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PubMed1993

What do applicants look for when selecting internal medicine residency programs? A comparison of rating scale and open-ended responses.

OBJECTIVE: To develop reliable scale measures of factors most important to applicants when they select internal medicine residencies and to assess their validity by comparing scores from these measures with responses to open-ended questions. DESIGN: All 353 applicants ranked by the University of North Carolina at Chapel Hill (UNC-CH) for the 1988 National Residency Match Program received a questionnaire after submitting their match lists. First, they listed the three most important factors considered in ranking residency programs and starred the single most important factor out of the three. Then, they rated 41 items on a five-point Likert scale ranging from 1 (not important) to 5 (extremely important). SETTING: Categorical internal medicine residency program at an academic medical center. MEASUREMENTS AND MAIN RESULTS: 315 (88%) applicants responded to the survey. Three reliable scales, Interpersonal Issues (7 items, alpha = 0.78), Reputation (5 items, alpha = 0.77), and Work Issues (11 items, alpha = 0.89), were developed using exploratory factor analysis of applicants' responses to the 41 items. Applicants felt interpersonal issues were very important (mean score = 4.2 +/- 0.5), academic reputation was important (3.3 +/- 0.8), and work issues were less important (2.8 +/- 0.7). The differences between these scores were significant (F = 3.76, p < 0.05). The ratings for the top five items not in these scales also indicated that education and location were very important. These results were corroborated by applicants' responses to the open-ended request to list the three most important factors in ranking residencies. CONCLUSION: These findings suggest that work issues are important, but greater emphasis is placed on interpersonal issues, education, location, and a program's reputation when applicants select residency programs. Furthermore, this study provides evidence supporting the reliability and validity of the three scales.

Adult↗
PubMed1994

General practitioner distribution and population dynamics: Munich, 1950-1990.

The problem of variable geographic distribution of physicians appears to be universal and intransigent. There is growing evidence from several developed countries of primary physicians avoiding areas in large cities increasingly populated by poor and ethnic minorities. This paper extends the research to Germany. Here, the changing population structure of Munich from 1950 through 1990, characterized by a large influx of foreign guestworkers, is illustrated. Selected changes in the medical care system and the role of the general practitioner pertinent to the question of supply and distribution are also discussed. Within this context, the geographic distribution of general practitioners' offices is examined for possible response to the concentration of foreigners in Districts within the City. In the aggregate, the distribution of general practitioners follows the geographic trends of the general population during the study period. However, geographic distribution of general practitioners varies widely on a District by District assessment. Though the exception, in several Districts there are indications that general practitioners may be avoiding locating offices in areas characterized by high density of foreign populations. This paper also draws attention to the importance of investigative scale to conclusions relating general practitioner distribution to spatial-temporal population trends.

Avoidance Learning↗
PubMed1990

Attitudes and behaviors of dental hygienists concerning tobacco use.

This study surveyed a proportionate random sample of licensed dental hygienists in five states and the District of Columbia, to assess their antitobacco use behaviors and attitudes. The response rate was 79.4 percent. Descriptive data as well as chi-square, analysis of variance (ANOVA), and Duncan's multiple range test statistical results were reported. Only 6.9 percent of the hygienists sampled currently smoked. These hygienists appeared to exhibit significantly different aggregate attitudes and select clinical practice behaviors than their nonsmoking counterparts. Years of employment and geographic location showed no significant relationship to aggregate clinical practice behaviors or attitudes, although each was related to individual behaviors and attitudes. Overall, dental hygienists appeared committed to involvement in both individualized and community-based antitobacco-use efforts. Measures to coordinate hygienists' involvement at both of these levels need to be enhanced.

Analysis of Variance↗
PubMed2003

A cohort study of family practice residency graduates in a predominantly rural state: initial practice site selection and trajectories of practice movement.

Limited information is available on long-term patterns of practice location choice among family physicians, although these patterns will significantly affect the quantity, quality, and continuity of health care provided in rural areas. From 1992 through 2000, five biennial surveys were administered to graduates of three family practice residency programs. Graduates were asked the location of their current and previous practice site locations, specific practice information, and global satisfaction with family practice. Identifiable practice sites were assigned a U.S. Department of Agriculture rural-urban continuum code based on the county in which the practice was located. The use of rural-urban continuum codes as a measure of rurality was believed to be particularly applicable to the small rural and frontier counties typical of the Great Plains region. For purposes of this study, practice locations were considered rural if they were in rural-urban continuum codes 7, 8, or 9. Of 593 graduates, 514 (87%) returned at least one questionnaire. Overall, about one-third of graduates had chosen their first practice sites in counties with rural-urban continuum codes of 7, 8, or 9. While most graduates remained in their initial practice site, almost half moved at least once. Those who left nonmetropolitan practices tended to move to less rural locations, though a few moved against this gradient. Moves away from the initial practice site occurred after a median of 3 years, and the likelihood of a first move decreased rapidly 5 to 6 years after graduation. Much remains to be learned about decisions to enter or leave practice in rural-urban continuum code 7, 8, and 9 counties.

