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PubMed2001

Relative value guide basic units in operating room scheduling to ensure compliance with anesthesia group policies for surgical procedures performed at each anesthetizing location.

Many anesthesia groups provide services in a spectrum of anesthetizing locations, including offices, free-standing ambulatory surgery centers, diagnostic clinics, and traditional hospital operating rooms. The use of a uniformly understood measure of case complexity could assist an anesthesia group in ensuring appropriate anesthesia provider expertise and equipment availability at each anesthetizing location. In this article, we show how the American Society of Anesthesiologists' Relative Value Guide (ASA RVG) basic units can be used as a criterion to establish the maximum level of complexity of cases performed at each location by an anesthesia group. By reviewing ASA RVG basic units at several anesthetizing locations in lowa, we found that ASA RVG basic units differ among sites. The ASA RVG basic units can be used to identify cases that are seemingly unexpected for an anesthetizing location. There are several reasonable values that an anesthesia group can use for its maximum number of basic units at an anesthetizing location.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Will rural family medicine residency training survive?

BACKGROUND AND OBJECTIVES: Rural family medicine residencies may be more threatened by declining interest in family medicine than their urban counterparts. This study examines the recent performance of rural residencies in the National Resident Matching Program as an indicator of their viability. METHODS: We surveyed all 30 family medicine residencies located in rural areas during the summer of 2004 and a geographically matched sample of 31 urban residencies. We gathered information about the matching process for 2002, 2003, and 2004. The response rate was 70.5%. RESULTS: Rural programs offer about one third fewer first-year (postgraduate year 1 [PGY-1]) positions than their urban counterparts. Rural programs had lower Match rates (60.1%) than urban programs (72.5%) in 2004 but no meaningful differences in the proportion of international medical graduates (IMGs) or osteopathic physicians (DOs) who ultimately accepted positions. The 44.2% of residencies that predicted they would be thriving 2 years in the future filled an average of 81.3% of their slots on Match Day; there were no rural/urban differences. Programs with less-optimistic appraisals of their future had much lower Match rates. Two factors were associated with lower Match rates when other variables were taken into account: the proportion of IMGs in the 2 previous entering years and a stated rural mission. CONCLUSIONS: Rural programs appear to be slightly less stable than their urban counterparts, but the differences are minor. The viability of rural family medicine residency programs is probably affected more by the overall attractiveness of family medicine as a discipline rather than the rural or urban location of the residency.

Family Practice↗
PubMed2005

A conceptual model for recruitment and retention: allied health workforce enhancement in Western Victoria, Australia.

Attracting and retaining allied health professionals in rural areas is a recognised problem in both Australia and overseas. Predicted increases in health needs will require strategic actions to enhance the rural workforce and its ability to deliver the required services. A range of factors in different domains has been associated with recruitment and retention in the allied health workforce. For example, factors can be related to the nature of the work, the personal needs, or the way an organisation is led. Some factors cannot be changed (eg geographical location of extended family) whereas others can be influenced (eg education, support, management styles). Recruitment and retention of allied health professionals is a challenging problem that deserves attention in all domains and preparedness to actively change established work practices, both individually as well as collectively, in order to cater for current and predicted health needs. Changes to enhance workforce outcomes can be implemented and evaluated using a cyclic model. The Allied Health Workforce Enhancement Project of the Greater Green Triangle University Department of Rural Health (GGT UDRH) is working towards increasing the number of allied health professionals in the south west of Victoria. Based on themes identified in the literature, an interactive model is being developed that addresses recruitment and retention factors in three domains: (1) personal or individual; (2) organisation; and (3) community.

Adult↗
PubMed2000

Survey of Australian and New Zealand Oral and Maxillofacial Surgery trainees and recent specialists--workforce issues.

