. Gary Hart, Frederick M. Chen, Susan Casey, George E. Fryer Jr
    Research center: WWAMI Rural Health Research Center
    Topics: International Medical Graduates (IMGs), Physicians, Workforce
    Citation: Fam Med 2003;35(2):93-9
    Date: 2003
    Background and Objectives: This study assessed the impact of the Balanced Budget Act (BBA) of 1997 on family practice residency training programs in the United States.
    Methods: We surveyed 453 active family practice residency programs, asking about program closures and new program starts (including rural training tracks), changes in the number of residents and faculty, and curriculum changes. Programs were classified according to their urban or rural location, university or community hospital setting, and rural and/or urban underserved mission emphasis.
    Results: A total of 435 (96%) of the programs responded. Overall, the impact of the BBA was relatively small. In 1998 and 1999, nationwide, there were 11 program closures, a net decrease of only 82 residents, and a net increase of 52 faculty across program settings and mission emphasis. The rate of family practice residency program closures increased from an average of 3.0 per year between 1988–1997 to 4.8 per year in the 4 years following passage of the BBA.
    Conclusions: The 1997 BBA did not have an immediate significant negative impact on family practice residency programs. However, there is a worrisome increase in the rate of family practice residency closures since 1997. A mechanism needs to be established to monitor all primary care program closures to give an early warning should this trend continue.