Career Mobility↗
PubMed1986

The future role of foreign medical graduates in U.S. medical practice: projections into the 1990s.

Projections of the effect of actual and hypothesized declines in the proportion of foreign medical graduates (FMGs) in residency training on the future distribution of physicians are explored. We find potential proportionate declines in the eventual location of physicians in rural areas and small towns in the North Central regions, and in solo and partnership arrangements in the Northeast, North Central, and Southern regions. Reductions in FMG house officers now could also lead to an increased proportionate presence of physicians in subspecialty practices in the largest U.S. cities. These changes might happen despite the current perception that there is a "surplus" of physicians.

Career Choice↗
PubMed2000

How managed care growth affects where physicians locate their practices.

Managed care has had a profound effect on physician practice. It has altered patterns in the use of physician services, and consequently, the practice and employment options available to physicians. But managed care growth has not been uniform across the United States, and has spawned wide geographic disparities in earning opportunities for generalists and specialists. This Issue Brief summarizes new information on how managed care has affected physicians' labor market decisions and the impact of managed care on the number and distribution of physicians across the country.

Forecasting↗
PubMed2000

Impact of rural training on physician work force: the role of postresidency education.

Many innovative strategies have been developed over the years to improve the recruitment and retention of physicians in the shortage areas of rural America. These strategies have met with varying success. Postresidency education, or fellowship training, for family physicians is yet another strategy that has been developed for the same purpose. Most applicants have been interested in obstetrical and rural health fellowship programs as a means for preparing for rural practice. This paper describes these programs (demographics, funding, applicant pool, curriculum) and reviews their graduate outcomes (practice location after matriculation, clinical privileges). Twenty-nine obstetrical and nine rural health fellowships are currently operational in the United States. Fellows who complete a rural health fellowship have a higher tendency to locate in rural settings. Almost all graduates from obstetrical and rural health programs attain general hospital privileges in family practice, including low-risk obstetrics. A significant number of graduates from both types of programs attain privileges in high-risk and operative obstetrics as well. Fellowship training can play an integral role in the preparation of family physicians for rural practice.

Career Choice↗
PubMed1998

Which medical school applicants will become generalists or rural-based physicians?

The hypotheses that data, available at the time when a medical school admission decision is made, can be used to predict generalist specialty choice and rural practice location were tested. Applicant data, available to admissions committee members at the University of Louisville in 1986 and 1987 about the classes of 1990 and 1991 respectively, were correlated with specialty choice and practice location in a retrospective cohort study. Data collected from 1994 to 1996 about the 1990 and 1991 graduates were used to develop a mathematical model to predict specialty choice and practice location using stepwise logistic regression. These models were more accurate in predicting which applicants would not select a generalist career (negative predictive value = 80.7%) than those who would (positive predictive value = 42.7%) and in predicting those who would not practice in a rural location (negative predictive value = 91.9%) than those who would (positive predictive value = 37.8%). We conclude that applicant data, available at the time admission decisions are made, are of limited value for identifying those who will eventually become generalist physicians or practice in a rural area. However, the data are useful for identifying those who will not.

Career Choice↗
PubMed1989

Locational decisions of physicians in rural North Carolina.

Recent literature suggests that there is a rural-urban imbalance of doctors in the United States. In order to investigate this maldistribution, a survey was conducted of 504 physicians in eastern North Carolina. The objective was to determine the factors which most influenced doctors' decisions to locate their practice. A conceptual framework was used to highlight the influence of the community, medical schools and the physician's personal preferences. A discriminant analysis of rural and urban physicians revealed the doctor's personal characteristics to be most important, followed by community and medical school factors. In particular, physicians raised in smaller communities showed a greater preference for practicing in rural areas. Tactics for recruiting rural doctors and other policy recommendations are suggested.

Career Choice↗
PubMed2006

Disparity in location of urban mental service providers.

This article investigates geographic disparities in the location of mental health providers in relation to population demographics. Associations between provider-to-population ratios and demographics were examined with density calculations and map algebra. This disparity in geospatial availability of specialists may constitute an important barrier for persons seeking mental health care.

Catchment Area, Health↗
PubMed1996

Practice characteristics and performance of primary care practitioners.

OBJECTIVES: The authors examined organizational characteristics of 16 primary care group practices to determine their influence on quality or quality improvement. METHODS: The authors used a data base compiled during a randomized, controlled trial of quality assurance interventions consisting of measures of guideline-related performance for 630 practitioners. The authors distinguished performance under practitioners' control from performance determined partly by systems of care within each practice. The authors conducted analyses for all criteria (practitioner-controlled and system-dependent criteria) before and after quality assurance interventions using analysis of variance models with adjustments in performance scores for patient and practitioner characteristics. Specifically, the authors used as covariates the full-time versus part-time status of practitioners, whether practices were in hospitals or in health centers, and for practices within health centers, the effect of size of practice in terms of the average number of practitioners on staff during a time period. RESULTS: Full-time practitioners performed similarly before interventions but improved more after interventions overall and for practitioner-controlled criteria than did part-time practitioners. Health center practitioners performed better than did those in hospitals for system-dependent criteria before intervention. For system-dependent criteria, larger health centers performed better before interventions and improved more than did smaller health centers. CONCLUSIONS: Organizational characteristics including practice size and location (hospital-based or not) and full- or part-time status of practitioners should be considered in measuring quality and planning quality improvements, particularly in relation to care that is predominantly under system versus practitioner control.