This study examined Oral and Maxillofacial Surgeon (OMS) workforce issues in relation to current training in Australia and New Zealand. Earlier findings identified that there was a requirement of approximately 6 additional OMS specialists per year in Australia and one per year in New Zealand to maintain an adequate level of supply in the profession. It was found in this study that through to the early part of the next decade the number of OMS entering the Australian workforce is appropriate (5.9 per annum), but there would appear to be concerns about the sufficiency of the number entering the New Zealand workforce (0.7 per annum). In addition, the study also found possible maldistribution in the location of intended future practices, with possible shortages outside of the metropolitan areas.

Australia↗
PubMed2000

The wineglass model: tracking the locational histories of health professionals.

This paper introduces a space-time continuum model to evaluate the effectiveness of programs that encourage recruitment and retention of health professionals. Based on the shape of a wineglass, the model provides a framework to study the locational histories of a cohort of health professionals, both conceptually and quantitatively. A key component of the model is that it measures geographic dispersion over time from a medical school, residency program, or other shared location. Geographic dispersion can be studied in the model through standard deviational ellipses, standard distance, or average distance circles. The model enables analysis through structuration theory, which is used as a guide for analyzing the interplay between human agency (e.g., individual decisions on practice location) and structure (e.g., medical education). Space-time modeling is linked with structuration theory. Variations in the shape of the wineglass reveal how people may be bound by a general structure, yet through lifetime locational decisions may change that structure over space and time. Using data on University of Nebraska alumni, the authors constructed a pilot demonstration to test and confirm the model's potential usefulness. In the pilot demonstration, standard deviational ellipses represented the range of physician locations during each year, overlaid on maps of the US. The pilot demonstration indicated the model's strength in identifying changing mobility over time, while also pointing to concerns about unevenness in data availability from one year to the next. Further application of the wineglass model could be used toward studying the life histories of health professionals. The impact of community-based training on long- or short-term retention, changes in the mobility of male vs female providers, and the career trajectories of people in different health professions or medical schools are only a few examples of potential future applications of the model.

Cohort Studies↗
PubMed2006

Private or public? An empirical analysis of the importance of work values for work sector choice among Norwegian medical specialists.

In the aftermath of the Norwegian hospital reform of 2002, the private supply of specialized healthcare has increased substantially. This article analyses the likelihood of medical specialists working in the private sector. Sector choice is operationalized in two ways: first, as the likelihood of medical specialists working in the private sector at all (at least 1% of the total work hours), and second, as the likelihood of working full-time (90-100%) privately. The theoretical framework is embedded in work values theory and the results suggest that work values are important predictors of sector choice. All analyses are based on a postal questionnaire survey of medical specialists working in private contract practices and for-profit hospitals and a control group of specialists selected from the Norwegian Medical Association's member register. The analyses revealed that while autonomy values impact positively on the propensity for allocating any time at all to the private sector, professional values have a negative effect. Given that the medical specialist already works in the private sector, a high valuation of professional values and payment and benefit values increases the likelihood of having a dual sector job rather than a full-time private position. However, due to the cross-sectional structure of the data and limitations in the dataset, causality questions cannot be fully settled on the basis of the analyses. The relationship between work values and sector choice should, therefore, be regarded as associations rather than causality links. Finally, the likelihood of working in the private sector varies significantly at the municipality level, suggesting that medical specialist's location is important for sector choice.

Adult↗
PubMed1993

An update on physician practice cost shares.

The 1988 physicians' practice costs and income survey (PPCIS) collected detailed costs, revenues, and incomes data for a sample of 3,086 physicians. These data are utilized to update the Health Care Financing Administration (HCFA) cost shares used in calculating the medicare economic index (MEI) and the geographic practice cost index (GPCI). Cost shares were calculated for the national sample, for 16 specialty groupings, for urban and rural areas, and for 9 census divisions. Although statistical tests reveal that cost shares differ across specialties and geographic areas, sensitivity analysis shows that these differences are small enough to have trivial effects in computing the MEI and GPCI. These results may inform policymakers on one aspect of the larger issue of whether physician payments should vary by geographic location or specialty.

Analysis of Variance↗
PubMed2004

Educational strategies to enhance placement and retention of nurse practitioners in rural Arkansas.

