219: Factors In Recruiting and Retaining Emergency Physicians to Rural Emergency Departments

Abstract

Study ObjectivesPrevious studies have shown a shortage of rural emergency physicians, especially emergency medicine (EM) residency-trained, board-certified emergency physicians. There are sparse data on rural emergency physicians to support potential strategies to increase recruitment and retention to rural emergency departments (EDs). We examined the characteristics of rural emergency physicians to determine factors influencing emergency physician decisions to choose and stay in their rural versus urban practice location.MethodsWe randomly sampled clinically active emergency physicians, at least 5 years post-training, using the 2008 American Medical Association's Physician Masterfile: 200 in small rural areas, 200 in large rural areas, and 200 in urban areas. Rural and urban areas were defined using the USDA county-based Urban Influence Codes. We oversampled EM residency-trained, board-certified emergency physicians in small (n=100) and large (n=100) rural areas to ensure sufficient representation of these groups in the overall sample (total n=600+200). We collected basic characteristics of all emergency physicians and the influence of 17 factors of potential relevance to rural emergency physician recruitment and retention. Data were analyzed using descriptive statistics, with 95% confidence intervals (CI).ResultsTo date, 499 (62%) of 800 emergency physicians in 46 states responded. Of these, 171 were excluded for recently switching practice area type or not being clinically active in EM. Of 328 eligible emergency physicians (54% of 629), 136 (60% response) were from small rural areas, 128 (57% response) from large rural areas, and 64 (40% response) from urban areas. 31% of rural and 14% of urban emergency physicians spent their entire childhood in a rural area; and 44% of rural and 22% of urban emergency physicians spent over half of their childhood in a rural area. 40% of rural and 28% of urban emergency physicians participated in a rural rotation/experience in residency. Of emergency physicians who did not participate in such a rotation, 57% of rural and 53% of urban emergency physicians said they would have participated in one if available. Among all emergency physicians, factors most often rated as “very important” (primary factors) in choosing a practice area were lifestyle (72%), family/spouse (56%), and quality of hospital facilities/resources (45%). Factors most often rated as “very important” (primary factors) in staying in an area were lifestyle (70%), family/spouse (67%), and support of colleagues (51%). Primary factors in selecting and remaining in a practice area did not vary substantially between rural and urban emergency physicians. However, secondary factors did; access to specialists (17% rural, 42% urban; delta 25%, 95%CI 16-41%) and quality of hospital facilities/resources (41% rural, 58% urban; delta 17%, 95%CI 4-31%) differed most between groups. When we looked at possible changes in the importance of factors for choosing versus staying at their ED, emergency physicians reported the largest change for: colleagues (17 versus 51%; delta 34%; 95%CI: 27-40%) and salary (25 versus 39%; delta 14%; 95%CI 7-22%).ConclusionEmergency physicians appear to select rural or urban practice areas for similar primary reasons, and most are of these reasons are not amenable to change. By contrast, secondary reasons for emergency physician's selection are more amenable to change. The relatively high rate of urban emergency physicians who said that they would have participated in a rural rotation in residency, if available, suggests that increasing such rotations may help attract more emergency physicians to rural practice. Increasing access to specialists may attract more emergency physicians to rural EDs, while higher salary and colleagues' support may encourage them to stay. Study ObjectivesPrevious studies have shown a shortage of rural emergency physicians, especially emergency medicine (EM) residency-trained, board-certified emergency physicians. There are sparse data on rural emergency physicians to support potential strategies to increase recruitment and retention to rural emergency departments (EDs). We examined the characteristics of rural emergency physicians to determine factors influencing emergency physician decisions to choose and stay in their rural versus urban practice location. Previous studies have shown a shortage of rural emergency physicians, especially emergency medicine (EM) residency-trained, board-certified emergency physicians. There are sparse data on rural emergency physicians to support potential strategies to increase recruitment and retention to rural emergency departments (EDs). We examined the characteristics of rural emergency physicians to determine factors influencing emergency physician decisions to choose and stay in their rural versus urban practice location. MethodsWe randomly sampled clinically active emergency physicians, at least 5 years post-training, using the 2008 American Medical Association's Physician Masterfile: 200 in small rural areas, 200 in large rural areas, and 200 in urban areas. Rural and urban areas were defined using the USDA county-based Urban Influence Codes. We oversampled EM residency-trained, board-certified emergency physicians in small (n=100) and large (n=100) rural areas to ensure sufficient representation of these groups in the overall sample (total n=600+200). We collected basic characteristics of all emergency physicians and the influence of 17 factors of potential relevance to rural emergency physician recruitment and retention. Data were analyzed using descriptive statistics, with 95% confidence intervals (CI). We randomly