Rural Doctors Research Articles

Measuring the attractiveness of rural communities in accounting for differences of rural primary care workforce supply.

Many rural communities continue to experience an undersupply of primary care doctor services. While key professional factors relating to difficulties of recruitment and retention of rural primary care doctors are widely identified, less attention has been given to the role of community and place aspects on supply. Place-related attributes contribute to a community's overall amenity or attractiveness, which arguably influence both rural recruitment and retention relocation decisions of doctors. This bi-national study of Australia and the USA, two developed nations with similar geographic and rural access profiles, investigates the extent to which variations in community amenity indicators are associated with spatial variations in the supply of rural primary care doctors. Measures from two dimensions of community amenity: geographic location, specifically isolation/proximity; and economics and sociodemographics were included in this study, along with a proxy measure (jurisdiction) of a third dimension, environmental amenity. Data were chiefly collated from the American Community Survey and the Australian Census of Population and Housing, with additional calculated proximity measures. Rural primary care supply was measured using provider-to-population ratios in 1949 US rural counties and in 370 Australian rural local government areas. Additionally, the more sophisticated two-step floating catchment area method was used to measure Australian rural primary care supply in 1116 rural towns, with population sizes ranging from 500 to 50 000. Associations between supply and community amenity indicators were examined using Pearson's correlation coefficients and ordinary least squares multiple linear regression models. It was found that increased population size, having a hospital in the county, increased house prices and affluence, and a more educated and older population were all significantly associated with increased workforce supply across rural areas of both countries. While remote areas were strongly linked with poorer supply in Australia, geographical remoteness was not significant after accounting for other indicators of amenity such as the positive association between workforce supply and coastal location. Workforce supply in the USA was negatively associated with fringe rural area locations adjacent to larger metropolitan areas and characterised by long work commutes. The US model captured 49% of the variation of workforce supply between rural counties, while the Australian models captured 35-39% of rural supply variation. These data support the idea that the rural medical workforce is maldistributed with a skew towards locating in more affluent and educated areas, and against locating in smaller, poorer and more isolated rural towns, which struggle to attract an adequate supply of primary care services. This evidence is important in understanding the role of place characteristics and rural population dynamics in the recruitment and retention of rural doctors. Future primary care workforce policies need to place a greater focus on rural communities that, for a variety of reasons, may be less attractive to doctors looking to begin or remain working there.

Nurturing rural doctors.

Medical Journal of AustraliaVolume 206, Issue 11 p. C1-C2 Career Nurturing rural doctors Cate Swannell, Cate SwannellSearch for more papers by this author Cate Swannell, Cate SwannellSearch for more papers by this author First published: 19 June 2017 https://doi.org/10.5694/mja17.1906C1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume206, Issue11June 2017Pages C1-C2 RelatedInformation

A targeted rural postgraduate education programme – linking rural doctors across New Zealand and into the Pacific

This article describes the University of Otago Rural Postgraduate medical programme, established in 2002 to provide a targeted rural education option for medical practitioners working in rural and remote areas of New Zealand. With both faculty and participants dispersed throughout New Zealand and the Cook Islands embedded in day to day rural clinical practice, this programme uniquely reflects the national and international clinical networks it has been developed to support. It now provides the academic component of two vocational training programmes: the New Zealand Rural Hospital Medicine Training Programme and The Cook Islands General Practice Training Programme. We describe the journey the Rural Postgraduate programme has taken over the last decade: the opportunities, learnings and challenges. The programme is continuing to expand and is creating a growing community of rural and remote practitioners throughout New Zealand and the Pacific.