2002

  • Rural Dimensions of Medicare Reimbursement for Inpatient and Outpatient Institutional and Physician Services
    Research center: Walsh Center for Rural Health Analysis
    Topics: Medicare, Physicians
    Date: 12 / 2002
    Examines major Medicare payment policies from the rural perspective. Specifically, it summarizes major payment policies with explicit rural dimensions that directly affect physicians and hospitals, examines existing evidence on whether there are direct rural impacts of the policy, and looks at whether direct rural impacts are consistent with legislative and regulatory inten
  • Accounting for Graduate Medical Education Funding in Family Practice Training
    Author(s): Frederick M Chen, RL Phillips Jr, R Schneeweiss, C Holly A Andrilla, L Gary Hart, GE Fryer Jr, S Casey, Roger A Rosenblatt
    Research center: WWAMI Rural Health Research Center
    Topics: Medicare, Physicians, Workforce
    Citation: Fam Med 2002;34(9):663-8
    Date: 10 / 2002
    Background and Objectives: Medicare provides the majority of funding to support graduate medical education (GME). Following the flow of these funds from hospitals to training programs is an important step in accounting for GME funding.
    Methods: Using a national survey of 453 family practice residency programs and Medicare hospital cost reports, we assessed residency programs’ knowledge of their federal GME funding and compared their responses with the actual amounts paid to the sponsoring hospitals by Medicare. Results: A total of 328 (72%) programs responded; 168 programs (51%) reported that they did not know how much federal GME funding they received. Programs that were the only residency in the hospital (61% versus 36%) and those that were community hospital-based programs (53% versus 22%) were more likely to know their GME allocation. Programs in hospitals with other residencies received less of their designated direct medical education payment than programs that were the only residency in the sponsoring hospital (-45% versus +19%).
    Conclusions: More than half of family practice training programs do not know how much GME they receive. These findings call for improved accountability in the use of Medicare payments that are designated for medical education.
  • Family Medicine Training in Rural Areas
    Author(s): Roger A. Rosenblatt, Ronald Schneeweiss, L. Gary Hart, Susan Casey, C. Holly A. Andrilla, Frederick M. Chen
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
    Citation: JAMA. 2002;288:1063-1064
    Date: 09 / 2002
    Letter to the Editor: The discipline of family medicine was created in the 1970s, in part, as a way to address the chronic shortage of US rural physicians. It was predicted that the new discipline would augment the supply of rural clinicians because family physicians are much more likely than other physicians to settle in rural areas.
    There is also empirical evidence that training family physicians in rural areas increases the likelihood that residency graduates will choose to settle in rural places. However, the exact proportion of family medicine residency programs located in truly rural parts of the United States remains unknown, as does the extent to which training rural physicians is a priority of existing family medicine residency programs.
  • Gender-Related Factors in the Recruitment of Generalist Physicians to the Rural Northwest
    Author(s): Ellsbury KE, Baldwin LM, Johnson KE, Runyan SJ, Hart LG
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Women, Workforce
    Citation: Journal of the American Board of Family Practice, 15(5), 391-400
    Date: 09 / 2002
    Background: This study examines differences in the factors female and male physicians considered influential in their rural practice location choice and describes the practice arrangements that successfully recruited female physicians to rural areas.
    Methods: This cross-sectional study was based on a mailed survey of physicians successfully recruited between 1992 and 1999 to towns of 10,000 or less in six states in the Pacific Northwest.
    Results: Responses from 77 men and 37 women (response rate 61%) indicated that women were more likely than men to have been influenced in making their practice choice by issues related to spouse or personal partner, flexible scheduling, family leave, availability of childcare, and the interpersonal aspects of recruitment. Commonly reported themes reflected the respondents' desire for flexibility regarding family issues and the value they placed on honesty during recruitment.
    Conclusions: It is very important in recruitment of both men and women to highlight the positive aspects of the community and to involve and assist the physician's spouse or partner. If they want to achieve a gender-balanced physician workforce, rural communities and practices recruiting physicians should place high priority on practice scheduling, spouse-partner, and interpersonal issues in the recruitment process.
