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PubMed1989

Practice locations of Texas family practice residency graduates, 1979-1987.

The location of a physician's residency training is known to be a factor in selection of a practice location. In this paper, the authors analyze the practice locations of 689 family physicians who graduated from residency programs in Texas between 1979 and 1987 and who were practicing in Texas in 1988. One-third of these graduates were practicing in cities the same size as their residency program city. More than half were in counties located within 60 miles of the residency city. Both of these trends can be explained to a large degree by the fact that a high percentage of graduates remained in their residency city to practice. When these nonmobile graduates are removed from the sample, the findings show no correlation between the size of the residency city and the size of the practice city. More than two-thirds of those graduates who left their residency city were in counties beyond a 60-mile radius. Almost two-thirds were practicing in communities of less than 25,000 population. The authors conclude that state support for family practice residency training has been effective in distributing family physicians in a manner that addresses the needs of the state of Texas as a whole.

Family Practice↗
PubMed1995

Variability in GPs' referral rates in Spain.

The purpose of this study is to explore the causes that may influence the variations on referral rates in a sample of 242 general practitioners (GPs) in Spain. We applied Poisson multivariant regression modeling to analyze the role played by different variables related to doctors, patients and practices. The mean referral rate was 6.92 +/- 0.22 with a variant coefficient of 50.6%. The results of the Poisson model showed a statistically significant variation on the following variables: 1) doctor gender; 2) proportion of consultations to the practice made by male patients; 3) proportion of consultations made by patients over 65 years of age; 4) list size, 5) number of doctors in the PCT; 6) number of practice consultations to each doctor per week; 7) accredited practice for VT; 8) location of practice; 9) proportion of outpatient referrals; 10) proportion of private referrals; 11) proportion of emergency referrals; 12) proportion of referrals in which the patient's attitude did not influence the doctor for the referral; 13) proportion of new referrals. The statistical significance for the final model was very high (P < 0.00001). The study draws attention to the influence of some structural characteristics of health care system on the referral rates that could be modified to reduce the number of referrals from Primary to Secondary Care.

Accreditation↗
PubMed1996

Comparison of female and male graduates of southern Appalachian family practice residencies.

PURPOSE: One aim of Southern Appalachian family practice residencies is to produce graduates for surrounding physician-needy areas. Some evidence suggests that women are less likely to go to rural areas and that they practice differently than men. This study investigated the practice patterns and location of Appalachian family practice residency female and male graduates. METHODS: Surveys were sent to graduates of seven family practice residencies from 1984 to 1994 in the Southern Appalachian area to determine practice patterns, locations, and reasons for choosing practices. RESULTS: Women were more likely than men to be single and not to have children. More women worked part-time. Women's and men's practice patterns and characteristics were similar except that women were more likely to provide prenatal care and do vaginal deliveries. Women in similar percentages practiced in small towns, and a greater percentage of women practiced in rural areas with populations of less than 2,500. CONCLUSIONS: Female family practice residency graduates from Appalachian residencies are fulfilling the purposes of their residencies as well as male graduates, although more of them are working part-time.

Appalachian Region↗
PubMed1999

The long-term effect of an innovative family physician curricular pathway on the specialty and location of graduates of the University of Washington.

PURPOSE: To report the specialty and rural/urban distribution a mean of 19 years after graduation for a cohort of students from a family physician curricular pathway. METHOD: Specialty and location information for medical students who had entered the University of Washington between 1968 and 1973 was obtained from the 1994 Physician Masterfile of the American Medical Association. RESULTS: Of the 239 family physician pathway graduates, 173 (72%) had intended family practice at graduation, and 136 (57%) were family physicians two decades later. The proportions of all graduates in family practice and of graduates serving rural Washington as family physicians had increased over that of a cohort of students who had entered the University of Washington prior to the introduction of the pathway curriculum. These proportions surpassed the goals set at the time the new curriculum was introduced. CONCLUSION: With early identification and support of students interested in family practice, an increased number entered the specialty and were still family physicians in mid-career.

