Mark Doescher, MD, MSPH

Email: mark-doescher@ouhsc.edu


Completed Projects - (9)

Aging of the Rural Generalist Physician Workforce: Will Some Locations Be More Affected than Others?
This study will identify rural locations with high proportions of generalist physicians nearing retirement age.
Research center: WWAMI Rural Health Research Center
Topics: Physicians, Workforce
Breast, Cervical, Colorectal, and Prostate Cancer Screening in Rural America: Does Proximity to a Metropolitan Area Matter?
The study compared cancer screening rates among various levels of rural versus urban Behavioral Risk Factor Surveillance System respondents and among white respondents versus those from racial/ethnic minority groups.
Research center: WWAMI Rural Health Research Center
Topics: Health disparities, Health promotion and disease prevention, Minority health
Burden of Asthma Among Rural Residents: A National Study
This study uses data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine the prevalence of and trends in asthma among rural residents by type of geographic location and by key risk factors.
Research center: WWAMI Rural Health Research Center
Topics: Chronic diseases and conditions, Health disparities, Minority health, Rural statistics and demographics
Current Contribution of Physicians, Advanced Practice Nurses, and Physician Assistants to the Rural Primary Care Workforce
This two-year, multi-state study is examining the practices of rural physicians, nurse practitioners (NPs), and physician assistants (PAs) regarding their primary care visit productivity and scope of practice. Through surveys, this study will examine the contributions of physicians, NPs, and PAs by state, degree of practice rurality, practice characteristics, and primary care HPSA status in order to provide information on a range of rural primary care workforce needs.
Research center: WWAMI Rural Health Research Center
Topics: Nurse practitioners, Nurses, Physician assistants, Physicians, Workforce
Dentist Supply, Access to Dental Care, and Oral Health among Rural and Urban Residents: A National Study
This study will determine whether shortages of dentists in rural areas of the U.S. are associated with impaired access to dental care and a higher prevalence of dental disease.
Research center: WWAMI Rural Health Research Center
Topics: Dental health, Workforce
General and Specialist Surgeon Supply and Inpatient Procedural Content: A National Rural-Urban Study
This study will examine the degree to which access to inpatient surgical care in rural areas is affected by the diminishing workforce of general surgeons. Using inpatient surgical procedure data, we will examine the availability and content of general surgical procedures in rural and urban hospitals nationally as a function of surgeon supply.
Research center: WWAMI Rural Health Research Center
Topic: Workforce
Policy Analyses of Rural Issues Related to Health Care Reform
Health care reform provides an array of opportunities to improve health care access and quality for rural Americans. The WWAMI RHRC will support HRSA's efforts to inform this process by summarizing existing evidence characterizing the rural health care workforce and rural health care delivery and will conduct analyses exploring the potential impact on rural populations of proposed and newly- enacted health care reform legislation.
Research center: WWAMI Rural Health Research Center
Topics: Health policy, Health services
The Rural/Urban Practice Location Patterns of Women Medical School Graduates
While women are becoming an increasingly large percentage of the graduates of medical schools, they are much less likely to locate their practices in rural towns. This study involved a survey including questions about where the residents preferred to locate and how much they thought they would be practicing in the future.
Research center: WWAMI Rural Health Research Center
Topics: Physicians, Women, Workforce
Unhealthy Lifestyle Behaviors Among Minority Group Members: A National Rural and Urban Study
Research center: South Carolina Rural Health Research Center
Topics: Health disparities, Health promotion and disease prevention, Minority health

Publications - (35)

  • 2005 Physician Supply and Distribution in Rural Areas of the United States (Full Report)
    WWAMI Rural Health Research Center
    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 (Project Summary)
    WWAMI Rural Health Research Center
    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.
  • The Aging of the Rural Primary Care Physician Workforce: Will Some Locations Be More Affected than Others?
    WWAMI Rural Health Research Center
    Date: 09/2013
    Reports that as the aging primary care physician population retires, rural provider shortages will be further exacerbated.
  • Assessing Rural-Urban Nurse Practitioner Supply and Distribution in 12 States Using Available Data Sources
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 08/2015

    This study compared estimates of nurse practitioner (NP) supply in 12 states (statewide and rural vs. urban) derived from two sources: state license records and National Provider Identifier (NPI) data. Estimates of state NP supply from license data were found to be higher than NPI-derived estimates for most, but not all states. While data from both license and NPI sources can be useful for health workforce planning, the limitations of each source should be acknowledged and workforce comparisons should be limited to estimates derived from the same types of data.

