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PubMed2006

Small-area estimates of general practice workforce shortage in rural and remote Western Australia.

OBJECTIVE: To trial a measure of rural and remote GP access for small areas. DESIGN: A cross-sectional study using geographical information systems software to calculate GP to population rates with a floating catchment of 100 km radius around census collection districts (CCDs). SETTING: Non-metropolitan Western Australia. PARTICIPANTS: The locations and full-time equivalents of GPs and other primary-care doctors were identified through a GP workforce survey. MAIN OUTCOME MEASURES: GP to population ratios for each CCD were classified as being above or below a benchmark of adequate GP access. CCDs with no GP sessions reported within 100 km were identified separately. These categories were investigated by divisions of general practice and by indigenous status, age and employment characteristics of the population. RESULTS: Small-area estimates detected greater variation in access than depicted by conventional methods. Sixty-four per cent of the non-metropolitan population live in CCDs with adequate GP access. Forty-five per cent of indigenous people and 52% of people working in rural industries live in CCDs with access below the benchmark. CONCLUSIONS: The floating catchment method is a powerful tool to identify small areas of inadequate service. It can be applied to measure access to other professionals, medical equipment or facilities.

Catchment Area, Health↗
PubMed1994

Controversies in the management of laryngeal cancer: results of an international survey of patterns of care.

Cancer of the larynx is the most prevalent non-cutaneous malignancy of the head neck region and its treatment presents a threat to both natural speech and survival. This study examines the manner in which two separate specialties in the same and different geographic regions vary in their opinions about the treatment of glottic laryngeal cancer. The goal was to define options available to patients and to classify controversies about optimal treatment which might be resolved in clinical trials. Questionnaires depicting different presentations of glottic larynx cancer were mailed to 1649 otolaryngologists and radiation oncologists in North America, Europe and Australasia. Half the doctors were asked to describe their preferred treatment for a patient while the others were asked to imagine that they themselves were the patient. In all the disease situations opinions varied significantly with respect to the treatment modality advised (whether to employ surgical or radiotherapy approaches) and in more extensive disease situations the intention of treatment also varied depending on whether a curative approach should involve conservation or loss of the larynx. Doctors also recommended similar treatment for their patients as they would for themselves. Apart from disease extent the most significant variables influencing recommendations were the physicians' specialty (P = 0.0001) and where they practice (P = 0.0001). These findings demonstrate diversity of opinion which is influenced more profoundly by the traditions of the specialties and geographic location of practice than by the reported results of treatments for laryngeal cancer. Convictions about optimal management have become barriers to the assessment of the relative value of different treatments and to ensuring that patients are fully informed about management options. The profession should regard as a high priority efforts to resolve these therapeutic conflicts which are associated with major differences in quality of life.

Attitude of Health Personnel↗
PubMed1996

Explaining variations in the frequency of night visits in general practice.

BACKGROUND AND OBJECTIVE: The study identifies factors which explain variations in the frequency of night visits made by general practitioners, and is based on a cross-section regression analysis of practices in Lincolnshire in 1993. METHOD: The independent variables comprise 22 general practice characteristics, related to health and socio-demographic structure of practice lists, practice management and organization, location and social deprivation. RESULTS AND CONCLUSIONS: A final model containing 6 of the 22 variables originally entered succeeds in explaining 72 per cent of the variation in the frequency of night visits per GP per quarter-year. These variables are average list size per GP, frequency of home visits, maternity claims, list inflation owing to the influx of temporary residents, the number of proximate practices and unemployment.

Adult↗
PubMed1995

The role of location in medical technologist job satisfaction.

The purpose of this study was to determine if a difference in job satisfaction existed between medical technologists working in an urban hospital and those working in a suburban hospital. The four areas of investigation were (1) satisfaction with pay, (2) professional status, (3) medical technologist-physician relationship, and (4) job task requirements. Sixty medical technologists, from two different hospital locations, were surveyed using a work satisfaction questionnaire. A response rate of 60 percent from the suburban and 58 percent from the urban hospital was achieved. Analysis using the Mann-Whitney U test indicated that urban laboratorians were more satisfied with all areas of interest than were their suburban counterparts. The surveyed medical technologists were most satisfied with professional status, medical technologist-physician relationship, pay, and job task requirements. All scores were, in general, low, suggesting a need to attend to improved job satisfaction among medical technologists.