Analysis of Variance↗
PubMed1999

Skin cancer screening by Australian family physicians: variation with physician beliefs and geographic locality.

INTRODUCTION: Australian national policies do not recommend skin cancer screening. We measured family physicians' beliefs, self-reported practices, and predictors of using clinical skin examination for skin cancer screening. METHOD: Random self-administered postal survey of 1271 Australian family physicians (FPs) performed during 1996, obtaining 855 completed questionnaires (67% response rate). RESULTS: Eighty-six percent of FPs surveyed indicated that they thought clinical skin examination was effective in reducing premature death from skin cancer; 72% indicated that they should be performed annually; and 60% indicated that all adults should be screened. Only 3% indicated correctly that screening has not been tested to determine its effectiveness. Although most FPs were unlikely to adopt an opportunistic approach to screening, 64% indicated that they would recommend clinical skin examination during a health check-up. FPs in northern (high incidence) latitudes were 3 to 4 times more likely to adopt opportunistic screening, and twice as likely to discuss clinical skin examination in a dedicated check-up. FPs were more likely to advocate screening in male rather than female patients. Half of respondents were unaware of relevant guidelines. CONCLUSION: Although Australian policies do not recommend clinical skin examination because of insufficient evidence as yet of effectiveness, FPs show considerable support for screening. Geographic location, patient gender, and physician beliefs predict the self-reported provision of clinical skin examination by family physicians, suggesting that factors other than published guidelines affect clinical practice.

Adult↗
PubMed1984

Rural rotations for senior surgical residents. Influence on future practice location.

No information is available on factors that influence a surgeon's decision of where to practice. We surveyed all recent graduates of a surgical training residency program from a single institution to determine factors that influence this decision. An attempt was made to determine if a rural rotation during training ultimately influenced surgeons to locate their practices in rural areas. Ninety percent of 58 graduates responded: 44% entered a rural practice and 56% an urban and/or academic practice. A rural rotation during residency had been completed by 64% of the respondents. A significantly larger number of those who entered rural practice had completed a rural rotation than those who entered urban practice. Hometown size, level of debt, and other factors thought to be influential for other subpopulations of physicians were not found to be significant in this review.

Decision Making↗
PubMed1986

Factors affecting decisions on practice locations.

Questionnaires designed to determine the major factors affecting the choice of practice were mailed to 305 graduates of the University of Oklahoma Tulsa Medical College and their spouses. Sixty-eight percent of the physicians responded. The results showed that graduates reared in large communities chose similar-sized communities as practice sites and placed high priority on their spouses' desires. The lack of career opportunities for spouses, especially those with high levels of education, was a critical factor in not selecting small communities as practice sites.

Career Choice↗
PubMed1987

More on the geographical distribution of physicians.

This paper presents more empirical evidence on the geographical distribution of physicians. Probit procedure and data for the Province of Quebec were used. The results are consistent with the standard location theory and therefore with those of Newhouse et al. (1982a). They also show that quality of leisure, distance to central city areas, average income and presence of a hospital are significant in explaining the probability that at least one physician (specialist or general practitioner) is present in a given town. Other variables were also considered.

Demography↗
PubMed2001

Rural career choice issues as reported by first year medical students and rural general practitioners.

Governments have recently instituted several programmes designed to attract medical students to rural practice. Questions may be raised as to whether interventions based around issues identified as important to practising rural general practitioners (GPs) are equally applicable to undergraduate medical students. The results of two studies on the importance of personal and practice issues as ascribed by Australian rural GPs and Victorian medical students are analysed. The effect of the students' gender, place of origin and intended location of practice is assessed. Findings suggest that practising GPs may have resolved many of the student issues and may be well placed to advise students on perceived hurdles to rural practice. Furthermore, students may be seeking a practice style similar to that sought by female GPs. The present paper concludes that while there are similarities between the groups, the differences identified support caution when basing student programmes on research performed on rural GPs.

Adult↗
PubMedDate not supplied

Real executives make career moves. Will you?

Not all physician executives have accepted the career move as a key part of executive life. They prefer to stay put and they often do just that. While clinicians may have the luxury of choosing a single geographic location and remaining there through retirement, physician executives often have to reorder their priorities to give the position greatest significance in career decision-making. Spouses and families need to be educated to the new reality of executive life--sometimes, to support an important career opportunity, a move is required. Physician executives unwilling to make career moves limit their career potential.

Career Mobility↗