  • Characteristics of Rural RNs Who Live and Work in Different Communities
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 09/2012

    Explores why many registered nurses (RNs) living in rural areas of the United States leave their communities to work in other rural and urban communities.

  • Characteristics of Rural RNs Who Live and Work in Different Communities (Final Report)
    WWAMI Rural Health Research Center
    Date: 09/2012
    Explores factors associated with registered nurses' decisions to commute away from their rural areas of residence for work.
  • The Contribution of Physicians, Physician Assistants, and Nurse Practitioners Toward Rural Primary Care: Findings from a 13-state Survey
    WWAMI Rural Health Research Center
    Date: 06/2014

    This study quantifies the average weekly number of outpatient primary care visits and the types of services provided within and beyond the outpatient setting by physicians, physician assistants (PAs), and nurse practitioners (NPs) in rural areas. Findings suggest that although a greater reliance on PAs and NPs in rural primary care settings would have a minor impact on outpatient practice volume, this shift might reduce the availability of services that have more often been traditionally provided by rural primary care physicians beyond the outpatient clinic setting.

  • The Contribution of Physicians, Physician Assistants, and Nurse Practitioners Toward Rural Primary Care: Findings from a 13-State Survey
    WWAMI Rural Health Research Center
    Date: 06/2014
    Evaluates a questionnaire that measures weekly outpatient visits and services provided in a rural setting.
  • The Contributions of Community Colleges to the Education of Allied Health Professionals in Rural Areas of the United States
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 10/2012

    Describes where community college allied health education programs (of those most relevant to rural health care delivery) are located in relation to rural populations and small rural hospitals.

  • The Contributions of Community Colleges to the Education of Allied Health Professionals in Rural Areas of the United States (Final Report)
    WWAMI Rural Health Research Center
    Date: 10/2012
    Community colleges educate a significant portion of the nation's allied health workforce (including Health Information/Medical Records Technicians, Surgical Technologists, and Dental Assistants, to name a few), and because they have a history of educating residents of their communities for local jobs, are important to the economies of many rural communities.
  • Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents
    Report
    WWAMI Rural Health Research Center
    Date: 05/2015

    Do adults in rural locations report lower dental care utilization or higher prevalence of dental disease or both compared with their urban counterparts? This analysis of data from the Behavioral Risk Factor Surveillance System (BRFSS) shows that residents of non-metropolitan counties were significantly less likely than residents of metropolitan counties to report having a dental visit or teeth cleaning in the past year and significantly more likely to report undergoing tooth extraction. These findings persisted even when controlling for demographic factors, income, insurance and health and smoking status. Policies aimed at increasing the supply of generalist dentists who will choose to work in rural areas may reduce these substantial rural/urban disparities in access to oral healthcare and dental outcomes.

  • The Distribution of Rural Female Generalist Physicians in the United States
    WWAMI Rural Health Research Center
    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.
  • Do Rural Patients with Early-Stage Prostate Cancer Gain Access to All Treatment Choices? (Final Report)
    Report
    WWAMI Rural Health Research Center
    Date: 02/2014

    Compares rates of receipt of prostate cancer treatments and of the different treatment options between early-stage prostate cancer patients living in urban and four levels of rural counties.

  • Family Medicine Residency Training in Rural Locations (Final Report)
    WWAMI Rural Health Research Center
    Date: 07/2010
    Rural physician supply has remained relatively stable over the past decade, but its future is threatened by reduced medical student interest in family medicine careers and a declining residency match rate. This 2007 survey of all U.S. family medicine residency programs found that 33 rural programs accounted for over 80% of family medicine training occurring in rural sites, although some urban programs offer rural training tracks. Expansion of rural family medicine training is limited by Medicare graduate medical education funding caps on residency slots, financial hardships facing rural hospitals, and the challenges of creating residency training programs.
  • The Future of Family Medicine and Implications for Rural Primary Care Physician Supply (Final Report)
    WWAMI Rural Health Research Center
    Date: 08/2010
    Examines the rural physician shortage, the effect of recent trends in specialty choice on provider supply, and major trends that are changing the dynamics that shape the delivery of health care.
  • Inadequate Prenatal Care Among Racial and Ethnic Groups in the Rural United States, 2005
    WWAMI Rural Health Research Center
    Date: 10/2013

    Reports that in most states, rural minority racial/ethnic groups had levels of inadequate prenatal care (less than 50% of expected visits) in the “worst” or “worse than mid-range” categories.