Career Choice↗
PubMed1999

Competitive behavior in local physician markets.

Competition often is viewed as a mechanism for controlling cost. Competition may work well in urban areas with many providers; competition may not exist in rural areas with few providers. The authors use the empirical framework developed by Bresnahan and Reiss to analyze the entry behavior of physicians into local markets to determine the level of physician supply consistent with competitive behavior. The study estimates entry patterns for total and specialty physicians located in nonmetropolitan health service areas using longitudinal data. The authors find a surprising drop in the population increments necessary for entry by the second provider, possibly due to the unattractiveness of being the solo physician in an area. Subsequent population increments stabilize at three to five physicians. Since more than 93 percent of the U.S. population lives in areas that can support three to five physicians, competition between physicians through mechanisms such as managed care may be feasible.

Catchment Area, Health↗
PubMed1994

The impact of marketing on hospital performance.

This study examines the effect of traditional and innovative marketing factors on the overall financial, operations and market performance of 71 not-for-profit hospitals in a metropolitan area. Traditional marketing factors of location, services offered and pricing did influence the financial performance of system-affiliated and non-system hospitals. They also influenced the operating performance of urban hospitals and the market performance of non-teaching institutions. In contrast, the innovative marketing factors of physician relations, community relations and specialized sales forces had no significant influence on performance differences among the hospitals in the entire sample and sub-samples based on geography, teaching involvement and system affiliation.

Community-Institutional Relations↗
PubMed1999

Dimensions of retention: a national study of the locational histories of physician assistants.

This study describes the locational histories of a representative national sample of physician assistants and considers the implications of observed locational behavior for recruitment and retention of physician assistants in rural practice. Through a survey, physician assistants listed all the places they had practiced since completing their physician assistant training, making it possible to classify the career histories of physician assistants as "all rural," "all urban," "urban to rural" or "rural to urban." The study examined the retention of physician assistants in rural practice at several levels: in the first practice, in rural practice overall and in states. Physician assistants who started their careers in rural locations were more likely to leave them during the first four years of practice than urban physician assistants, and female rural physician assistants were slightly more likely to leave than men. Those starting in rural practice had high attrition to urban areas (41 percent); however, a significant proportion of the physician assistants who started in urban practice settings left for rural settings (10 percent). This kept the total proportion of physician assistants in rural practice at a steady 20 percent. While 21 percent of the earliest graduates of physician assistant training programs have had exclusively rural careers, only 9 percent of physician assistants with four to seven years of experience have worked exclusively in rural settings. At the state level, generalist physician assistants were significantly more likely to leave states with practice environments unfavorable to physician assistant practice in terms of prescriptive authority, reimbursement and insurance.

Adult↗
PubMedDate not supplied

Overview of research on women in medicine--issues for public policymakers.

The recent expansion of the nation's supply of physicians has brought with it dramatic increases in the number of women entering medical school and practice. This paper provides an overview of the literature on women in medicine and synthesizes major findings on the differences between male and female physicians in terms of specialty choice, productivity, income, geographic location of practice, practice settings and types of patients, leadership within the profession, and other characteristics. Between 1981 and the year 2000, the total supply of physicians in practice is expected to increase by 27 percent; the number of women in practice is expected to increase by 153 percent. By the year 2000, one physician in five will be a woman. The fairly limited research on gender-related differences indicate that women tend to cluster in a few specialties (pediatrics, psychiatry, pathology, preventive medicine, physical medicine and rehabilitation, and anesthesiology), many of which are specialties expected to have fewer physicians than needed nationally by 1990. Women have also been shown to have lower productivity and lower income than male physicians, to choose urban locations more frequently, to prefer salaried and institutional settings more often, to serve different types of patients, and to belong to medical organizations less frequently. From the standpoint of public policy, the differences between the characteristics of male and female physicians have mixed implications. For example, the choice of specialty and lower productivity of women could lessen the negative impact of future physician surpluses. On the other hand, a preference for urban practice could exacerbate geographic maldistribution problems. More research will be required to define and predict the long-term effect of significant increases in the number of female physicians in the United States.

