Physicians In Rural Areas Research Articles

A High-Performance FPGA-Based Fuzzy Processor Architecture for Medical Diagnosis

An auto-decision-making system for medical diagnosis could help make up for the lack of physicians in rural areas of many third-world countries. This high-performance, low-power, pipelined parallel fuzzy processor based on a dedicated single-chip architecture performs high-speed fuzzy inferences with processing speed up to 5.0 Mflips at a clock frequency of 40 MHz using 256 rules having one consequent each, 16 input variables, and 16-bit resolution. The processor operates in real time producing results within an interval of 1.92mus. The processor implemented on board consumes as low as 70 milliwatt power. The processor performs medical diagnosis with 97.5 percent accuracy.

A Contract‐Based Training System for Rural Physicians: Follow‐Up of Jichi Medical University Graduates (1978‐2006)

The number of studies on long-term effects of rural medical education programs is limited. Personal factors that are associated with long-term retention of physicians in rural areas are scarcely known. The authors studied the outcomes of Jichi Medical University (JMU), whose mission is to produce rural doctors, and analyzed the characteristics of its graduates who engaged in rural practice even after their 9-year obligation of rural practice. A retrospective cohort study was conducted including 2,988 JMU students who graduated between 1978 and 2006. Baseline data were collected at matriculation and graduation. Workplace addresses were surveyed in 2000, 2004, and 2006. Follow-up rates were 98.7%, 98.2%, and 98.0% respectively. After their obligation period, JMU graduates were 4 times more likely than non-JMU graduates to work in rural areas. The higher proportion of JMU graduates in rural areas did not change significantly between 1994 and 2004. The rural recruitment rate of post-obligation JMU graduates was somewhat lower than rates reported for top rural medical education programs in the United States. In multivariate analyses, rural upbringing and primary care specialty were positively associated with having a rural address in at least one post-obligation study year (OR 1.89 [95% CI 1.27-2.81]; and 7.63 [4.37-13.34], respectively) and settlement (ie, having a rural address over multiple years) after the contract (1.90 [1.04-3.48]; and 32.07 [4.43-232.24], respectively). Graduation from a private high school had a negative association with recruitment (0.56 [0.33-0.96]). JMU was successful in increasing the number and retention of rural physicians. Rural origin and primary care specialty have a positive impact on both recruitment and retention after the rural obligation.

Increasing the number of rural physicians

Many rural communities are desperate to recruit and retain physicians. Although there are important shortages of family physicians and specialists in all areas of Canada, physicians in rural areas are far fewer in number and fulfill a wider range of roles. The loss of a single physician from a rural

Trade policy and health: from conflicting interests to policy coherence

Policy incoherence at the interface between trade policy and health can take many forms, such as international trade commitments that strengthen protection of pharmaceutical patents, or promotion of health tourism that exacerbates the shortage of physicians in rural areas. Focusing on the national policy-making process, we make recommendations regarding five conditions that are necessary, but not sufficient, to ensure that international trade policies are coherent with national health objectives. These conditions are: space for dialogue and joint fact-finding; leadership by ministries of health; institutional mechanisms for coordination; meaningful engagement with stakeholders; and a strong evidence base.

What factors are affecting physician payment by acute care hospitals in rural Japan?

The regional discrepancies of physician supply have been a growing concern in Japan. To find out how hospitals are responding in terms of physician payment (by monthly salaries and additional benefits), we conducted a survey of acute care hospitals in Yamagata, Japan. We asked about the salary and additional benefits of full-time physicians and the structural and functional characteristics of health care service provision. From these data we set out to assemble a model that can explain effectively the variability of physician payment in acute care hospitals within the prefecture. We found that physician payment was associated with variables such as type of management, staff employed per bed, full time doctors employed per bed and average length of stay. Hospital location was found to have a significant effect on payment. Variables expressing workload, like number of in-patients per doctor and number of surgical operations per doctor were inversely related. Our results suggest that hospitals may have adapted to physician preferences of workplace in terms of physician payment. To further address the problems of unbalanced geographic distribution of physicians in rural areas, work-sharing and educational and technical support schemes may also help.