Influencing factors for rural doctors′ training effect in Shandong province based on pre-intervention theory

Objective To identify the influencing factors for rural doctors′ effect, and suggest on the improvement of such training. Methods On the basis of rural doctors′ survey, the theory of pre-intervention was used to probe into the influencing factors for such in five dimensions of attention notice, mega-cognitive strategies, advance organizer, goal orientation, and preparatory information. Results 73.2% of the groups were found with satisfying effect.In the single factor analysis, comparison of effect involving such factors as age, gender, length of work life and pre-intervention revealed statistical significance(P<0.05). As shown in the logistic regression analysis, High in meta-cognitive strategies, Clear goals in goal orientation, Tiered and categorized training in advance organizers, and Practical learning in preparatory information, as well as variants like age would influence rural doctors′ effect significantly. Conclusions The key to better effect lies in better motivation of the trainee, setting correct goals, emphasis on the practicability of contents and, the pertinence of the objects. Key words: Shandong province; Rural doctor; Training effect; Influencing factor; Pre-intervention

The influence of urban-rural united and continuous care on the intensive treatment of multi-drug-resistant pulmonary tuberculosis patients inserted with PICC

Objective To summarize the effect of urban-rural united and continuous care on the intensive treatment of multi-drug-resistant pulmonary tuberculosis patients inserted with PICC. Methods A total of 32 multi-drug-resistant pulmonary tuberculosis patients who applied PICC for standardized treatment for a long term after discharge were given the urban-rural united and continuous care and PICC was implanted during their hospitalization. The rural doctors of the patients' residence were given PICC application training before their discharge.The patients were discharged inserted with PICC when the sputum bacterium turned negative and the daily infusion was finished by the rural doctors. The nurses made the follow-up visit twice a week to maintain the catheters and to supervise drug use.The application of PICC and the completion of intensive treatment were evaluated after 3, 6 and 9 months' intensive treatment. Results Among the 32 cases of patients, 1 case was lost for the follow-up visit and 1 case was forced to withdraw the tube because of the exhaustion of the kidney function.The completion rate during the intensive-treatment period with the application of PICC was 93.8%.The relationship between nurses and patients was harmonious in the process of follow-up and the satisfaction rate for nursing reached 100%, which lay a sound foundation for the completion of the entire standardized treatment. Conclusions Urban-rural united and continuous care can improve the long-term usage of PICC and enhance the completion rate of intensive treatment of the multi-drug-resistant tuberculosis, hence it is worth promoting. Key words: Multidrug-resistant tuberculosis; PICC; Continuous care

A study on the feasibility of increasing the teaching content of nursing education in the stage of rural doctor education

Objective To explore the insertion of the teaching contents of nursing in rural doctors' higher education, so as to increase their understanding of medical knowledge and improve their medical skills. Method 90 rural doctors of Grade 2014 were chosen as the research object, and according to their willingness to participate, they were divided into control group and observation group. The students in the control group were mainly taught by the relevant knowledge of clinical medicine, while nursing teaching content was inserted in the teaching of observation group. In the teaching process, firstly, the teaching contents of nursing were reorganized, and then the teaching content of clinical medicine was taken as the main line, according to the development of teaching content, flexibly inserting nursing teaching part. The results of the final examination of the internal medicine of the two groups were compared and the specific learning experience of rural doctors was investigated. SPSS 20.0 was used to analyze the data, the count data was expressed as percentage, and chi square test was performed. Results The number of students in the con-trol group and the observation group whose subjective score was more than 40 was 17.65% and 48.72% respectively. The number of students scoring <30 points accounted for 23.53% and 5.13% of the total number of students, and there was a statistically significant difference between the two groups (P<0.05) . The ob-servation group had a better learning experience, and had little influence on the learning of clinical medical knowledge. Conclusion In the stage of education for rural doctors, inserting the teaching contents of nursing can improve the teaching effect. Key words: Rural doctor; Nursing teaching; Teaching reform

Rural retention of new medical graduates from the Collaborative Project to Increase Production of Rural Doctors (CPIRD): a 12-year retrospective study.

