Shortage Of Physicians In Rural Areas Research Articles

Expert Opinion: Potential Barriers of PPG Sensor Booth for Combatting U.S. Rural Healthcare Gap

Rural areas lack sufficient access to healthcare. Previous studies have shown that this issue, known as the rural healthcare gap, is a result of the following factors: physician shortages in rural areas, traditional healthcare facilities being far away from rural communities, and a lack of patient affordability of health screenings. This qualitative survey study aimed to explore the barriers to a solution to the rural healthcare gap combining two existing technologies: PPG sensors and telehealth booths. Twelve professionals from rural health, telehealth, and PPG sensor backgrounds were recruited to answer a questionnaire inquiring about the different social, economic, and political barriers that potentially exist to this solution. Analysis identified 8 major barriers: 1) Fear of Confidentiality Breach, 2) Wariness of technology, 3) Implementation cost, 4) Maintenance Cost, 5) Funding, 6) Insurance Access, 7) Partisanship, and 8) Pressure from Healthcare Organizations. Rural health, telehealth, and PPG sensor professionals were more likely to state the wariness of technology, implementation cost, maintenance cost, funding, and healthcare organization pressure as the major barriers to the implementation of the PPG sensor booth. Understanding these barriers will not only inform future direction to mitigate hurdles to the PPG Sensor booth, but also other novel technologies that are applied in the rural setting as well.

Rurality and Origin-Destination Trajectories of Medical School Application and Matriculation in the United States.

Physician shortages are more pronounced in rural than in urban areas. The geography of medical school application and matriculation could provide insights into geographic differences in physician availability. Using data from the Association of American Medical Colleges (AAMC), we conducted geospatial analyses, and developed origin–destination (O–D) trajectories and conceptual graphs to understand the root cause of rural physician shortages. Geographic disparities exist at a significant level in medical school applications in the US. The total number of medical school applications increased by 38% from 2001 to 2015, but the number had decreased by 2% in completely rural counties. Most counties with no medical school applicants were in rural areas (88%). Rurality had a significant negative association with the application rate and explained 15.3% of the variation at the county level. The number of medical school applications in a county was disproportional to the population by rurality. Applicants from completely rural counties (2% of the US population) represented less than 1% of the total medical school applications. Our results can inform recruitment strategies for new medical school students, elucidate location decisions of new medical schools, provide recommendations to close the rural–urban gap in medical school applications, and reduce physician shortages in rural areas.

Physician preferences for working in deprived areas: a systematic review of discrete choice experiment.

Background: Physician shortages in rural areas is a universal concern, and most countries face this challenge. Many attributes influence the physician preferences about the choice of working location. The aim of this systematic review was to investigate which attributes were included in discrete choice experiment studies and which of them valued the most by physicians. Methods: The following databases were searched: PubMed, Embase, and Web of Science Core Collection. Further studies were retrieved from reference lists of included studies, and grey literature. Studies used discrete choice experiments methods to elicit preferences for working in the deprived area, focus on physicians or medical students, and published between 2000 and 2017 in the English language were included. Results: The literature search yielded 192 studies, of which 14 studies met inclusion criteria. The attributes and attribute levels were identified by literature review and qualitative research. The number of attributes varied from five to ten, and the most frequent number was six attributes. In most studies, maximum of sixteen different scenarios were given to the study samples. The "salary or income" attribute was the most important in fifty percent of the studies and the attributes related to "study and education" was at the next level. Conclusion: Financial attributes are not the only significant attributes considered by the physicians for deciding where to practice, but also the other non-financial attributes are important. It is suggested that based on the economic, social and cultural conditions of each country, a specific incentive package, including a set of financial and non-financial incentives, is developed to attract physicians to the deprived areas.

Surveillance of Noncommunicable Diseases by Community Health Workers in Kerala: The Epidemiology of Noncommunicable Diseases in Rural Areas (ENDIRA) Study