  • Inadequate Prenatal Care in the Rural United States, 2005
    WWAMI Rural Health Research Center
    Date: 10/2013

    Reports that the states with levels of rural inadequate prenatal care (less than 50% of expected visits) in the “worst” or “worse than mid-range” categories were largely in southern and southwestern areas of the United States.

  • Low Birth Weight Rates Among Racial and Ethnic Groups in the Rural United States, 2005
    WWAMI Rural Health Research Center
    Date: 10/2013
    Reports that non-hispanic blacks generally had the highest rural low birth weight rates of all races/ethnicities, regardless of geographic location.
  • Low Birth Weight Rates in the Rural United States, 2005
    WWAMI Rural Health Research Center
    Date: 10/2013
    Reports that the rural U.S. low birth weight rate in 2005 was significantly higher than the urban U.S. low birth weight rate.
  • A National Study of Lifetime Asthma Prevalence and Trends in Metro and Non-Metro Counties, 2000-2003 (Full Report)
    WWAMI Rural Health Research Center
    Date: 01/2007
    Reports the findings of a study of the prevalence of and recent trends in asthma among adults residing in metropolitan and non-metropolitan counties in the United States. In 2003, the adjusted prevalence of lifetime asthma diagnosis was 12.0 percent for metropolitan counties and 11.0 percent for non-metropolitan counties (p < 0.001). Prevalence of lifetime asthma diagnosis trended upwards across the rural-urban spectrum between 2000 and 2003, and states with the highest 2003 prevalence and the greatest increase in prevalence among non-metropolitan residents were concentrated in the West Census region (e.g., Arizona, California, Oregon and Washington). Asthma prevalence in non-metropolitan counties was highest for those aged 18 to 34 (15.9%), the unemployed (13.5%), American Indians (12.7%) and women (12.4%).
  • A National Study of Obesity Prevalence and Trends by Type of Rural County
    WWAMI Rural Health Research Center
    Date: 2005
    Analyzes data from the Behavioral Risk Factor Surveillance System for 1994-1996 and 2000-2001 to estimate the recent trends in obesity among U.S. adults residing in rural locations. In 2000-2001 the prevalence of obesity was 23.0% for rural adults and 20.5% for urban, representing increases of 4.8% and 5.5%, respectively, since 1994-1996.
  • Obesity Prevalence In Rural Counties: A National Study
    WWAMI Rural Health Research Center
    Date: 01/2004
    Using a telephone survey of adults aged 18 and older residing in states participating in the Behavioral Risk Factor Surveillance System in 1994-96 and 2000-2001, researchers found that the prevalence of obesity was 23 percent for rural adults and 20.5 percent for urban adults.
  • Persistent Primary Care Health Professional Shortage Areas (HPSAs) and Health Care Access in Rural America
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 09/2009

    Resources are needed to increase and sustain the number of primary care providers and reduce financial barriers to care in all rural primary care HPSAs.

  • Prevalence And Trends In Smoking: A National Rural Study
    WWAMI Rural Health Research Center
    Date: 2006
    Using data from the Behavioral Risk Factor Surveillance System, the prevalence of smoking between 1994-1996 and 2000-2001 did not change substantially for the United States as a whole. The prevalence of smoking for rural residents decreased by more than 2 percent in six states. However, it increased by 2 percent or more in ten states.
  • Problem Drinking: Rural and Urban Trends in America, 1995/1997 to 2003
    WWAMI Rural Health Research Center
    Date: 03/2006
    Assesses the prevalence of, and recent trends in, alcohol use among adults 18 years and older in rural areas of the United States. The paper finds that heavy drinking was highest and increasing in urban areas, but that binge drinking was greater in rural areas. It recommends tailoring interventions specifically to meet the needs of rural residents.
  • The Production of Rural Female Generalists by U.S. Medical Schools
    WWAMI Rural Health Research Center
    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.
  • Receipt of Recommended Radiation Therapy Among Rural and Urban Cancer Patients (Summary)
    WWAMI Rural Health Research Center
    Date: 10/2012
    Examines whether rural patients with cancer are less likely than urban patients with cancer to receive recommended radiation therapy and identifies factors influencing rural versus urban differences in radiation therapy receipt.
  • Recruitment of Non-U.S. Citizen Physicians to Rural and Underserved Areas through Conrad State 30 J-1 Visa Waiver Programs
    Report
    WWAMI Rural Health Research Center
    Date: 07/2015