PURPOSE: To examine the factors and incentives enhancing nurse practitioners' (NPs') long-term employment in rural areas. DATA SOURCE: The participants were 121 master's prepared or higher educated NPs located in rural Arkansas. A survey about role preparation and employment factors was mailed to the participants. CONCLUSIONS: We found that 10% of all respondents were not currently employed in the role of an NP. The majority of rural-employed NPs had didactic content focusing on rural-practice opportunities and engaged in rural practicums while in graduate school. Rural NPs were much more likely to have graduated from research-intensive universities. Nearly 90% of NPs reported they were somewhat to very well prepared for practice in rural Arkansas. IMPLICATIONS FOR EDUCATION: The shortage of health care providers remains one of the most irresolvable problems in the U.S. health care delivery system. Compounding the shortage is the unequal distribution of health care practitioners in rural areas. Evidence indicates that NP students engaged in rural clinical practicums were more likely to practice in rural areas. In light of this information, nurse educators should expand the NP educational process beyond rurally located practicums to deliver the entire educational process to the NP students' rural homes.

Adult↗
PubMed1989

A preliminary investigation of the relationship between certain practice characteristics and practice location: chiropractor-population ratio.

Two surveys of 121 preselected Victorian and South Australian chiropractors were conducted during the period of December 1986 to February 1987 in order to investigate whether practice location (metropolitan area and country town) and chiropractor/population ratio (number of chiropractors per 10,000 inhabitants) have any effect on patient numbers, practice procedures and practitioner attitudes. Practitioners' response rates to the first and second questionnaires were 82% and 61%, respectively. Analysis of data revealed that metropolitan chiropractors utilized more adjunctive therapies than their country town colleagues. Most chiropractors felt that the number of chiropractors in their area was sufficient. However, there appeared to be no difference in patient numbers (patient visits and new patients) and ratio of new patients to patient visits as related to practitioner density or practice location. Patient volume appeared to be practitioner-induced; fewer new patients corresponded to a higher number of revisiting patients, and maintenance care corresponded to a higher number of patient visits.

Adult↗
PubMed1984

The effect of decentralized education versus increased supply on practice location. Experience with physician assistants and nurse practitioners in California, 1972-1982.

To improve the geographic distribution of physician assistants and nurse practitioners in California, the Primary Care Associate Program established five community-based training sites in outlying areas while continuing to operate its core program within the San Francisco Bay Area. To evaluate this effort, the authors prospectively compared the employment locations of graduates from both groups, achieving a follow-up rate of 95%. Graduates from community sites were twice as likely to locate first practices outside the Bay Area (91% vs. 43%, P less than 0.05) and in towns with less than 10,000 inhabitants (33% vs. 16%, P less than 0.05). Over the decade, the percentage of graduates practicing outside the Bay Area rose from 0 to 9% for trainees both recruited from and entirely trained within the Bay Area versus 76-84 percent for trainees experiencing any element of decentralization. The slopes of these two lines represent the effect of the increasing supply of graduates on practice location away from Stanford (9%); the distance between the lines, the greater effect of decentralization (73%). Given the goal of statewide deployment of a small number of graduates, decentralization appears to have been an effective approach.

Adult↗
PubMed2002

Solving inequities in provider distribution: loan repayment.

The distribution of primary health care professionals in England and Wales is inequitable, with relatively lower concentrations of professionals in deprived areas. The objective of the present study was to determine whether graduate health professionals would be willing to work in under-served areas in return for educational loan repayment. The study group consisted of a convenience sample of 50 newly qualified and trainee general practitioners, and 50 newly qualified community nurses and health visitors in mid- and west Wales. At interview, the subjects were presented with descriptions of general practices and asked to indicate their preferred practice. Practice descriptions varied systematically in terms of location (i.e. urban, suburban and rural), population deprivation (i.e. deprived or mixed affluent/deprived) and availability of loan repayment (i.e. none or loans paid off over a period of between one and 4 years). The main outcome was the probability that a practice with loan repayment was chosen. Compared with a suburban practice, a one-year loan repayment option made the rural and urban deprived practices 1.6 times and 1.2 times more likely to be chosen, respectively. Nurses were generally more willing than doctors to work in a deprived area in return for loan repayment. The findings suggest that loan repayment may offset health professionals' aversion to working in deprived areas. Such a scheme needs to be piloted to see whether it does offer value for money in recruiting health professionals to under-served areas.

