Stay or Leave: Evidence from a Cohort of Young Rural Physicians

Research center:
Lead researcher:
Project funded:
September 2003
Project completed:
May 2009
The goal of this project is to improve our understanding of the dynamics of physician practice location decision making. The inability of rural areas to attract and retain physicians has been of concern to health services researchers and policymakers for many years. Workforce supply constraints may adversely affect access to care and outcomes in these areas. Much of the evidence on how physicians make practice location decisions is based on point-in-time evidence which tends to distort behavioral profiles of those serving rural areas for longer periods of time. A better understanding of the dynamics of behavior is needed, e.g., studies of observed changes in practice locations over time by a cohort of providers.

This project tracked practice locations of a cohort of physicians using information on physicians who were identified during the early stages of their medical careers as part of the National Survey of Rural Physicians (NSRP), conducted in 1993-1994 with funding from the Robert Wood Johnson Foundation. These data were supplemented with information on the current practice locations of physicians in the cohort, and with data from a follow-up survey that also asked a battery of satisfaction questions. For the subset of sampled physicians who responded to the NSRP, we identified factors correlated with the decision to maintain a rural practice. Contingency tables were used to test a variety of hypotheses concerning factors affecting the physician's decision to continue practice in a rural community, along with statistical analyses to examine relationships between these factors. A Policy Brief will summarize findings.