Expanding undergraduate medical education in British Columbia: a distributed campus model

As in the rest of Canada, British Columbia has a shortage of physicians in rural areas, particularly in the northern parts of the province and on the remoter parts of Vancouver Island. People living in these areas have reduced access to health care and poorer health outcomes compared with people in

Incentives and Physician Specialty Choice: A Case Study of Florida's Program in Medical Sciences

The growing shortage of primary care physicians in medically underserved areas of the nation led medical schools and policymakers years ago to design and fund numerous innovative medical education programs to foster the development of a more balanced physician workforce. Florida's Program in Medical Sciences (PIMS) was an example of one such initiative that was established in fall 1971 at Florida State University (FSU). A precursor of the present-day FSU College of Medicine, this program was created specifically to address the growing need for primary care physicians in rural areas of northwest Florida. The results of empirical tests on the career choices of PIMS graduates in the first 20 years provide weak evidence that the program was more effective than the existing channels of medical education in producing additional primary care physicians to rural Florida counties.

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.

Trends in the physician workforce, 1980-2000.

Over the past twenty-five years the nation has struggled with a series of physician workforce issues: determining the appropriate number of physicians needed and the appropriate number to produce; the role of international medical school graduates; the mix of primary care and non-primary care physicians; efforts to increase the number of underrepresented minorities in medicine and the supply of physicians in rural areas; and the impact of the growing number of female physicians. This paper documents physician workforce trends over the past twenty years, especially as they relate to these issues.

The roles of nature and nurture in the recruitment and retention of primary care physicians in rural areas: a review of the literature.

A systematic review of factors associated with recruitment and retention of primary care physicians in rural areas. Using PubMed and Medline databases, 21 quantitative articles analyzing recruitment and retention of primary care physicians in rural areas from 1990 to 2000 were found. To assess the methodologic strengths of these articles, a formal evaluation was conducted based on study design, study population, response rate, years studied, data source, and statistical methods (total possible score = 60 points). Studies were grouped by whether the factors assessed were related to pre-medical school, medical school, or residency. A total of six studies (score range: 30-52) analyzed pre-medical school factors, 15 (score range: 30-52) considered medical school factors, and six (score range: 20-52) analyzed residency factors related to rural recruitment and retention. Pre-medical school factors such as rural upbringing and specialty preference were most strongly correlated with recruitment of physicians to rural areas. Training factors such as commitment to rural curricula and rotations, particularly during residency, were most strongly correlated with retention in rural areas. Although important gaps exist, scientific studies available to health educators and policymakers show there are predictable factors that influence recruitment and retention in rural areas. Policies for staffing rural areas with primary care physicians should be aimed at both selecting the right students and giving them during their formal training the curriculum and the experiences that are needed to succeed in primary care in rural settings.

Physicians, Rural Practice, and Health Care Justice

There is a shortage of physicians in rural areas, and since these areas have more poor, elderly, and persons with chronic diseases than other areas, strategies need to be developed to better serve rural populations. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Rural practice evaluation: how do rural physicians evaluate their working conditions?

Evaluating the quality of rural doctors' working conditions is essential for retaining physicians in rural areas. We carried out a trial to investigate those aspects of working conditions that are important to rural physicians and with which aspects they are satisfied or dissatisfied. Questionnaires were mailed to 204 doctors who were working in rural clinics in Japan. The professional conditions of rural clinic practices were classified into 17 items. The doctors were then asked to evaluate the importance of and degree of satisfaction with each item. Among the 17 items, the clinic's equipment, the municipal government's attitude and the base hospital were evaluated to be more important than the overall average. With regard to satisfaction, the distance to major cities, the municipal government's attitude and locum availability were rated significantly lower than that overall. There were some items where there was a discrepancy between the importance and the degree of satisfaction. Identifying these discrepancies may contribute to creating an environment that will raise the level of rural physicians' satisfaction.

RURAL PRACTICE EVALUATION: HOW DO RURAL PHYSICIANS EVALUATE THEIR WORKING CONDITIONS?