  • Rural Research Focus: Rural Physician Shortages
    Author(s): George E. Wright, C. Holly A. Andrilla, L. Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
    Date: 05 / 2002
    Discusses a model for understanding how many physicians a rural community can support, based on research at the WWAMI Rural Health Research Center.
  • Immediate and Future Role of the J-1 Visa Waiver Program for Physicians: The Consequences of Change for Rural Health Care Service Delivery
    Author(s): Keith J. Mueller
    Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
    Topics: J-1 Visa Waiver, Physicians, Workforce
    Report Number: Policy Brief 2002-3
    Date: 04 / 2002
    Examines the consequences for the delivery of health care services in rural underserved areas if current policies governing the granting of J-1 visa waivers are changed and increases or decreases the numbers of physicians affected. Among its findings: J-1 visa waiver doctors provide care to more than 4 million people living in underserved areas of rural America. If all primary care doctors in the program were to leave, the number of rural counties with no primary care physicians would go from 161 to 212. Makes several recommendations: 1) The Department of Health and Human Services--which currently only requests waivers for physicians involved in research-should consider requesting waivers for doctors to practice in underserved areas. 2) Physicians recommended for waivers should be allowed to begin practicing in underserved areas as soon as the request is made. If, in subsequent screening, a problem turns up the waiver would be revoked. 3) The Conrad State 20 Program, which allows the 44 states that participate in it to sponsor waivers, should be expanded from 20 waivers per year to 40.
  • Family Medicine Residency Training in Rural Areas: How Much is Taking Place, and Is It Enough to Prepare a Future Generation of Rural Family Physicians?
    Author(s): Roger A Rosenblatt, R Schneeweiss, L Gary Hart, S Casey, C Holly Andrilla, Fredercik M Chen
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
    Report Number: No. 69
    Date: 03 / 2002
    Determines how much rural family practice training is taking place in the United States. Among the results are that only 33 family medicine residency programs (7.4 percent) are located in rural areas and most of the training sponsored by these programs occurs in rural areas. On the other hand, while more than one-third of the urban programs listed rural training as an important part of their mission, only 2.3 percent of the training they supported took place in rural areas. For the nation as a whole, only 7.5 percent of family medicine residency training occurred in rural areas despite the fact that 22.3 percent of the U.S. population lives in rural places. The report concludes that to the extent that there is a link between the place of training and future practice, the lack of rural training contributes to the shortage of rural physicians. Furthermore, unless significant efforts are made to increase rural residency training, rural physician shortages are likely to persist.
  • Assessing Physicians' Continuing Medical Education (CME) Needs in the U.S.-Associated Pacific Jurisdictions
    Author(s): Michael J Thompson, Sue M Skillman, Karin Johnson, Schneeweiss R, Kathleen Ellsbury,L Gary Hart; Pacific Islands Continuing Clinical Education Program Study Team
    Research center: WWAMI Rural Health Research Center
    Topic: Physicians
    Citation: Pacific Health Dialog, 9(1):11-6
    Date: 03 / 2002
    OBJECTIVE: To assess the self-perceived continuing medical education (CME) needs of physicians in American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Federated States of Micronesia, Republic of the Marshall Islands, and the Republic of Palau. METHODS: Questionnaire-based survey of all physicians. RESULTS: Responses obtained from a total of 143 physicians in the region provided information on training backgrounds, previous experiences with CME, local access to regular CME sessions, perceived priority educational needs and preferred methods of CME delivery. CONCLUSIONS: Overall 64% of respondents had attended a formal CME event in 1999 or 2000, and 71% had access to local weekly or biweekly CME. However the perceived usefulness of these events varied by region. Priority learning needs were identified by physicians including non-communicable diseases such as diabetes, hypertension, cardiac disease; communicable diseases such as tuberculosis, HIV/AIDS and tropical diseases; as well as skills such as EKG and X-ray interpretation, trauma management and cardiac life support. Information on the most pressing educational needs and desired methods of delivery will be crucial in planning CME in this region.

