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PubMed1990

Medical education and the rural health crisis: a personal perspective from experiences in five states.

While there is good evidence that decisions regarding practice site are influenced by experience in medical school and residency, medical education constitutes only one of a complex set of factors that have made it difficult to recruit physicians to rural America. A solution to the rural health crisis will require not only changes in student selection, curriculum, and training location, but also strengthening of the rural economy, improved reimbursement to rural hospitals and primary care physicians, and increased sensitivity by leaders of the medical profession to the needs of rural areas and rural practitioners.

Attitude of Health Personnel↗
PubMed1991

The influence of medical school clinical experiences on career preferences: a multidimensional perspective.

This study examines the multiple influences of medical school clinical experiences on student career preferences. The analysis of responses to pre-clerkship and post-clerkship questionnaires administered to the 1983 graduating class of a well-established medical school in the Great Lakes region of the United States indicates significant changes in career plans: away from primary care practice towards the surgical specialties; away from office-based practice towards clinical practice in a university medical center; and away from practice in small towns and communities towards locations in larger cities. These changes in the last 2 years of medical school appear to stem from an increased exposure to research and sophisticated medical technology. If allowed to continue, this trend in medical education will contribute further to the clinical specialty and geographic maldistribution problems of medicine in the United States.

Career Choice↗
PubMed1990

Effect of training on the scope of oral and maxillofacial surgery.

The relationships between training and qualifications and the scope of oral and maxillofacial surgical practice was investigated by a survey of all full members of the Australian and New Zealand Association of Oral and Maxillofacial surgeons. It was found that scope did correlate to length of training. Three were differences in scope for more recently trained surgeons and by practice location. The possession of medical qualification did not necessarily affect scope of practice but did affect attitudes.

Attitude of Health Personnel↗
PubMed2002

Tracking NP prescribing trends.

This article presents the results of three surveys on NP prescribing practices from 1996 to 2001. The data elucidate differences in prescribing practices by practice location, specialty, type of drug, and years of practice. We highlight prescribing trends and identify areas for future research.

Adult↗
PubMed2000

1997 Graduates Speak: initial employment experiences of residency and fellowship graduates.

OBJECTIVE: The American College of Radiology sought to detail the initial employment experience of 1997 diagnostic radiology graduates and recent trends. MATERIALS AND METHODS: In early 1998, questionnaires were mailed to all graduates; 65% responded. Results were compared with similar surveys of 1995 and 1996 graduates. RESULTS: Much as in past years, immediately after graduation 4% of residency graduates and 9% of fellowship graduates spent some time working as a locum tenens, working outside radiology, or unemployed, but by 6-12 months after graduation, 2% or fewer were not employed. The median fellowship graduate's salary was 5% greater than in 1996. Twelve percent of fellowship graduates were in non-ownership-track jobs, much the same as in earlier years. Thirty-two percent had one or more of 12 possibly undesirable job characteristics, down from 39% in 1996; 14% not only had, but actually disliked, one or more of these characteristics, much the same as in 1996, but down from 23% in 1995. Multivariate analysis showed that women graduates were more likely than men to have had serious employment difficulties in the immediate postgraduation months; and that graduates having a spouse who also had to find a job in the same area were more likely than others to be in a putatively "seriously undesirable" location or in "holding pattern" employment while looking for something better or more permanent. CONCLUSION: Unemployment remained very low. Some other indicators of the employment market showed improvement. Factors expected to affect employment outcomes-for example, training program quality or having major non-spouse-related restrictions on job location-had surprisingly little effect.

Education, Medical, Graduate↗
PubMed2006

U.S. board-certified pain physician practices: uniformity and census data of their locations.