Career Choice↗
PubMed2000

Texas physician immunization practices.

INTRODUCTION: Immunization levels among young children could be improved if physicians administered immunizations at both well and urgent visits, provided simultaneous vaccinations, and knew the guidelines on valid contraindications, part of the Standards for Pediatric Immunization Practices (Standards). We report on a survey measuring the immunization knowledge and practice of Texas pediatricians, family practitioners, and general practitioners. METHODS: A survey was mailed to a random sample of physicians. Questionnaire items covered 8 of the 18 Standards. RESULTS: The response rate was 62% (608 of 976 eligible physicians). The mean summary adherence-to-Standards score was 4.1 for pediatricians, 3.6 for family practitioners, and 3.0 for general practitioners. Specialty and practice location were significant predictors of the summary score, whereas gender, managed-care participation, and graduation year were not. DISCUSSION: Our study results suggest that in Texas, pediatricians and rural physicians most often adhere to the Standards. Improving the reimbursement level of administrative costs for immunization delivery, educating physicians on the Standards, and encouraging the use of patient immunization tracking systems are actions that could potentially improve immunization rates.

Adult↗
PubMed1991

The geographic relationships between physicians' residency sites and the locations of their first practices.

The uneven geographic distribution of physicians has been identified as a significant problem for the delivery of health care services. The present study examined one of the factors that contribute to the distribution of physicians; how far they move from their residency sites to establish their first practices. In 1989, the authors selected a random sample of 701 U.S. residency programs in the ten specialties with the most practitioners, and measured the distance each of these physicians moved to his or her first practice location. Of the 701 programs, 58.5% provided usable information about 2,612 physicians. Of these physicians, over 40% had moved less than 10 miles from their residencies, and over 50% had moved less than 75 miles. Comparisons among the physicians from the various specialties showed that the primary care physicians moved significantly shorter distances than did those from the other specialties. In the last two decades, many efforts have been made to increase the geographic distribution of physicians. The evidence from this study suggests that so far as the distances that physicians move from their practice sites are concerned, little has changed. Recent graduates of residency programs show no more tendency to move far from their residency sites than did their counterparts 30 years ago, as reported in the literature.

Internship and Residency↗
PubMed1994

National survey on hospital-based privileges in family practice obstetrics.

PURPOSES: To document the content and level of obstetrical hospital-based privileges for members of the American Academy of Family Physicians and to describe variations between regions, rural vs urban practices, and various physician characteristics. METHODS: About 12% of the active members of the American Academy of Family Physicians listed as offering obstetrical care by the Academy as of March 1991 were randomly sampled by mailed questionnaire. Samples were drawn from three national regions. Privileges were grouped by degree of restriction, based on whether consultation or transfer was required. RESULTS: Of 1464 surveys mailed, 1026 physicians (70%) responded. Only 740 (72%) stated that they still practiced obstetrics. Privileges ranged from least restricted (100% provided vaginal vertex delivery, with no consultation required) to most restricted (79% provided amniocentesis, with consultation or transfer required). A surprisingly large proportion of physicians reported having fewer routine and more advanced privileges without consultations being required, such as ultrasonography (53%), vaginal breech delivery (41%), and cesarean section (25%). Physicians having more advanced privileges tended to be located in the West or mountain-plains region; be trained in the Midwest, mountain-plains region, or the West; work in middle-sized, nonteaching hospitals in more rural countries; have completed advanced obstetrical training (> or = 6 months); and deliver more than 40 infants per year. CONCLUSIONS: Overall, a considerable number of hospital-based obstetrical privileges are granted to family physicians. No uniformity in privileges prevails, owing to significant regional and practice variations. Teaching hospitals reportedly restrict obstetrical care by family physicians more than other hospitals. The variations in restrictions could not be explained by degree of training.

Adult↗
PubMed2001

Physicians certified in family medicine. What are they doing 8 to 10 years later?