Hospitals, Urban↗
PubMed1997

Refining a method of identifying CUNY Medical School graduates practicing in underserved areas.

PURPOSE: To determine what percentage of graduates from the City University of New York (CUNY) Medical School/Sophie Davis School of Biomedical Education practiced in underserved areas of New York State and, in the process, to develop a reliable way of collecting and verifying the information needed to carry out such an outcomes study. METHOD: The study group consisted of the 414 CUNY graduates who had completed their MD degrees by 1986. Addresses of graduates' practices were confirmed for 79% of the graduates, 49% of whom practiced in New York State. New York State zip codes were used as a way to identify underserved areas throughout the state. RESULTS: Of the 160 graduates with practices in New York State, 33% had practices in underserved areas (and 81% of these were located in New York City). In all, 26% of the whites, 73% of the African Americans, 43% of the Asian Americans, 50% of the Latinos, 34% of the women, and 32% of the men had practices in underserved areas. CONCLUSION: The graduates' race-ethnicity was an important factor in the likelihood of their practicing in an underserved area, whereas gender was not, a finding consistent with previous studies. Medical schools and residency programs need to institute long-term programs to track the career paths of all their graduates so that questions about the proportions of graduates in underserved areas will be relatively easy to answer.

Data Collection↗
PubMed1991

The role of local hospitals in physician rural location decisions.

This study has two objectives. First, it identifies how much the presence of community hospital beds adds to the stock of physicians practicing in nonmetropolitan counties. Second, it estimates the impact hospital closures or other reductions in beds have on the net flow of physicians into rural counties. The study relies primarily on data from the 1981 and 1986 Physician Masterfiles of the American Medical Association. We find that hospital bed reductions and closures essentially do not affect the availability of physicians--they have apparently already left by the time the downsizing occurs. Further, population change and the number of physicians already in the county determine for the most part the entry or exit of physicians.

Career Choice↗
PubMed1995

Evaluation of methods for calculating census health indicators for GP practices.

The patients registered with a general practice are usually spread over many census areas and overlap with the distribution of neighbouring practices, so a validated method of aggregating census data to describe the characteristics of practice patients is required. Four methods were used to provide estimates of the percentage of patients aged 75 years and over from census data for 81 practices in Suffolk, England, and these were compared with values derived from the FHSA patient register. Census values for practice areas produced better estimates than those based on the location of the surgery, but the best methods were based on patient-weighted averages of ward and enumeration district data. The finer geographical detail of enumeration districts did not produce substantially more accurate estimates than the ward-level data: both gave estimates with limits of agreement within 2% of the patient register values. Errors in the census, errors in patient registers and selective geographical distributions of practice patients prevent close matching of census and register measures, but two of the methods tested produced estimates that allow broad comparisons between practices.

Aged↗
PubMedDate not supplied

Differences in physician referral practices and attitudes regarding hereditary breast cancer by clinical practice location.

PURPOSE: To compare physician referral practices and attitudes regarding hereditary breast cancer by clinical practice location. METHODS: A self-administered survey of 214 physicians in Ohio's tri-state region. RESULTS: Rural-practice physicians were less likely to have ever referred for an indication of hereditary breast cancer than urban- and suburban-practice physicians combined. Rural-practice physicians reported stronger barriers to referral, including distance, lack of awareness, lack of effective cancer risk reduction, and lack of patient interest. CONCLUSION: These findings demonstrate a need for increased clinical genetics outreach, physician education, and public awareness of genetic services for hereditary breast cancer in rural areas.

Attitude of Health Personnel↗
PubMed2005

A database to record, track and report health student rural placements.

The Spencer Gulf Rural Health School (SGRHS), South Australia, is funded by the Australian Commonwealth Government to deliver health education in the rural setting. The SGRHS required a database to record, track and report on student rural placements to satisfy Commonwealth reporting requirements, and for internal academic and administration staff use. Staff in widely separate rural locations needed to be able to access the database. A web-based relational database was created using Microsoft Access. The student rural placement database has been successfully utilised as the primary tool to record and track student placements in the SGRHS for 2 years, and has generated data for eight Commonwealth reports in this time. Future database developments include student accessible sections. With few alterations the database could be utilised by other Australian Rural Clinical Schools and University Departments of Rural Health.