Adult↗
PubMed1993

Factors which discriminate rural and urban family physicians practicing in South Carolina.

A sample of 28 rural and urban private practicing family physicians was compared on a number of attitudes and practice characteristics based on results from a mailed questionnaire. Results cross-validated previous findings and provided new ones. A number of self-report discriminators are discussed to better predict which physicians will locate in rural areas.

Adult↗
PubMed1994

The spatial distribution and geographic analysis of endodontic office locations at the national scale.

The major purpose of this article was to quantify and describe the spatial distribution of endodontic office locations at the national scale. This study consisted of 2858 US American Association of Endodontists member endodontists as subjects. Three research questions were developed and explored. The location quotient technique, the spatial autocorrelation approach, and the multiple-regression procedure were the major analytical methods. Major results were as follows: the highest concentration (2.09 to 2.62) of endodontic offices per 100,000 US population was located in just two states, Massachusetts and Connecticut; the spatial distribution of endodontic office locations did exhibit significant (p < or = 0.05, two-tailed test) spatial autocorrelation. Therefore, the spatial distribution of endodontic office locations was nonrandom. Individually, the most significant predictor of endodontic office locations was the location of general practice dentists (its beta coefficient was 0.960606, significant at p < or = 0.0001).

Adult↗
PubMed1997

Dental practice location: some aspects of the importance of selection of place.

In the past, dentists' decisions regarding location have been characterized as "irrational." With increasing competition, more thought and planning must accompany the dental practice location and development decision. The history of the community and site selection process by dentists is reviewed, and a call for is made for the application of atmospherics to dental site development.

Catchment Area, Health↗
PubMed2005

Factors influencing decisions about the state in which doctors plan to practise: additional results from the 2002 Australian Medical Workforce Advisory Committee national survey.

As a result of growing doctor shortages, postgraduate doctor recruitment and retention within Australian states and territories has become an issue of concern. Australia's policy of national self-sufficiency in health workforce supply implies that state medical schools will, at a minimum, enroll a sufficient number of locally born students to meet future medical workforce requirements. This article focuses on factors influencing the state or territory in which doctors plan to practise medicine, identified through a national survey. Independent variables of interest were birth place, medical school and vocational training location because of their importance to medical workforce policy. The study found that the career location plans of Australian-born and overseas-born doctors in vocational training were similar and that 5% of doctors planned to work overseas. Of Australian-born doctors who planned to work in Australia, 88% graduated from a medical school in the state in which they were born, while 78% and 65%, respectively, were undertaking vocational training in, and proposed to work in, the state in which they were born. The study concludes that trainee-doctor decisions about the state or territory in which they will practise medicine when they are fully qualified are more complex than location of birth.

Adult↗
PubMed2003

Patients' attitudes regarding physical characteristics of family practice physicians.

BACKGROUND: This study examined patient perceptions and attitudes toward various aspects of the male and female physician's professional appearance in the family practice setting. METHODS: Four hundred ninety-six patients from two family practice clinics in Knoxville, Tennessee, completed a valid and reliable questionnaire. Questionnaires were offered to all patients on registering at their respective clinic during a 2-week period. RESULTS: Most patients had no preference regarding the age or sex of their medical care provider. A nametag, white coat, and visible stethoscope were the most desirable characteristics, whereas sandals, clogs, and tennis shoes were the least desirable items. Younger patients were generally more accepting of casual attire than were older patients. Office clinic location was the most important predictor of preferences in six of the significant characteristics. CONCLUSION: Our findings support the results of both studies published two decades earlier and more recently. Patients prefer a traditionally dressed physician as opposed to one who is dressed more casually.

Adult↗