OBJECTIVE: To determine field of medicine and location of a cohort of physicians certified in family medicine between 1989 and 1991 and residing in Ontario in 1993 and to gather information on the scope of practice of family physicians in the cohort in 1999. DESIGN: Responses to a mailed questionnaire sent in 1999 were compared with responses to a 1993 survey of this group. SETTING AND PARTICIPANTS: All family physicians in Ontario in 1993 who received certification in 1989, 1990, or 1991 after completing a family medicine residency. Seven of 557 respondents to the 1993 survey were ineligible; 293 physicians (53%) responded to the 1999 survey. MAIN OUTCOME MEASURES: Field, location, and scope of practice. RESULTS: About 91% of the cohort were still practising family medicine, although 11% of these had restricted their practices to certain areas within family medicine. Physicians migrated from Ontario (6%) in nearly equal numbers to other provinces and other countries, predominantly the United States. More family physicians offered counseling, shared antenatal care, and newborn care in 1999 than in 1993. Those with restricted family practices provided fewer types of services and were less likely to provide antenatal or intrapartum care or to provide in-hospital services. CONCLUSION: Receiving certification in family medicine does not guarantee that physicians will remain in family practice 8 to 10 years later. Loss from general family medicine to restricted practices within family medicine and specialization was greater than loss from migration.

Family Practice↗
PubMed1999

Physicians in service to the underserved: an analysis of the practice locations of alumni of Western University of Health Sciences College of Osteopathic Medicine of the Pacific, 1982-1995.

PURPOSE: To determine how many osteopathic medical graduates (DOs) of the Western University of Health Sciences were practicing in underserved communities. METHOD: Practice address information was available for 765 of the 850 practicing DO alumni who had graduated from the University from 1982 through 1995. Alumni were categorized as practicing in underserved areas or not, following federally established guidelines; they were also categorized by gender, ethnicity, and medical specialty. RESULTS: Overall, 20.9% of these 765 alumni were practicing in underserved communities. The percentages of alumni practicing in underserved communities by gender, ethnicity, and specialty were: men, 20.9%; women, 21.0%; Caucasians, 20.5%; Asian Americans, 18.0%; African Americans, 25.0%; Hispanic Americans, 32.1%; Native Americans, 33.3%; primary care physicians, 20.9%; and non-primary care physicians, 20.9%. CONCLUSIONS: Approximately one in five practicing DO alumni of Western University was practicing in an underserved area. Examining these data by sex, ethnicity, and practice specialization suggested only weak associations between subgroup membership and practice in an underserved area.

California↗
PubMed2004

The effects of payment method on clinical decision-making: physician responses to clinical scenarios.

BACKGROUND: The influence of payment mechanisms on physician decisions is not well understood. OBJECTIVES: The objective of this study was to test 2 null hypotheses: 1) physicians' clinical decisions would not be influenced by payment incentives; and 2) physicians would have equal concern about medical decisions made under capitation or fee-for-service (FFS) arrangements. RESEARCH DESIGN: We conducted a physician survey in which patient insurance status (capitated or FFS) was randomly incorporated into 4 clinical scenarios using a Latin square design. SUBJECTS: We used a nationally representative random sample of family physicians in direct patient care. MEASURES: We used treatment decisions and physician "bother" scores (a measure of discomfort about decisions) in response to the clinical scenarios and adjusted for physician gender, age, board certification, income, practice location, practice mix, practice setting, geographic region, local area managed care penetration, and capitation or risk pool contracts in practice. RESULTS: Seventy-two percent of sampled physicians responded. Comparing decisions made under capitation to FFS, physicians were less likely to indicate they would perform discretionary care (relative risks [RR] range, .64-.82; P<0.001), but payment had no effect on selection of life-saving care (RR, 1.02, not significant). Physicians felt significantly more "bothered" when they made clinical decisions under capitated payment (P<0.001 in all scenarios), regardless of whether a treatment was discretionary or life-saving, and whether the decision was made for or against the treatment (P<0.001). CONCLUSIONS: Payment mechanism has significant effects on clinical decision-making. Reduction of resources spent for discretionary care might be achieved under capitated arrangements; however, physicians respond with greater levels of discomfort under capitation than FFS.