Clinical Clerkship↗
PubMed2000

How do general practitioners choose their practice? Preferences for practice and job characteristics.

OBJECTIVES: To investigate the strength of preferences for practice and job characteristics among recently appointed general practitioners (GPs) in south-east England. METHODS: Conjoint analysis based on a postal questionnaire survey of all 293 GPs who joined a new practice between April 1997 and March 1998 in London, Essex and Hertfordshire. GPs were presented with descriptions of practices in pairs, which varied systematically for key characteristics, and asked to indicate their preferred practice in each pair. RESULTS: The response rate was 58.7%. The most important influence on GPs' choice of practice was aversion to location in an area of high deprivation. They were more likely to choose a practice that: had an extended primary health care team; offered opportunities to develop outside interests; and offered them higher income, shorter working hours and smaller list sizes. The model generated estimates of the strength of these preferences. For example, GPs would require additional income of just over 5000 Pounds per annum to work in an area with a high proportion of deprived patients. CONCLUSIONS: Potential policy interventions to attract GPs to under-served areas include increasing their level of remuneration, providing opportunities to develop outside interests and ensuring that practices have a primary health care team.

Attitude of Health Personnel↗
PubMed1988

Marketing issues in continuing medical education.

Marketing is an important component of continuing medical education (CME). However, marketing is more than the identification of methods to recover costs of delivering programming. It focuses on meeting the needs and desires of physician participants, identifying an appropriate location, satisfying the goals of a sponsoring institution, and making an effect on the quality of care given by receivers and deliverers of CME. This paper discusses these issues as well as describes results of a survey designed to gather opinions on CME activities from alumni of training programs of a large, referral-based, multispecialty group practice. The data suggest that CME programs should be targeted to certain specialty groups as determined by field of training rather than practice specialty. Physicians' preferences for CME activities held at resort settings should be considered. Finally, participation in CME may itself be a marketing tool for a sponsoring institution to increase referrals.

Consumer Behavior↗
PubMed1988

A procedure for locating emergency-service facilities for all possible response distances.

The problem of locating emergency-service facilities involves the assignment of a set of demand points to a set of facilities. One way to formulate the problem is to minimize the number of required facilities, given that the maximum distance between the demand points and their nearest facility does not exceed some specified value. We present a procedure for determining the numbers of such facilities for all possible values of the maximum distance. Computational results are presented for a microcomputer implementation.

Decision Support Systems, Management↗
PubMed2006

Matching community need with physician training: the OSU Urban Family Medicine Program.

There continues to be a shortage of primary care physicians practicing within urban, Iower-socioeconomic and minority communities despite the fact that many of the 125 allopathic and 19 osteopathic medical schools are located within the affected urban cities. Recognizing a need to better train and recruit primary care physicians to serve in urban settings and provide care to those underserved. The Ohio State Department of Family Medicine established an Urban Family Medicine Residency Program headquartered in Near East Columbus, OH. Starting in 2003, the Urban Family Medicine Residency Program began training up to two residents each academic year. The mission, vision and (curriculum have attracted residency applicants and faculty who have displayed sincere interest and commitment to practicing in urban lower socioeconomic communities.

Competency-Based Education↗
PubMed1983

Continuing education and the geographically isolated therapist.

The relationship between therapists' geographic location and three program planning variables in continuing education was studied using the descriptive survey method. The findings suggested that learning needs were high in evaluation related competencies and that family responsibility and lack of appropriate programs were major barriers to participation. The overwhelming preference in delivery systems was the one or two day workshop. The study concluded that there were few significant differences between urban and rural therapists in relation to the variables studied indicating restraint rather than innovation in programming for the geographically isolated therapist.

Analysis of Variance↗
PubMedDate not supplied

Beyond retention: National Health Service Corps participation and subsequent practice locations of a cohort of rural family physicians.

