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Importance of community size in practice location decisions of final year residents.

Final year residents in training in Louisiana were surveyed regarding plans for medical practice and their perceptions of the importance of various factors in choosing practice locations. Most specialty groups selected smaller communities at similar rates. Growing up in small towns is associated with wanting to practice in small towns while concerns about opportunities for the family and income of the region are associated with wanting to practice in a larger city.

Health Services Research↗

Migration of obstetrician-gynecologists into and out of rural areas, 1985-1990.

This study sought to determine if county-level demographic, health care resource, policy, and competitive factors are associated with the movement of obstetrician-gynecologists (ob-gyns) into and out of rural areas. County-level descriptive data from the Area Resource File, the American Medical Association Physician Masterfile, and the American Hospital Association Guide were used for hospital descriptions. This was a correlational study that measured the association of ecologic indicators of nonmetropolitan counties with indicators of gain or loss of ob-gyns. Descriptive statistics characterize the supply and movement of ob-gyns by size and location of the counties. Multinomial logistic regression models describe the net effect of the ecologic indicators on physician movement. During the period 1985 to 1990, a total of 962 patient care ob-gyns moved out of 531 nonmetropolitan counties, and 979 ob-gyns moved into 528 counties. Counties in the southern Atlantic states experienced the greatest net inflow, whereas Illinois, Missouri, and Texas had the greatest net outflow. Counties that retained ob-gyns during this period were in the mid-range of population. Positive correlates of outward migration were adjacency to a metropolitan county and loss of hospital bed supply; negative correlates with outward migration were the supply of hospital beds and total population. Inward migration was positively correlated with retention or gain of county family physicians and with adjacency; negative correlates were overall population and total family physician supply. The movement of ob-gyns in nonmetropolitan counties is influenced by state policies, local resources, and relative location. No clear evidence shows that there are competitive relations between family physician supply and ob-gyn supply.

Adult↗

The value of goodwill in medical practice.

Accountants measure goodwill as the amount paid to acquire a medical practice over and above the current value of its net tangible assets. Patient lists, a well-respected practice, an ideal location, and other factors are expected to result in greater than normal earning power. In this article, the author discusses the hidden value of goodwill and its important in medical acquisitions and other business transactions.

Accounting↗

To stay or not to stay: factors influencing family practice residents' choice of initial practice location.

BACKGROUND AND OBJECTIVES: This study examined what factors influence US third-year family practice residents' choice of location of their first practice. METHODS: A survey was developed by the members of Northeastern Ohio Network to assess the influence of factors related to family, education, geography, finances, the medical community, and others on the selection of practice location. Surveys were sent to all program directors listed in the American Academy of Family Physicians 1994 Directory of Family Practice Residency Programs to be distributed to all third-year family practice residents. The program directors indicated the type of residency program, the number of surveys distributed, and the number returned, then forwarded completed surveys to the investigators. RESULTS: Two hundred fifty-nine of the 380 programs (68%) with PGY-3 residents responded. Of the programs that responded, 1,012 residents (64%) of a possible 1,578 completed surveys. Estimated from the directory, 812 residents from non-responding programs did not complete the survey for an overall response rate among residents of 42% (1,012/[1,578+812]). Family-related items seem to have the most influence on choice of practice location and are more important to married people. More than 50% of residents want to practice in the same size community in which they grew up. Money-related factors were not rated as highly as expected. CONCLUSIONS: Several factors appear to be important to family practice residents when selecting their first practice location. Hospitals interested in retaining their graduates can maximize their success by concentrating on these areas.

Adult↗

Project USAP the use of sedative agents in pediatric dentistry: 1991 update.

A national survey of members of the American Academy of Pediatric Dentistry was conducted to update information on the use of sedative agents by pediatric dentists. All 2532 members of the Academy were sent questionnaires regarding their use of sedation and 1497 responded. Practitioners were questioned regarding how frequently they used sedative agents and the nature of patients receiving sedation. In addition, they were questioned on reasons for change, if any, in their use of sedation during the past two years. A separate survey was conducted of directors of all 55 postdoctoral training programs in pediatric dentistry. Forty-six directors responded to questions concerning the type and frequency of sedation use in their programs. Both surveys demonstrated wide differences in sedation use between different training programs and between different practitioners. The heavier use of sedation by some practitioners or by some training programs, as compared with others, generally was not related to the percentage of handicapped patients who received sedation, nor to the type of training. Frequent users of sedation (more than once each day) were located more in the south/southeastern and western parts of the country and they tended to have been in specialty practice for more than 10 years.

