Factors Influencing the Decision to Practice Medicine in West Virginia: Training Experiences

Abstract

INTRODUCTION The study describes pipeline, training, and contextual experiences and factors that influence the decision to practice medicine in West Virginia (WV). METHODS The cross-sectional study using descriptive statistics was conducted between November 2019 and March 2020 using an online link to an anonymous survey sent to all physicians licensed to practice medicine in WV with an e-mail address on file with the WV Board of Medicine or WV Osteopathic Medical Association at the time of the study. RESULTS More WV medical school graduates identifying as a WV native practiced primary care than non-native WV medical graduates in this sample. More native WV medical graduates practiced primary care than non-native peers; however, both groups chose primary care at a greater rate than out-of-state medical school graduates. Returning to home communities and an established network of family and friends were influential factors for WV medical graduates. More WV natives completed residency in-state (n = 127) compared to out-of-state (n = 55). More than half of the sample (69.4%) participated in at least one pipeline program during medical school (n=153), residency (n = 86), undergraduate (n = 50), other graduate training (n = 18), or K-12 (n = 16). Approximately 24% of all respondents' primary practice was in a rural area, and 60% of respondents practiced in a primary health profession shortage area. DISCUSSION More native WV respondents are currently providing primary care and completed residency in-state compared to non-native respondents. The choice of primary care practice was similar across graduates of WV's three medical schools. A majority of respondents participated in pipeline programming though the effect on career and practice location decisions are unclear. CONCLUSIONS Continued recruitment of WV medical school graduates into in-state residency programs, concurrently with expanded primary care training placements and promotion, may increase the number and retention of WV primary care physicians in the coming years. Further study should examine factors that influence physician choice not to return to WV to practice after residency or fellowship training.