BackgroundIndia carries the greatest burden of noncommunicable disease (NCD) globally. However, there are few contemporary, community-based studies of prevalence in India. Given the physician shortages in rural areas, large-scale, region-specific studies of NCD using community health workers (CHW) may offer a feasible means of NCD surveillance. ObjectivesThis study sought to conduct a large-scale, population-based, CHW-led study of NCDs in Kerala, India. MethodsIn rural Kerala, India, a population of 113,462 individuals was defined geographically by 5 panchayats (village councils). The ENDIRA (Epidemiology of Noncommunicable Diseases in Rural Areas) study was conducted via accredited social health activists (ASHA), who are CHW employed by Kerala state government. After training of ASHA, standardized questionnaires were used during 2012 in household interviews of individuals ≥18 years of age to gather sociodemographic, lifestyle, and medical data. ResultsASHA recruited 84,456 adults who were included in the analyses (25.4% were below the poverty line). The prevalence of NCD was comparable to contemporary studies in India: myocardial infarction (MI) 1.4%; stroke 0.3%; respiratory diseases 5.0%; and cancer 1.1%. The dietary habits were as follows: 84.1% of the population was vegetarian; 15.9% ate meat/fish ≥1 day per week; 4.2% had ≥1 alcoholic drink per week; and 8.1% smoked regularly. Compared with men, women were older, had lower body mass index, more likely to be hypertensive, less likely to smoke or drink alcohol, and have diabetes or dyslipidemia (p < 0.0001). NCD were more common in men than women: MI (1.9% vs. 0.9%); stroke (0.5% vs. 0.3%); cancer (1.2% vs. 0.9%); and respiratory diseases (5.9% vs. 4.0%) (p < 0.0001). Age ≥65 years, hypertension, diabetes mellitus, dyslipidemia, smoking, and male sex were strongly associated with MI and stroke. There were high levels of agreement between ASHA and physicians for diagnoses of MI, stroke, hypertension, and diabetes. ConclusionsCHW effectively conducted a large-scale prevalence study of NCD in Kerala, including prevalence of risk factors. In rural Kerala, traditional risk factors were strongly associated with MI and stroke.

Unfreezing the Flexnerian Model: introducing longitudinal integrated clerkships in rural communities

Physician shortages in rural areas remain severe but may be ameliorated by recent expansions in medical school class sizes. Expanding student exposure to rural medicine by increasing the amount of prolonged clinical experiences in rural areas may increase the likelihood of students pursuing a career in rural medicine. This research sought to investigate the perspective of rural physicians on the introduction of a rurally based nine-month Longitudinal Integrated Clerkship (LIC). In this mixed-methods study, nine physician leaders were interviewed from five Maine, USA, rural hospitals participating in an LIC. Semi-structured interviews were audiotaped and transcribed. Qualitative analysis techniques were used to code the transcripts and develop themes. Forty-seven participating rural LIC preceptors were also surveyed through an online survey. Four major themes related to implementing the LIC model emerged: (1) melting old ways, (2) overcoming fears, (3) synergy of energy, and (4) benefits all-around. The faculty were very positive about the LIC, with increased job satisfaction, practice morale, and ongoing learning, but concerned about the financial impact on productivity. The importance of these themes and perceptions are discussed within the three-stage model of change by Lewin. These results describe how the innovative LIC model can conceptually unfreeze the traditional Flexnerian construct for rural physicians. Highlighting the many stakeholder benefits and addressing the anxieties and fears of rural faculty may facilitate the implementation of a rural LIC. Given the net favorable perception of rural faculty of the LIC, this educational model has the potential to play a major role in increasing the rural workforce.

Experiences of Organization for Economic Cooperation and Development countries with recruiting and retaining physicians in rural areas.

This present study discusses the potential pitfalls in measuring physician shortages in rural areas and presents existing evidence of the effectiveness of policy interventions designed to influence the geographical distribution of physicians. Information on the geographical distribution of physicians was derived from a survey of Organization for Economic Cooperation and Development (OECD) countries and a desk review of the academic literature and policy documents of OECD governments. Whether policies have been effective in recruiting and retaining physicians in rural areas. Existing measures of physician shortages in rural areas may be misleading as they do not account for a number of supply side factors (e.g. physician productivity, mobility of physicians across areas) and demand-side factors (e.g. patient needs for physician services). Increases in the national number of physicians have narrowed, but not eliminated, shortages in rural areas. Some success in increasing physician supply to rural areas has been reported with educational, regulatory and financial policies; whereas countries' experiences with education-related funding policies are mixed. There is some evidence suggesting that the effectiveness of these policies can be enhanced by supporting occupational opportunities for the spouse/partner, education of children and accommodation. Although there has been little evaluation of policy interventions, physician shortages in rural areas may be reduced by supply side policies that focus on the physician in combination with measures to sustain the economic and social viability of rural communities.