ABSTRACT: Evaluating the quality of rural doctors' working conditions is essential for retaining physicians in rural areas. We carried out a trial to investigate those aspects of working conditions that are important to rural physicians and with which aspects they are satisfied or dissatisfied. Questionnaires were mailed to 204 doctors who were working in rural clinics in Japan. The professional conditions of rural clinic practices were classified into 17 items. The doctors were then asked to evaluate the importance of and degree of satisfaction with each item. Among the 17 items, the clinic's equipment, the municipal government's attitude and the base hospital were evaluated to be more important than the overall average. With regard to satisfaction, the distance to major cities, the municipal government's attitude and locum availability were rated significantly lower than that overall. There were some items where there was a discrepancy between the importance and the degree of satisfaction. Identifying these discrepancies may contribute to creating an environment that will raise the level of rural physicians' satisfaction.

Trends in HIV-related consultation in Dutch general practice.

New medicine against AIDS and a possible changing attitude towards AIDS will affect the role of the general practitioner (GP). We aim to explore and assess the changing role of the GP in preventing and detecting AIDS, which will be done by providing insight into the changing numbers and content of HIV-related consultations in the general practice. Since 1988 a representative sample of 63 Dutch GPs have participated in a network. They recorded all face-to-face consultations with non HIV-infected patients in which the subject of AIDS was brought up. Timetrend analysis is used to investigate variations over time in the number and content of the consultations, GPs' actions and patients' characteristics. The influence of a rural or urban setting and the characteristics of the patients who are involved are also taken into account. Until 1994 a significant increase was found in the number of consultations. In highly urban areas the number of consultations is higher and still growing, whereas physicians in rural areas see fewer patients every year. The most important topic of conversation was the request for an HIV test (74%). This figure grew over the years, as did the number of tests performed. GPs became less passive and restrictive in advising tests. The group of patients has also changed, e.g. patients do not mostly belong to traditional risk groups anymore, and are significantly younger. AIDS seems to have become more familiar to patients and doctors. A lot of general information is available from different sources. Because of this change in attitude and knowledge of patients, the GPs' role as it relates to AIDS is becoming more specific in tracing infected patients and giving customized information to individuals. Patients visit their physicians less often because of concerns about AIDS, but the GP continues to fulfil a very important role in the prevention and detection of AIDS.

A Program to Increase the Number of Family Physicians in Rural and Underserved Areas

The shortage of physicians in rural areas is a longstanding and serious problem, and national and state policymakers and educators continue to face the challenge of finding effective ways to increase the supply of rural physicians. To determine the direct and long-term impact of the Physician Shortage Area Program (PSAP) of Jefferson Medical College (JMC) on the rural physician workforce. Retrospective cohort study. A total of 206 PSAP graduates from the classes of 1978 to 1991. The PSAP graduates currently practicing family medicine in rural and underserved areas of Pennsylvania, compared with all allopathic medical school graduates in the state, and with all US and international allopathic graduates. All PSAP graduates were also compared with their non-PSAP peers at JMC regarding their US practice location, medical specialty, and retention for the past 5 to 10 years. The PSAP graduates account for 21% (32/150) of family physicians practicing in rural Pennsylvania who graduated from one of the state's 7 medical schools, even though they represent only 1% (206/14710) of graduates from those schools (relative risk [RR], 19.1). Among all US and international medical school graduates, PSAP graduates represent 12% of all family physicians in rural Pennsylvania. Results were similar for PSAP graduates practicing in underserved areas. Overall, PSAP graduates were much more likely than their non-PSAP classmates at JMC to practice in a rural area of the United States (34% vs 11%; RR, 3.0), to practice in an underserved area (30% vs 9%; RR, 3.2), to practice family medicine (52% vs 13%; RR, 4.0), and to have combined a career in family practice with practice in a rural area (21% vs 2%; RR, 8.5). Of PSAP graduates, 84% were practicing in either a rural or small metropolitan area, or one of the primary care specialties. Program retention has remained high, with the number of PSAP graduates currently practicing rural family medicine equal to 87% of those practicing between 5 and 10 years ago, and the number practicing in underserved areas, 94%. The PSAP, after more than 22 years, has had a disproportionately large impact on the rural physician workforce, and this effect has persisted over time. Based on these program results, policymakers and medical schools can have a substantial impact on the shortage of physicians in rural areas.

Do international medical graduates reduce rural physician shortages?