Chi-Square Distribution↗

The uneven landscape of newborn intensive care services: variation in the neonatology workforce.

CONTEXT: In the past 30 years, the number of neonatologists has increased while total births have remained nearly constant. It is not known how equitably this expanded workforce is distributed. OBJECTIVE: To determine the geographic distribution of neonatologists in the United States. DATA SOURCES: 1996 American Medical Association physician masterfiles; 1999 survey of all U.S. neonatal intensive care units; 1995 American Hospital Association hospital survey; and 1995 U.S. vital records. MEASURES: The number of neonatologists and neonatal mid-level providers per live birth within 246 market-based regions. RESULTS: The neonatology workforce varied substantially across neonatal intensive care regions. The number of neonatologists per 10,000 live births ranged from 1.2 to 25.6 with an interquintile range of 3.5 to 8.5. The weakly positive correlation between neonatologists and neonatal mid-level providers per live birth is not consistent with substitution of neonatal mid-level providers for neonatologists (Spearman rank-correlation coefficient, 0.17; P < 0.01). There was no difference in the percentage of neonatal fellows in the lowest and highest workforce quintile (14% vs. 16%) or in the percentage of neonatologists engaged predominantly in research, teaching, or administration (14% in lowest and highest quintiles). CONCLUSIONS: The regional supply of neonatologists varies dramatically and cannot be explained by the substitution of neonatal mid-level providers or by the presence of academic medical centers. Further research is warranted to understand whether neonatal intensive care resources are located in accordance with risk and whether more resources improve newborn outcomes.

Age Distribution↗

Quality of care and the National Practitioner Data Bank: are the two related?

As the National Practitioner Data Bank (NPDB) approaches its tenth year of operation, it is time to review Data Bank operations in comparison to the goals set forth in the legislation that created it, the Health Care Quality Improvement Act of 1986. The goal of the enabling legislation was to improve the quality of health care rendered in this country. The NPDB was created as one step in the achievement of that goal by identifying problem practitioners who may move from one geographic location to another, thus leaving a poor performance record behind. The premise of this article is to review the contributions of the NPDB in terms of accurately identifying practitioners who pose a quality problem.

Clinical Competence↗

Orthodontic treatment provided by general dentists who have achieved master's level in the Academy of General Dentistry.

INTRODUCTION: The purposes of this study were to document orthodontic treatment currently provided by general dentists for comparison with past and future studies and to ascertain variables that influence practitioners' orthodontic treatment patterns. METHODS: A 21-item survey was mailed to 750 master's level members of the Academy of General Dentistry. Surveys returned within 8 weeks were included for statistical analysis. RESULTS: The response rate was 62%. Most practitioners spent less than 10% of their practice time providing orthodontic treatment and reported that this would not change in the future. Many provided orthodontic treatment in the permanent dentition, and the most common conditions or malocclusions treated were space maintenance, anterior crossbite, rotation, habits, molar uprighting, and posterior crossbite. The most common orthodontic appliances used were removable Hawley appliances with finger springs, straight wire orthodontic therapy, rapid palatal expanders, and functional appliances. CONCLUSIONS: The number of general dentists providing comprehensive orthodontic treatment has not changed since previous surveys; practitioners also do not expect a change in the next 5 years. Factors that influenced the orthodontic treatment provided included the primary source of orthodontic training, the number of orthodontic continuing education hours earned per year, the practitioner's location, and the proximity to the nearest orthodontist.

Adult↗

Geographic origin and its impact on practice location in Kentucky.

This study examined which medical students from the University of Kentucky College of Medicine are most likely to return to their geographic origins to practice medicine and the frequency with which this occurs. This study is based on statistical analysis of longitudinal data (1974-1985). The database includes 1243 matriculants for whom residency data were available. Follow-up data were available for 1093 physicians-in-practice. Results indicate that a significant percentage of matriculants return to their in-state district of origin to practice. Significant predictors of practice location included gender, undergraduate institution, and residence at admission. However, these factors explained only 8% of the variance in physician practice location. Expanding the model to include location of residency program and specialty choice contributed an additional 14% of the variance. Admissions officers seeking to improve the ratio of graduates practicing in rural areas should devise new measures to assess applicant's attraction to positive aspects of rural medical practice or small town life.