2001

  • Proximity of Rural African American and Hispanic/Latino Communities to Physicians and Hospital Services
    Author(s): Donald E. Pathman, Thomas R. Konrad, Robert Schwartz
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: African Americans, Health services, Hispanics, Minority health, Physicians
    Report Number: Working Paper No. 72
    Date: 06 / 2001
    Assesses how local physician concentrations and distances to hospitals differ for rural communities of varying African American and Hispanic/Latino compositions. Uses data at the town-area level for nine southern and six western states to compare town-areas with low, medium, and high proportions of African Americans and Hispanics on their local physician-to-population ratios and distances to nearest hospital offering each of four levels of services. Among the findings are that rural Hispanics, but not African Americans, face longer travel distances to physicians, and both groups face longer distances to some types of hospital services than do non-minority rural individuals.
  • Proximity of Rural Black and Hispanic/Latino Communities to Physicians and Hospital Services
    Author(s): Donald E. Pathman, Thomas R. Konrad, Robert Schwartz
    Research center: North Carolina Rural Health Research and Policy Analysis Center
    Topics: African Americans, Health services, Hispanics, Hospitals and clinics, Minority health, Physicians
    Date: 05 / 2001
    This brief reports the findings of a study of how the African American and Hispanic/ Latino composition of rural communities relates to local physician concentrations, and relates to distances to hospitals offering various levels of services.
  • How Many Physicians Can a Rural Community Support? A Practice Income Potential Model for Washington State
    Author(s): George E Wright, C Holly Andrilla, L Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
    Report Number: No. 45
    Date: 04 / 2001
    Addresses the ability of smaller and underserved rural communities to financially support needed physicians. Reports on an experimental simulation model that projects potential practice income for primary care physicians in rural communities of Washington State. Finds that the distribution of physicians follows predicted economic potential. Surprisingly, the types of rural communities most likely to have fewer physicians are not small isolated towns, but larger communities with above average population growth, closer proximity to metro areas and somewhat lower average family incomes. Towns in HPSAs were predominantly constrained by demand deficits. To overcome demand barriers, continuous subsidies such as enhanced Medicare payments for certified Rural Health Clinics or 10 percent Medicare supplemental payments for care provided in a HPSA could be offered. Signing-bonus approaches may help overcome initial reluctance to practice in rural areas where demand is sufficient to support long-term retention.
  • Gender-Related Factors in the Recruitment of Generalist Physicians to the Rural Northwest
    Author(s): Katherine E Ellsbury, Laura-Mae Baldwin, Karin E Johnson, SJ Runyan, L Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Women
    Report Number: No. 62
    Date: 02 / 2001
    Examines differences in the factors female and male generalist physicians considered influential in their rural practice location choice and identifies the practice arrangements that attracted female generalist physicians to rural areas. Findings include: women were more likely than men to have been influenced in practice choice by issues related to spouse/personal partner, flexible scheduling, family leave, and availability of childcare; women were more highly influenced by the interpersonal aspects of recruitment; and men and women were equally likely to consider community factors, practice content, practice partner compatibility, and financial issues. Findings indicate that rural communities and practices recruiting physicians should place high priority on practice scheduling, spouse/partner, and interpersonal issues in the recruiting process if they want to achieve a gender-balanced physician workforce.