The authors examined whether international medical graduates (IMGs) constitute a greater percentage of the US physician workforce in rural underserved areas than in rural non-underserved areas. Research findings could help policymakers determine whether the role of international medical graduates in compensating for local physician shortages counterbalances international medical graduates' potential for exacerbating a national oversupply. This research was based on data from the American Medical Association Physician Masterfile and the Bureau of Health Professions' Area Resource File. The authors calculated the percentage international medical graduates of all US primary care physicians in rural areas, stratified by the Health Professional Shortage Area (HPSA) designation of underservice. The study showed that international medical graduates do constitute a greater percentage of US primary care physicians in rural areas with physician shortages than in rural areas without physician shortages. This finding held true at the national, Census region, and state scales of analysis, but to varying degrees. The finer the scale of analysis, the greater the variation in international medical graduates' practice in rural, underserved areas. There was substantial interstate variation in the extent to which international medical graduates practice in rural underserved areas. International medical graduates do help reduce rural physician shortages, but interstate variation points to the role of state policies in influencing international medical graduates' distribution in rural, underserved areas. Such variation also can come about from many different causes, so there is a need for further research to determine why international medical graduates help compensate for physician shortages more so in some states than in others.

Training for rural family medicine: a cooperative venture of government, university, and community in Alberta.

Training, recruiting, and retaining family physicians in rural areas are issues that have attracted the attention of governments, university training programs, medical governing bodies, and rural communities. In this article, the authors describe a cooperative venture between government, university, and community in the province of Alberta to train medical students and residents in rural areas. The Rural Physician Action Plan (RPAP) was developed in the early 1990s to improve the recruitment and retention of physicians in rural areas. The RPAP is coordinated by a committee composed of representatives of the Alberta government, the Alberta Medical Association, the College of Physicians and Surgeons of Alberta, and the faculties of Medicine at the University of Alberta and the University of Calgary. Residents in the University of Alberta Department of Family Medicine are required to do 20 weeks of blocktime training in a community practice, and under the auspices of the RPAP rural training sites were identified and rural rotations developed. Faculty development activities were developed for the community physicians who would host the residents. The RPAP funds 24 third-year residency positions, equally divided between the University of Calgary and the University of Alberta. Beginning in 1994, undergraduate medical students at the University of Alberta were required to complete a four-week family medicine rotation, with a majority of students being posted to rural training sites. The extent to which the RPAP has helped to recruit and retain physicians in rural areas is not clear. The provincial Ministry of Health evaluated the RPAP in 1995 and concluded that, at a minimum, without the RPAP the province would have suffered a net loss of rural physicians. The communities have been very accepting and supportive of the students and residents.

Recruitment of Primary Healthcare Physicians in Rural Areas

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsC. William RoeAnne Perch intends to work in healthcare administration. RamMohan R. Yallapragada is an associate professor in the Department of Accounting Betty Birkenmeier is a graduate student and research assistant in the Department of Management; Joel P. Authement is the Celeron Professor of Management; and C. William Roe is the associate dean and MBA director, all at the University of Southwestern Louisiana.

Physician reporting of and referral for patient complaints about sleep disorders.

The first goal of this Nebraska-based study was to determine physician reporting of patient complaints about sleep. The second goal was to determine the patterns of referral to sleep disorders laboratories by geographic location and specialty practice. A total of 299 Nebraska physicians (177 in urban areas and 122 in rural areas) completed a questionnaire concerning sleep complaints among patients. We found no statistically significant differences between urban and rural physicians in the percentage of patients reporting insomnia, excessive daytime sleepiness, snoring, or other sleep complaints. Psychiatrists reported on significantly more patients with insomnia and excessive daytime sleepiness than did other physicians; however, they tended to refer fewer patients to sleep disorders laboratories than did physicians practicing internal medicine. Urban physicians referred significantly more patients to sleep disorders laboratories than did rural physicians. We concluded that physician reporting of patient complaints about sleep is similar in urban and rural areas of Nebraska. However, physicians in rural areas tend to refer fewer patients to sleep disorders laboratories than do physicians in urban communities.

Do we need physician assistants in the UK?

The concept of the physician assistant (PA) arose in North America in the 1960s as a response to the shortage of physicians in rural areas. The first PA training of three ex-military corpsmen was initiated by Dr Eugene Stead of Duke University in 1965, following a collaborative project with the nursing faculty on the training of nurse practitioners.