UNLABELLED: We determined the profiles of the board-certified pain physician workforce and the profiles of those residing near medical pain practices. Data from a mail survey of U.S. pain specialists were compared with U.S. Census data, and different settings and types of practices were contrasted. The 750 respondents (32.1%) were similar to the entire board-certified group in age, geographic distribution, and primary specialty. Although pain practices were underrepresented in rural areas, their prevalence was unrelated to other demographic data. Ninety-six percent of pain physicians treated chronic pain; 84% followed patients longitudinally; 31% worked in an academic environment; 50% had an interdisciplinary practice; and 29% focused on a single modality. Academics were more likely to be neurologists (P < .05) and to have had a pain fellowship (P < or = .0001). Modality-oriented practitioners were more likely to be anesthesiologists (P < or = .0001) and were less likely to follow patients with chronic pain longitudinally (P < or = .0001), provide training to fellows, prescribe controlled substances (P < or = .0001, respectively), or require an opioid contract (P < or = .01). Although boarded specialists learn from similar curricula and must pass a certifying examination, their practices vary considerably. Data are needed to further clarify the nature of workforce variation, its impact on patient care, and the role of other pain management clinicians. PERSPECTIVE: A survey of board-certified pain specialists reveals considerable variation in practice and a total number of specialists that is probably insufficient to meet the needs of the population with chronic pain. The location of pain management practices largely corresponds to census data, with the exception of underrepresentation in rural areas.

Adult↗
PubMed1995

Predictive validity of medical student choices of practice location.

We compared University of Alabama medical students' 1980-1981 practice location and specialty preferences with actual practice locations and specialties in 1991 with the following results. (1) Primary care physicians were located mostly in small or large communities, whereas larger than expected numbers of subspecialists practiced in smaller cities. (2) Actual proportions in primary care and surgical subspecialties were less than in earlier preferences; more than expected chose nonsurgical subspecialties. (3) Large city practice locations showed an increase in 1991 at the expense of earlier preferences for medium-sized cities. We suggest that the shift of primary care physicians to larger cities reflects concerns about the financial viability of small town practice, coupled with greater earnings in affluent suburbs. Excess numbers of subspecialists in smaller locations may be due to a perceived oversupply of subspecialists in larger cities.

Adult↗
PubMed2004

A case for more year-long internships outside metropolitan areas?

OBJECTIVE: To determine whether medical graduates who spent their intern year at a non-metropolitan hospital were more likely to practise outside metropolitan areas on completion of training than were interns in metropolitan hospitals. DESIGN: Retrospective follow-up of doctors who held year-long internships at a non-metropolitan hospital and interns from metropolitan hospitals. SETTING: Ballarat Base Hospital (BBH) (Rural, Remote and Metropolitan Area [RRMA] rural zone) and hospitals in Melbourne and Geelong (RRMA metropolitan zone). PARTICIPANTS: 57/63 (90%) Victorian medical graduates completing internships at BBH between 1989 and 1997 and 126/126 (100%) sex-matched metropolitan interns, chosen at random. MAIN OUTCOME MEASURES: Practice location in 2002. RESULTS: More BBH interns were practising as GPs outside metropolitan areas (44%) than metropolitan interns (13%) (difference, 31%; 95% CI, 17%-45%). The proportion of interns in specialist practice outside metropolitan areas was small for both groups - zero and 3%, respectively (difference, - 3%; 95% CI, - 6% to 0). None of the specialist training posts held by interns were outside metropolitan areas. Of BBH interns entering general practice, 41% (95% CI, 24%-58%) did so in the local health region. CONCLUSIONS: Regional interns are a good source of non-metropolitan GPs, especially locally. Prospective studies to determine the precise influence of regional internships on eventual practice location, and whether more such posts would lead to more graduates entering non-metropolitan practice, would be worthwhile.

Family Practice↗
PubMed1983

Physician shortage areas and policies to influence practice location.

Our intention is to examine the common assumption that physician supply is related strongly to more direct measures of economic shortage. The concept of a medical shortage defined by untreated illness or excess rates of preventable illness is not considered here. We examine the more policy-specific issue of whether the present shortage areas include the most extreme areas, based on these indicators of market tightness. If supply is a poor predictor of shortage, then more direct measures or other more carefully targeted policies should be explored.