    Conrad State 30 J-1 visa waiver programs (commonly called Conrad 30 programs) allow international medical graduates (IMGs) training in the U.S. on J-1 visas to remain in the U.S. after completing residency to provide healthcare for rural and urban medically underserved populations. This study collected information from state health department personnel, using both quantitative and qualitative methods, to characterize national trends in waivers and factors related to states’ successful recruitment of IMGs for the years 2000-01 through 2009-10. States varied greatly in the number of waivers used and in the resources devoted to operating the Conrad 30 program. Over the decade there was a shift away from rural primary care placements of IMGs toward non-rural specialist placements. States with larger populations gained an increasing share of J-1 visa waiver physicians during the decade of the 2000s. States devoting more staff to the Conrad 30 program recruited more physicians seeking waivers. Whether or not states charged applicant fees had no association with the number of waivers used.

  • Rural Residency Training for Family Medicine Physicians: Graduate Early-Career Outcomes
    WWAMI Rural Health Research Center
    Date: 01/2012
    This policy brief describes the characteristics of family physicians who have completed graduate medical education in Rural Training Track (RTT) residency programs and their outcomes in terms of practice in rural communities, health professional shortage areas, and safety net facilities.
  • Rural Residency Training for Family Medicine Physicians: Graduate Early-Career Outcomes, 2008-2012
    WWAMI Rural Health Research Center
    Date: 01/2013
    This policy brief provides an update on the rural and shortage area practice outcomes of family physicians who have completed graduate medical education in Rural Training Track (RTT) residency programs.
  • Training Physicians for Rural Practice: Capitalizing on Local Expertise to Strengthen Rural Primary Care
    WWAMI Rural Health Research Center
    Date: 01/2011
    This policy brief explains the challenges of ensuring sufficient numbers of well-prepared family physicians for rural communities and describes the Rural Training Track (RTT) Technical Assistance Program, a strategy to utilize local expertise in sustaining the “1-2” RTT as a national model for training physicians for rural practice.
  • Trends in Cervical and Breast Cancer Screening Practices Among Women in Rural and Urban Areas of the United States
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 08/2008

    Documents the receipt of timely breast and cervical cancer screening using a rural-urban classification system and nationally representative data.

  • Trends in Cervical and Breast Cancer Screening Practices Among Women in Rural and Urban Areas of the United States (Final Report)
    WWAMI Rural Health Research Center
    Date: 08/2008
    Reports on trends in breast cancer screening practices. Participation in mammography improved nationally, but women living in rural locations remained less likely to receive this test than those living in urban settings.
  • Trends in Professional Advice to Lose Weight Among Obese Adults, 1994-2000
    WWAMI Rural Health Research Center
    Date: 2005
    The authors studied whether rising obesity prevalence in the U.S. was accompanied by an increasing trend in professional advice to lose weight among obese adults, and found that disparities in professional advice to lose weight associated with income and educational attainment increased from 1994 to 2000. They concluded that there is a need for mechanisms that allow health care professionals to devote sufficient attention to weight control and to link with evidence-based weight loss interventions, especially those that target groups most at risk for obesity
  • Variability in General Surgical Procedures in Rural and Urban U.S. Hospital Inpatient Settings
    Report
    WWAMI Rural Health Research Center
    Date: 03/2015

    This report addresses rural/urban differences in surgical practices in commonly performed inpatient surgical procedures that are typically handled by general surgeons. National Inpatient Sample data from rural and urban hospitals in 24 states were used to examine the frequency of general surgical procedures, complications during hospitalizations and predicted resource demand. Findings indicate that rural hospitals concentrated on relatively common, low complexity procedures that can be handled by general surgeons, especially if they have received additional training in obstetrics/gynecology and orthopedics. Resource demand, length of stay, complication rates and mortality were lower for patients undergoing common procedures in rural hospitals. Rural training tracks for general surgery that provide a high case load for common general surgery, obstetrics/gynecology and orthopedics procedures may help sustain the general surgery workforce in rural areas.