Adult↗

Factors that influence minority dental students' career plans.

Questionnaires were mailed to all 443 minority senior dental students and to a randomly selected control group of 200 nonminority seniors. Questions were asked about background income, debt, and future plans. Minorities reported lower family income, but similar debt levels. Minorities were more likely to locate in a minority community, less likely to enter solo practice. About one-third of each group stated that debt influenced practice plans. However, only the minority plans appeared to vary with debt: as debt increased, minorities were less likely to plan a solo private practice.

Adult↗

Medical specialists' choice of location: the role of geographical attachment in Norway.

The relation between current place of work (area of the country) and factors that might possibly represent doctors geographical attachments was studied in a sample of 322 Norwegian medical specialists. Location of hospital residency, age and geographical origin of spouse were associated with current location. Geographical attachment seems to influence doctors' locational choices from start of medical school until the end of their residency. The probability that a doctor shall locate in peripheral areas may increase from less than 10% to more than 50% if the doctor has the residency training in the periphery. Hence, favoring entrance to medical schools of students from the underserved areas, and location of graduate and postgraduate medical training in the underserved areas, as far as it is feasible while still maintaining medical standards, is suggested by the study.

Adult↗

Physician and practice characteristics associated with the early utilization of new prescription drugs.

BACKGROUND: Prescription of new drugs contributes to substantial increases in annual drug expenditures. A small proportion of physicians appear to be early users of new prescription drugs and little is known about their characteristics. OBJECTIVE: To estimate the initial utilization rate of new prescription drugs among physicians, and the physician and practice characteristics associated with early use. DESIGN: Cumulative prospective assessment over a 5 year period (1989-1994) of new drug utilization rates in a randomly selected cohort of Quebec physicians. PARTICIPANTS: 1661 physicians and 669,867 elderly patients. OUTCOME: Prescribing rate of 20 new drugs, in 6 therapeutic categories, to elderly patients in the first 6 months after inclusion in the Quebec formulary. RESULTS: The 20 new drugs were prescribed by 1.3-22.3% of physicians, and there was an 8 to 17-fold difference in new drug utilization rates among prescribers. Characteristics associated with higher rates of utilization differed for general practitioners and specialists. Male general practitioners, and physicians graduating from the most recently established medical school in the province, had higher rates of new drug utilization, whereas recent graduation was only associated with higher utilization rates among specialists. Practice volume was associated with higher rates of utilization among GPs. For both GPs and specialists, having a high proportion of elderly in one's practice and a rural or remote practice location was associated with lower utilization rates. CONCLUSIONS: Physician sex, specialty, medical school, years since graduation, practice location, volume, and relative proportion of elderly in the physician's practice influence the utilization of new drugs.

Age Factors↗

A comparison of measures of access to child health clinics and the implications for modelling the location of new clinics.

OBJECTIVE: To determine whether measurement of access to existing child health clinics, and modelled location of new clinics, was affected by the spatial definitions of the target population. METHOD: Populations requiring childhood screening services were defined as located at individual households, and at geographic and population-weighted centroids of small and large areas. Straight-line and network distances were measured and compared from these origins to varying numbers of existing clinics. The same origins were used to model sets of locations for new clinics, and access levels were again compared. RESULTS: Travel distances for 82,499 annual baby-visits to 140 existing clinics were between 136,000 km and 84,000 km, depending on origin definition. An analysis based on small area centroid data was as accurate as one based on household data. Planning solutions for new clinics located on the basis of few large areas, with populations centred at spatially defined centroids, resulted in poorer access for the population (231,000 km of travel) than one based on many small areas with populations centred at population weighted centroids (194,000 km of travel). IMPLICATIONS: Public access to health facilities will be improved if decisions about their locations are aided by the application of spatial analysis techniques based on small area definitions.

Ambulatory Care Facilities↗

Factors in the physician practice location puzzle: a survey of New York State residency-trained family physicians.