2000

  • Why do Rural Primary-Care Physicians Sell Their Practices?
    Author(s): Jeffrey Stensland, Michelle Brasure, Ira Moscovice
    Research center: Minnesota Rural Health Research Center
    Topic: Physicians
    Date: 06 / 2000
    This study evaluates why rural primary care physicians sell their practices. Examines the factors that led independent physicians to sell their practices to either non- local buyers, local hospitals or local physicians.
  • U.S. Medical Schools and the Rural Family Physician Gender Gap
    Author(s): Kathleen E. Ellsbury, Mark P. Doescher, L. Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Women, Workforce
    Citation: Fam Med. May 2000;32(5):331-337
    Date: 05 / 2000
    Background: Women comprise increasing proportions of medical school graduates. They tend to choose primary care but are less likely than men to choose rural practice.
    Methods: This study used American Medical Association masterfile data on 1988–1996 medical school graduates to identify the US medical schools most successful at producing rural family physicians and general practitioners of both genders.
    Results: The number of listed rural female family physician or general practitioner graduates among schools ranged from 0–27 (0% to 4.4% of each school’s 1988–1996 graduates). There were approximately twice as many male as female rural family physicians and general practitioners. Publicly funded schools produced more rural female family physicians and general practitioners than their privately funded counterparts.
    Conclusions: Our findings suggest that a few schools, most of them public, may serve as models for schools that aim to train women who later enter rural practice.
  • Effect of the Doctor-Patient Relationship on Emergency Department Use Among the Elderly
    Author(s): Roger A Rosenblatt, GE Wright, Laura-Mae Baldwin, Leighton Chan, P Clitherow, Frederick M Chen, L Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Emergency medical services (EMS), Physicians
    Citation: American Journal of Public Health, 90(1), 97-102
    Date: 01 / 2000
    OBJECTIVES: This study sought to determine the rate of emergency department use among the elderly and examined whether that use is reduced if the patient has a principal-care physician.
    METHODS: The Health Care Financing Administration's National Claims History File was used to study emergency department use by Medicare patients older than 65 years in Washington State during 1994. RESULTS: A total of 18.1% of patients had 1 or more emergency department visits during the study year; the rate increased with age and illness severity. Patients with principal-care physicians were much less likely to use the emergency department for every category of disease severity. After case mix, Medicaid eligibility, and rural/urban residence were controlled for, the odds ratio for having any emergency department visit was 0.47 for patients with a generalist principal-care physician and 0.58 for patients with a specialist principal-care physician.
    CONCLUSIONS: The rate of emergency department use among the elderly is substantial, and most visits are for serious medical problems. The presence of a continuous relationship with a physician--regardless of specialty--may reduce emergency department use.
  • Educating Generalist Physicians for Rural Practice: How Are We Doing?
    Author(s): John P Geyman, Gary L Hart, Tom E Norris, John B Coombs, Denise Lishner
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
    Citation: Journal of Rural Health, 16(1), 56-80
    Date: 2000
    Although about 20 percent of Americans live in rural areas, only 9 percent of physicians practice there. Physicians consistently and preferentially settle in metropolitan, suburban and other nonrural areas. The last 20 years have seen a variety of strategies by medical education programs and by federal and state governments to promote the choice of rural practice among physicians. This comprehensive literature review was based on MEDLINE and Health STAR searches, content review of more than 125 relevant articles and review of other materials provided by members of the Society of Teachers of Family Medicine Working Group on Rural Health. To the extent possible, a particular focus was directed to "small rural" communities of less than 10,000 people. Significant progress has been made in arresting the downward trend in the number of physicians in these communities but 22 million people still live in health professions shortage areas. This report summarizes the successes and failures of medical education and government programs and initiatives that are intended to prepare and place more generalist physicians in rural practice. It remains clear that the educational pipeline to rural medical practice is long and complex, with many places for attrition along the way. Much is now known about how to select, train and place physicians in rural practice, but effective strategies must be as multifaceted as the barriers themselves.
  • Distribution of Rural Female Generalist Physicians in the United States
    Author(s): Mark P Doescher, Kathrine E Ellsbury, Gary L Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Women, Workforce
    Citation: Journal of Rural Health, 16(2), 111-118
    Date: 2000
    Female physicians are underrepresented in rural areas. What impact might the increasing proportion of women in medicine have on the rural physician shortage? To begin addressing this question, we present data describing the geographic distribution of female physicians in the United States. We examine the geographic distribution of all active U.S. allopathic physicians recorded in the October 1996 update of the American Medical Association Physician Masterfile. Percentages and numbers of female physicians by professional activity, specialty type, and geographic location are reported. Findings reveal there were fewer than 7,000 female allopathic physicians practicing in rural America in 1996. The proportion of generalist female physicians who practice in rural settings was significantly lower than the proportion who practice in urban locations. Although members of the most recent 10-year medical school graduation cohort of female generalist physicians were slightly more likely to practice in rural areas than members of earlier cohorts, female physicians remained significantly underrepresented in rural areas. States varied dramatically in rural female generalist underrepresentation. Should female generalists continue to be underrepresented in rural locations, the rural physician shortage will not be resolved quickly. Effective strategies to improve rural female physician placement and retention need to be identified and implemented to improve rural access to physician care.

