Factors associated with placement of rural primary care physicians in North Carolina.

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The objective of this study was to determine what factors influence primary care physicians to choose rural practice locations to better develop the rural workforce in North Carolina. To better recruit and retain physicians, residents, and medical students for rural practice, we must understand what factors positively influence their choice of practice location. A survey was sent to all primary care physicians licensed in the state of North Carolina (N = 2829), with 975 usable (return rate 34.5%). Results were analyzed using basic descriptive statistics and χ(2) automatic interaction detection analysis. Findings indicated that solo practice, critical access hospital, community health center, or federally qualified health center sites were strongly associated with rural practice. Pay as a factor in choosing a work site, financial support from a hospital, and medical school loan repayment also was correlated with rural practice. Seventy-two percent of rural physicians reported being raised in a town of ≤11,000, which was found to be highly associated with working in a rural area. This single point is highly indicative of rural practice and by defining this new level it roughly doubles the predictive value previously defined by other researchers. Incentives such as loan repayment, salary guarantees, and practice assistance for rural physicians currently provided under several federal and state programs should continue to assist in attracting primary care physicians to rural areas. Having been raised in an area of ≤11,000 was highly predictive of future rural medical practice and could be used in the recruitment of physicians and residents to increase the ultimate yield for rural areas. With these new data, North Carolina medical schools and practices serving rural areas may be able to better recruit and retain physicians with a predilection to rural practice.