BACKGROUND: For the past 5 years fewer medical students have selected primary care specialties, and one-third of all physicians have indicated they will move in the next 5 years. These two factors make family physicians one of the most recruited specialties in medicine. METHODS: A questionnaire about practice profiles and factors that have an impact on a physician's location decision was mailed to all physicians who graduated from New York State family medicine residencies between 1970 and 1989. Data from completed responses were analyzed by year of graduation from residency, community size, and whether the responder remained in New York State or chose to locate outside New York State. RESULTS: There were 711 (46 percent) physicians who responded. The number of minorities remained stable at 14 percent during these years, but women graduates increased from 12 percent to 21 percent. The graduates in the 1980s, when compared with those in the 1970s, were more likely to be salaried, make less money, and to believe employment for the physician's spouse to be important in practice location. The 38 percent of responders from communities of fewer than 25,000 were less likely to be salaried, were more likely to practice in a group, worked more hours, offered a broader range of services including obstetrics, made less money, and placed less importance on availability of hospital consultants. Extended family, previous negotiated obligations, and geographic or climate issues were the reasons 64 percent of out-of-state responders gave for leaving New York. Spouse's opinion, hospital consultants, hospital services, colleague interaction, and after-hours coverage were most frequently rated as important factors for family physician practice location. CONCLUSIONS: Factors important in attracting new physicians to a community include the spouse's opinion, institutional and colleague support, and lifestyle issues.

Adult↗

Procedures in ambulatory care. Which family physicians do what in southwestern Ontario?

OBJECTIVE: To determine how often family physicians perform 12 ambulatory care procedures and factors associated with procedure performance. DESIGN: Mailed, self-administered survey. The survey was conducted according to the Dillman Total Design method. SETTING: Family physicians' offices in London, Ont, and in surrounding communities. PARTICIPANTS: A total of 395 family physicians practising within the London area were mailed surveys, 237 in London and 158 outside London. Response rates were 80.6% and 75.9%, respectively. Nonresponders did not differ significantly from responders in sex but included more solo practitioners. MAIN OUTCOME MEASURES: Performance of ambulatory care procedures, sex, and practice characteristics of participant family physicians. RESULTS: For all responders, activities significantly associated with procedure performance were delivering babies, managing psychological problems, working emergency, and teaching. Mean total procedure scores ranged from 6.55 for managing psychological problems to 7.68 for working emergency. Sex-specific analysis showed that practice location and years in practice were significant factors for female but not for male family physicians. Mean total procedure scores for female physicians were 7.06 (outside London) and 4.74 (in London). CONCLUSIONS: Factors associated with procedure performance for family physicians in and around London included delivering babies, working in emergency, managing psychological problems, and teaching. Practice location was a significant factor for only female family physicians; those practising outside London performed procedures more than their urban counterparts and at similar rates to male physicians.

Ambulatory Care↗

The determinants of utilization of nonphysician providers in rural community and migrant health centers.

The use of nonphysician providers, such as nurse practitioners, physician assistants, and certified nurse midwives, in rural areas is critically important due to the continued primary care access problems. This study examines the major factors influencing the use of nonphysician providers in rural community and migrant health centers based on a 1991 national survey of the centers. This study demonstrates that the employment of nonphysician providers in rural community and migrant health centers is significantly influenced by both supply and demand factors. Among supply factors, there is a significant and positive relationship between the number of total staff and the number of nonphysician providers employed. There is a significant but inverse relationship between the number of physicians and the number of nonphysician providers employed, indicating nonphysician providers primarily serve as substitutes for physicians in rural community and migrant health centers. The supply of nonphysician providers, as measured by the number of affiliated training programs, is significantly related to the employment of nonphysician providers. The demand variable, geographic location, and the centers' staffing policies are also significant determinants of the use of nonphysician providers.

Community Health Centers↗

Location decisions made easier.

"Should we have a facility at XYZ location?" Location plays an important role, though perhaps not a dominant one, in determining consumer patronage, and many healthcare providers are now facing major location decisions. Some of the subjectivity can be taken out of these decisions through the use of readily available demographic data from the US Census Bureau and the National Center for Health Statistics, along with a program designed for microcomputers.

Catchment Area, Health↗

The delivery of medical services in a retail shopping mall: a strategy for growth.

The successful medical practice of the future will continually search for growth strategies. This writer believes the location of a primary care medical clinic in a retail shopping mall, with a full menu of primary services, is one strategy for growth. It is an effective method of health care delivery to a community.

Group Practice↗