1999

  • Production of Rural Female Generalists by U.S. Medical Schools
    Author(s): Katherine E Ellsbury, Mark P Doescher, L Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Women, Workforce
    Date: 05 / 1999
    Compares the production of rural female generalists among medical schools. Data from the 1996 AMA Physician Masterfile for the 1988-96 graduate cohort were analyzed to compare the production of rural female generalists by medical school. Outcome measures included total number and percentage of rural female generalist graduates of each school. Only a few schools contribute most of ht erural female generalists. These schools' admissions policies, curricula, extracurricular programs, and career advising efforts may serve as models of schools who make it a priority to encourage more of their female graduates to enter rural practice.
  • Dimensions of Retention: A National Study of the Locational Histories of Physician Assistants
    Author(s): Eric H Larson, Gary L Hart, Goodwin MK, John Geller, C Holly Andrilla
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
    Citation: Journal of Rural Health, 15(4), 391-402
    Date: 1999
    This study describes the locational histories of a representative national sample of physician assistants and considers the implications of observed locational behavior for recruitment and retention of physician assistants in rural practice. Through a survey, physician assistants listed all the places they had practiced since completing their physician assistant training, making it possible to classify the career histories of physician assistants as "all rural," "all urban," "urban to rural" or "rural to urban." The study examined the retention of physician assistants in rural practice at several levels: in the first practice, in rural practice overall and in states. Physician assistants who started their careers in rural locations were more likely to leave them during the first four years of practice than urban physician assistants, and female rural physician assistants were slightly more likely to leave than men. Those starting in rural practice had high attrition to urban areas (41 percent); however, a significant proportion of the physician assistants who started in urban practice settings left for rural settings (10 percent). This kept the total proportion of physician assistants in rural practice at a steady 20 percent. While 21 percent of the earliest graduates of physician assistant training programs have had exclusively rural careers, only 9 percent of physician assistants with four to seven years of experience have worked exclusively in rural settings. At the state level, generalist physician assistants were significantly more likely to leave states with practice environments unfavorable to physician assistant practice in terms of prescriptive authority, reimbursement and insurance.
  • Rural and Urban Physicians: Does the Content of Their Medicare Practices Differ?
    Author(s): Laura-Mae Baldwin, Roger A Rosenblatt, Schneeweiss R,Denise M Lishner, L Gary Hart
    Research center: WWAMI Rural Health Research Center
    Topics: Medicare, Physicians
    Citation: Journal of Rural Health, 15(2), 240-251
    Date: 1999
    Rural and urban areas have significant differences in the availability of medical technology, medical practice structures and patient populations. This study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physicians practicing in rural and urban areas. This study compared the number of patients, outpatient visits, and inpatient visits per physician in the different specialties, diagnosis clusters, patient age and sex, and procedure frequency and type for board-certified rural and urban physicians in 12 ambulatory medical specialties. Overall, 14.4 percent of physicians in the 12 specialties practiced exclusively in rural Washington, with great variation by specialty. Rural physicians were older and less likely to be female than urban physicians. Rural physicians saw larger numbers of elderly patients and had higher volumes of outpatient visits than their urban counterparts. For all specialty groups except general surgeons and obstetrician-gynecologists, the diagnostic scope of practice was specialty-specific and similar for rural and urban physicians. Rural general surgeons had more visits for gastrointestinal disorders, while rural obstetrician-gynecologists had more visits out of their specialty domain (e.g., hypertension, diabetes) than their urban counterparts. The scope of procedures for rural and urban physicians in most specialties showed more similarities than differences. While the fund of knowledge and outpatient procedural training needed by most rural and urban practitioners to care for the elderly is similar, rural general surgeons and obstetrician-gynecologists need training outside their traditional specialty areas to optimally care for their patients.

1997

  • National Health Service Corps: Rural Physician Service and Retention
    Author(s): Cullen TJ, L Gary Hart, Whitcomb ME, Roger A Rosenblatt
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Workforce
    Citation: Journal of the American Board Family Practice, 10(4):272-9
    Date: 1997
    BACKGROUND: The National Health Service Corps (NHSC) scholarship program is the most ambitious program in the United States designed to supply physicians to medically underserved areas. In addition to providing medical service to underserved populations, the NHSC promotes long-term retention of physicians in the areas to which they were initially assigned. This study uses existing secondary data to explore some of the issues involved in retention in rural areas.
    METHODS: The December 1991 American Medical Association (AMA) Masterfile was used to determine the practice location and specialty of the 2903 NHSC scholarship recipients who graduated from US medical schools from 1975 through 1983 and were initially assigned to nonmetropolitan counties. We used the AMA Masterfile to determine what percentage of the original cohort was still practicing in their initial county of assignment and the relation of original practice specialty and assignment period to long-term retention.
    RESULTS: Twenty percent of the physicians assigned to rural areas were still located in the county of their initial assignment, and an additional 20 percent were in some other rural location in 1991. Retention was highest for family physicians and lowest for scholarship recipients who had not completed residency training when they were first assigned. Retention rates were also higher for those with longer periods of obligated service. Substantial medical care service was provided to rural underserved communities through obligated and postobligation service. Nearly 20 percent of all students graduating from medical schools between 1975 and 1983 who are currently practicing in rural counties with small urbanized populations were initially NHSC assignees.
    CONCLUSIONS: Although most NHSC physicians did not remain in their initial rural practice locations, a substantial minority are still rural practitioners; those remaining account for a considerable proportion of all physicians in the most rural US counties. This study suggests that rural retention can be enhanced by selecting more assignees who were committed to and then completed family medicine residencies before assignment.

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