BACKGROUND: This report addresses the long-term career paths and retrospective impressions of a cohort of family physicians who served in rural National Health Service Corps (NHSC) sites in return for having received medical school scholarships during the early 1980s. METHODS: We surveyed all physicians who graduated from medical school between 1980 and 1983, received NHSC scholarships, completed family medicine residencies, and served in rural areas. Two hundred fifty-eight physicians responded to our survey with complete information, 76 percent of the members of the cohort who could be located and met the study criteria. RESULTS: In 1994 one quarter of the respondents were still practicing in the county to which they had been assigned by the NHSC, an average of 6.1 years after the end of their obligation. Another 27 percent were still in rural practice. Of the entire group, less than 40 percent were in traditional urban private or managed care settings. CONCLUSIONS: Although only one quarter of NHSC assignees remain long term in their original assignment counties, they provide a large (and growing) amount of nonobligated service to those areas. Of those who leave, many remain in rural practice or work in community-oriented urban practices.

Cohort Studies↗
PubMedDate not supplied

Effects of educational focus on a graduate nurse's initial choice of practice area.

Nursing students have been educated to acquire the skills necessary to practice in different settings. This study examined whether the focus of education (rural or urban) had an effect on the area that the graduate nurse chose to practice in after graduation. To prepare the nursing student for her or his role in rural nursing, one program focused its curriculum on rural health needs. Another nursing program located in an urban area had a traditional educational nursing program with only once community nursing course. A curriculum review was completed to examine whether the curriculum focus of the study programs were consistent with the stated foci. A retrospective study design was used to answer the research questions. Survey instruments were mailed to 379 urban and rural nursing school graduates. The analysis of study results showed that students who attended a nursing program focusing on rural nursing were twice as likely to practice in rural areas than nurses who completed an urban-focused nursing program. Another factor that had an impact on the graduate nurses' choice of practice area was the students' original places of residence.

Adult↗
PubMed1995

CFO compensation influenced by organizational size, ownership.

Results of a 1995 compensation survey of healthcare organization chief financial officers (CFOs) indicate that the larger the organization for which the CFO works (as measured by operating revenues), the larger the CFO's compensation package. The survey findings show that CFOs who work for organizations with annual operating revenues of more than $199 million earn an average of $189,300 annually, while CFOs at organizations with operating revenues less than $50 million earn $76,400. Other factors influencing CFOs compensation, according to survey results, include education level, gender, and job responsibilities; geographic location of the employing organization; organizational type (multi-unit system, stand-alone hospital, etc.); and organizational ownership (physician-owned, not-for-profit, etc.) The survey was co-sponsored by the Healthcare Financial Management Association (HFMA) and Aetna Life Insurance and Annuity Company and conducted by Management Compensation Services, a division of Hewitt Associates LLC. It is the first HFMA survey to be devoted entirely to compensation. In previous years, compensation data were obtained as part of CFO profile survey findings.

Data Collection↗
PubMed1997

Graduates speak: the employment experience of 1995 graduates of diagnostic radiology and radiation oncology training programs.

PURPOSE: To determine the initial employment experience of 1995 graduates of radiology programs. MATERIALS AND METHODS: A questionnaire was mailed to all graduates of radiation oncology programs and to a stratified, random sample of 600 graduates of diagnostic radiology programs. The final response rate was 66%. RESULTS: After graduation, 4%-10% of graduates worked for a period as locum tenens, worked in a job unrelated to radiology, or were unemployed. Immediate postgraduation unemployment was 2%-5%; 7-12 months later, it was less than 0.5%. Median actual salary was approximately equal to median expected salary. Radiation oncology fellowship graduates often had poorer outcomes. Almost half of the graduates with posttraining employment had a job with at least one characteristic regarded as unfavorable by some commentators (most commonly, undesirable location or no opportunity to become a partner), and at least one-fifth had and disliked such a characteristic. Geographic constraints, including the need to find employment for a spouse or companion, did not adversely affect employment outcome. CONCLUSION: Eventual unemployment was low, and starting salaries have not collapsed. Generally, the implications of job characteristics are best assessed by monitoring trends, but the prevalence of non-partnership track employment may well have increased.

Attitude of Health Personnel↗