sampled clinically active emergency physicians, at least 5 years post-training, using the 2008 American Medical Association's Physician Masterfile: 200 in small rural areas, 200 in large rural areas, and 200 in urban areas. Rural and urban areas were defined using the USDA county-based Urban Influence Codes. We oversampled EM residency-trained, board-certified emergency physicians in small (n=100) and large (n=100) rural areas to ensure sufficient representation of these groups in the overall sample (total n=600+200). We collected basic characteristics of all emergency physicians and the influence of 17 factors of potential relevance to rural emergency physician recruitment and retention. Data were analyzed using descriptive statistics, with 95% confidence intervals (CI). ResultsTo date, 499 (62%) of 800 emergency physicians in 46 states responded. Of these, 171 were excluded for recently switching practice area type or not being clinically active in EM. Of 328 eligible emergency physicians (54% of 629), 136 (60% response) were from small rural areas, 128 (57% response) from large rural areas, and 64 (40% response) from urban areas. 31% of rural and 14% of urban emergency physicians spent their entire childhood in a rural area; and 44% of rural and 22% of urban emergency physicians spent over half of their childhood in a rural area. 40% of rural and 28% of urban emergency physicians participated in a rural rotation/experience in residency. Of emergency physicians who did not participate in such a rotation, 57% of rural and 53% of urban emergency physicians said they would have participated in one if available. Among all emergency physicians, factors most often rated as “very important” (primary factors) in choosing a practice area were lifestyle (72%), family/spouse (56%), and quality of hospital facilities/resources (45%). Factors most often rated as “very important” (primary factors) in staying in an area were lifestyle (70%), family/spouse (67%), and support of colleagues (51%). Primary factors in selecting and remaining in a practice area did not vary substantially between rural and urban emergency physicians. However, secondary factors did; access to specialists (17% rural, 42% urban; delta 25%, 95%CI 16-41%) and quality of hospital facilities/resources (41% rural, 58% urban; delta 17%, 95%CI 4-31%) differed most between groups. When we looked at possible changes in the importance of factors for choosing versus staying at their ED, emergency physicians reported the largest change for: colleagues (17 versus 51%; delta 34%; 95%CI: 27-40%) and salary (25 versus 39%; delta 14%; 95%CI 7-22%). To date, 499 (62%) of 800 emergency physicians in 46 states responded. Of these, 171 were excluded for recently switching practice area type or not being clinically active in EM. Of 328 eligible emergency physicians (54% of 629), 136 (60% response) were from small rural areas, 128 (57% response) from large rural areas, and 64 (40% response) from urban areas. 31% of rural and 14% of urban emergency physicians spent their entire childhood in a rural area; and 44% of rural and 22% of urban emergency physicians spent over half of their childhood in a rural area. 40% of rural and 28% of urban emergency physicians participated in a rural rotation/experience in residency. Of emergency physicians who did not participate in such a rotation, 57% of rural and 53% of urban emergency physicians said they would have participated in one if available. Among all emergency physicians, factors most often rated as “very important” (primary factors) in choosing a practice area were lifestyle (72%), family/spouse (56%), and quality of hospital facilities/resources (45%). Factors most often rated as “very important” (primary factors) in staying in an area were lifestyle (70%), family/spouse (67%), and support of colleagues (51%). Primary factors in selecting and remaining in a practice area did not vary substantially between rural and urban emergency physicians. However, secondary factors did; access to specialists (17% rural, 42% urban; delta 25%, 95%CI 16-41%) and quality of hospital facilities/resources (41% rural, 58% urban; delta 17%, 95%CI 4-31%) differed most between groups. When we looked at possible changes in the importance of factors for choosing versus staying at their ED, emergency physicians reported the largest change for: colleagues (17 versus 51%; delta 34%; 95%CI: 27-40%) and salary (25 versus 39%; delta 14%; 95%CI 7-22%). ConclusionEmergency physicians appear to select rural or urban practice areas for similar primary reasons, and most are of these reasons are not amenable to change. By contrast, secondary reasons for emergency physician's selection are more amenable to change. The relatively high rate of urban emergency physicians who said that they would have participated in a rural rotation in residency, if available, suggests that increasing such rotations may help attract more emergency physicians to rural practice. Increasing access to specialists may attract more emergency physicians to rural EDs, while higher salary and colleagues' support may encourage them to stay. Emergency physicians appear to select rural or urban practice areas for similar primary reasons, and most are of these reasons are not amenable to change. By contrast, secondary reasons for emergency physician's selection are more amenable to change. The relatively high rate of urban emergency physicians who said that they would have participated in a rural rotation in residency, if available, suggests that increasing such rotations may help attract more emergency physicians to rural practice. Increasing access to specialists may attract more emergency physicians to rural EDs, while higher salary and colleagues' support may encourage them to stay.