Attitude of Health Personnel↗
PubMed2000

The subspecialty training, practice type, and geographical distribution of recently trained ophthalmologists: a study of male and female physicians.

OBJECTIVE: To characterize the distribution of male and female ophthalmologists with regard to practice type, subspecialty training, rural-urban distribution, and regional distribution. METHODS: Ophthalmology Matching Program files containing the records of residents who began their second year at accredited programs between 1986 and 1990 (inclusive), were compared to membership files of the American Academy of Ophthalmology. Practice locations for each individual were classified according to region, stage, and Rural-Urban Continuum County Code, as defined by the US Department of Agriculture. RESULTS: This cohort comprised 2,494 individuals, 77.1% (1922) of whom were male and 22.9% (572) of whom were female. Group practice was most common (55.9% for women and 61.3% for men). More women were in salaried positions associated with health maintenance organizations (p = 0.006) and academic settings (p < 0.001) than were men. Notable differences in subspecialty choice were restricted to pediatric ophthalmology, chosen three times more frequently by women, and vitreoretinal diseases/surgery, chosen twice as often by men. Only 5.6% of women selected nonmetropolitan practice locales compared to approximately twice that percentage of men. The Middle Atlantic and New England regions attracted more women, while the South Atlantic attracted more men.

Cohort Studies↗
PubMed2001

Surveying graduates of one school to determine regional workforce demand.

PURPOSE: To study the demand for physician graduates from one school in one region of the country. The use of demand as a measure of potential regional variation should be of interest to medical educators and policymakers. METHOD: All residency graduates of the University of Washington School of Medicine between 1975 and 1995 (n = 3,824) were surveyed about their ability to gain employment in a timely manner and whether they were recruiting physicians for their practices. RESULTS: The response rate was 50.29%. A non-responder survey was done using a subsample (n = 200), with a 28% return. Over 95% of the graduates had found employment in their desired specialties and locations within two years of finishing their residencies. This was the same for graduates over all years. Approximately 30% of all practices of respondents within the Northwest region were recruiting for new physicians (26% of specialty practices and 34% of generalist practices were recruiting). There was no difference between recruitment in the urban and rural practices or between respondents to the initial survey and those responding to the follow up. CONCLUSIONS: Despite a significant oversupply of specialist physicians and at least a sufficient supply of generalist physicians nationally, there appears to be a strong demand for both specialists and generalists in the Northwest region of the country. This raises questions concerning the use of national averages to inform the education policies in specific regions of the country. More validated measures of demand are needed for future studies.

Data Collection↗
PubMed1987

Competition in health care markets and the development of alternative forms of service delivery.

This paper examines whether alternative forms of health care delivery locate in highly competitive health service markets. The analysis uses cross-sectional Florida data on the penetration of HMOs, ambulatory surgery centers, urgent care centers, hospices and home health programs in local markets characterized by varying levels of competitiveness among hospitals and among physicians. The results show generally that the development of these newer forms of service delivery are not systematically linked to inter-hospital competition but are influenced by physician supply and insurance demand. The potential contribution of such development to cost-containment efforts is thus questioned.

Ambulatory Care Facilities↗
PubMed1984

Osteopathic physician location and specialty choice.

Physician distribution continues as a major national issue despite the projected oversupply of physicians by 1990. Kirksville College of Osteopathic Medicine (KCOM) in Kirksville, Missouri, has a high percentage of its graduates going into rural primary care. In this study of physicians who graduated from KCOM from 1930 to 1974, the authors sought to identify the factors influencing physicians to select rural primary care. The size of the physician's hometown, KCOM curricular experiences, and faculty role models were the most important factors influencing a physician to select rural primary care. While these findings are similar to other studies, this is the first to examine osteopathic medicine.

Career Choice↗