Health Policy↗
PubMed2001

Location of family medicine graduates' practices. What factors influence Albertans' choices?

OBJECTIVE: To examine factors that influence family medicine graduates' choice of practice location. DESIGN: Cross-sectional, retrospective survey employing a self-administered, mailed questionnaire. SETTING: Family medicine residency programs at the University of Alberta (U of A) and the University of Calgary (U of C) in Alberta. PARTICIPANTS: Graduates (n = 702) who completed the family medicine residency program at U of A or U of C between 1985 and 1995. MAIN OUTCOME MEASURES: Current practice location; 23 factors influencing current practice location; physicians' sex; community lived in until 18 years of age. RESULTS: Response rate was 63% (442 graduates completed the questionnaire). Overall, the most influential factors in attracting graduates to their current practice locations were spousal influence, type of practice, and proximity to extended family. Type of practice, income, community effort to recruit, medical need in the area, and loan repayments had a substantial influence on family physicians' decisions to practise in rural areas. Male physicians ranked type of practice, whereas female physicians ranked spousal influence, as having the most influence on choice of practice location. Significantly more female than male physicians identified working hours, familiarity with the medical community or resources, and availability of support facilities and personnel as having a moderate or major influence on their decisions. CONCLUSION: Differences between rural and metropolitan residents and between sexes affect family medicine graduates' choices of practice location. These differences should be taken into account in recruitment strategies.

Adult↗
PubMed2005

Relationship between practice location of Ontario family physicians and their rural background or amount of rural medical education experience.

INTRODUCTION: The present study was designed to determine if there was a difference in rural background and rural medical education experience between practising rural physicians and practising urban physicians in Ontario. METHOD: A cross-sectional survey was mailed to 507 strictly defined rural family physicians and 505 urban family physicians practising in Ontario. The main outcome measures were population of the community while growing up, rural medical education and medical school attended. RESULTS: Responses of 264 rural physicians were compared with 179 urban physician responses. The groups were comparable in years of practice. Rural physicians were significantly more likely to have grown up in a rural community (34.9% v. 14.6%), to have had clinical training in a rural setting during medical school (55.4% v. 35.2%) and to have had clinical training in a rural setting of 8 weeks or more during postgraduate residency training (38.8% v. 20.2%). During residency training, longer duration of rural placements (more than 6 months) was significantly associated with practice in a rural area (15.5% of rural physicians, 1.7% of urban physicians). After controlling for other predictors, each of the following were independent variables: growing up in a community of less than 10 000 people (odds ratio [OR] 3.31), having had some undergraduate rural clinical training (OR 2.46), having had postgraduate rural training of 8 weeks or more (OR 2.17), attending a Canadian medical school outside Ontario (OR 3.80) and being male (OR 2.57). CONCLUSION: Practising rural physicians compared with urban physicians were significantly more likely to have come from a rural background, to have had an undergraduate rural medical education, to have had postgraduate rural training, to have graduated from a Canadian medical school outside Ontario, and to be male. Each of these had an independent effect on practice location.

Adult↗
PubMed2006

Spousal perspectives on factors influencing recruitment and retention of rural family physicians.

INTRODUCTION: Recruiting and retaining medical personnel to rural communities is a human resource challenge. Studies suggest that the spouse's experiences and perceptions of a rural community are among the most influential factors in a physician's decision to remain in or leave a rural practice. This study describes the factors that both directly and indirectly influence spousal contentment and explores how these factors contribute toward recruitment and retention of physicians to rural practice locations. METHODS: In this explorative study, 13 interviews were conducted with spouses of rural physicians to gain a better understanding of spousal concerns and experience regarding rural living. Participants in the present study included the spouses of general practitioners and family physicians practising and living in rural communities (population<or=10,000) on the Burin and Bonavista peninsulas of Newfoundland and Labrador. Specialists, residents and locums were excluded from the study. RESULTS: The findings indicate that physician workload and community integration most highly influence spousal contentment. Other factors, including licensure, remuneration and physician demand, indirectly influence spousal contentment and, ultimately, practice location decisions. Many of the factors that directly influence spousal contentment are personal, and, as a result, it is difficult to implement policies that will influence them. CONCLUSION: The physician's spouse is highly influential in the decision to move to, remain in, or leave a rural practice location. Understanding the factors that contribute to, and detract from, spouses' contentment in rural practice offers useful insights for human resource policies.

Adult↗
PubMed1993

Assessing the validity of the geographic practice cost indexes.

Data on physician practice inputs were used to test the degree to which the geographic practice cost indexes (GPCIs) of the Medicare physician payment schedule reflect geographic variation in input prices. For purposes of this study, input quantity information was collected through the American Medical Association's Socioeconomic Monitoring System survey in 1990 and 1991. These data, along with practice expense information, were used to construct unit input prices. The GPCIs were correlated with input prices; however, "real" or GPCI-adjusted prices varied significantly across locations. We conclude that the GPCIs are useful, but imperfect measures of geographic differences in physician practice input prices.

American Medical Association↗
PubMed1984

A realistic approach to locating dental practices.

A realistic approach to locating a dental practice involves the consideration of factors affecting the demand for dental services in an area. This dictates examination of the demographic and economic determinants of demand. Many retail businesses have used this approach to making locational decisions, and dentistry should benefit from this same process. If the thesis is accepted that dentistry is a business as well as a profession, it follows that the dentist-business person must be permitted, indeed expected, to make a reasonable return in revenue on the investment of dollars in education, equipment, and other related expenses. This return on investment occurs only when there is adequate patient flow. An objective procedure to assess demand for dental services at a particular location has been described. With this method, students were expected to: Visit the community and, through interviews with other professionals and knowledgeable business persons, determine the extent of the probable dental service area. The service area is circumscribed on a census map. Use the census subdivision numbers on the map to secure data from the state data center that describes the area's population, in regard to age, race, gender, income, and education. Transfer the data to a spreadsheet designed to generate total visits, according to each of the demand determinants. Calculate the number of FTE practitioners needed to meet this potential demand, and compare this with the number of FTE dentists presently practicing in the community. Fourteen senior dental students, who have since graduated, have completed this procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1997

Distribution of physicians in Ontario. Where are there too few or too many family physicians and general practitioners?

OBJECTIVE: To assess the regional distribution of family physicians and general practitioners in Ontario after adjusting for practice intensity and the population's patterns of health care use. DESIGN: Analysis of administrative data. SETTING: Ontario. MAIN OUTCOME MEASURES: Intensity of patient use of GP services, GP practice density, and physician density for each Ontario county (measured as the ratio of practice-intensity equivalent GPs to use-intensity equivalent inhabitants). RESULTS: Despite adjustment for practice intensity and use patterns, wide variations exist in GP densities. chi 2 tests identified counties that consistently reported GP densities significantly different (P < 0.001) from the provincial average. Four of the five counties with health science teaching centres had densities significantly higher than the provincial average, while 10 other counties had significantly lower densities. CONCLUSIONS: Results of this study provide useful information for physician resource planning and might inform debate concerning proposals to restrict physician billing numbers and practice locations to rectify perceived maldistribution of physicians.

Adult↗
PubMed1987

Estimating the impact of state manpower policy: a case study of reducing medical school enrollments.

Perceptions of an impending oversupply of physicians have prompted proposals to reduce medical school enrollments in a number of states. Most of these states are also concerned with improving the specialty and geographic distribution of their medical manpower. The present study provides estimates of the effects of reduced numbers of in-state medical school graduates upon the future supply of physicians in Texas, and examines the medical school origin, medical specialty, and practice location of selected groups of Texas physicians. The results suggest that in Texas enrollment reductions would have no significant impact on physician supply over the next 15 years, and might actually prove counterproductive in altering physician distribution. The analysis of Texas data illuminates the unintended consequences likely to accompany a policy option that has been widely embraced by state officials largely on the basis of its intuitive appeal.

Forecasting↗