Physician scarcity in rural areas is a major obstacle to healthcare access, leading to health inequity worldwide. In Thailand, a special recruitment program of medical education [Collaborative Project to Increase Production of Rural Doctors (CPIRD)] was initiated with four different medical training tracks. No previous research has examined the rural retention of new medical graduates across the CPIRD tracks, compared with those receiving conventional medical education (Normal track). This study examines the public retention of rural physicians from different tracks of entry. A retrospective study was conducted in new medical graduates who entered Ministry of Public Health (MoPH) hospitals from January 2003 to October 2014, and followed up until June 2015, using administrative data from the Personnel Administration Division, MoPH. The CPIRD registry database was used to identify physicians' tracks of entry. Survival analyses and multiple logistic regression analyses were applied to compare the annual retention and the probability of 3-year retention of rural physicians. Results clearly demonstrated a high rural retention of CPIRD medical graduates, compared with their Normal track peers, regarding both lower annual resignation (HR 0.456, P < 0.001) and higher 3-year retention (OR 2.441, CI: 2.192, 2.719). Some variations of rural retention were revealed across the different CPIRD tracks. Evidence from this study can be used as part of the information to reshape the physician production policy to reduce health inequity in rural areas.

A virtual tumor board-driven synaptic knowledge network.

89 Background: In 2006, Tahoe Forest Hospital District—a 25-bed hospital in Truckee, CA, a mountain resort community one hour from regional and two hours from academic cancer services—designed and implemented an oncology program utilizing effective telecommunications with a committed academic partner, the UC Davis Comprehensive Cancer Center in Sacramento. Methods: The UC Davis Cancer Care Network was established with four remote cancer programs, enabling participation in daily virtual tumor boards, clinical trial enrollment, and quality assurance assistance. (Richard J. Bold, et. al., Virtual tumor boards: community-university collaboration to improve quality of care. Community Oncol 10(11):310-315, November 2013.; Laurence J. Heifetz, MD, et. al., A Model for Rural Oncology. J Oncol Pract, 7:168-171, May 2011.). An increasing number of patients were observed to in-migrate to Truckee from even more remote rural areas in the mountains. In 2013, the now Gene Upshaw Memorial Tahoe Forest Cancer Center developed four remote telemedicine clinics to allow even more physically distant patients the capacity to be followed locally. Results: Since we opened the remote telemedicine clinics, our Sullivan-Luallin patient satisfaction scores have averaged 4.82/5.00 for “overall satisfaction with the practice” and 4.90/5.00 for “recommending your provider to others”; our in-migration rate of patients from outside our primary catchment area increased from 43% to 52%: and clinical trial accrual rate averaged 10%. Conclusions: Reducing cancer health disparities is an ASCO mission. (cover, ASCO Connection, July 2014; Laurence J. Heifetz, MD. Country Docs with City Technology Can Address Rural Cancer Care Disparities. Oncol, 29(9):641-644, September 2015.). We believe this synaptic knowledge network effectively addresses that mission for rural communities. This model can be scaled in many configurations to address the inherent degradation of quality care as a function of physical distance to an academic center that rural doctors and patients deal with on a daily basis. The key is to insist on a cultural shift – Do something smart at lunch every day. Attend a virtual tumor board.

Learning on the fly: How rural junior doctors learn during consultations with retrieval physicians.

This study explores how rural junior doctors learn while consulting retrieval physicians about critically ill and injured patients, as well as the tensions characterising teaching and learning in this setting. Data were collected via three focus groups, involving rural junior doctors (n = 8), rural senior doctors (n = 3) and retrievalists (n = 3). The discussions were transcribed and subject to multistage coding. Rural junior doctors believe they learn from interactions with retrieval physicians. Their learning was greatest when the retrieval physician explained his or her clinical reasoning and provided feedback. The level of stress was sometimes overwhelming and learning ceased. Both groups described limited time for teaching due to the medical needs of the patient and the needs of concurrent patients. Retrieval physicians were not certain that rural junior doctors wanted to learn. Rural junior doctors hold retrievalists in very high regard. Support provided by retrievalists extends the abilities of the junior doctors and often results in learning. When junior doctors are extended too far, they become overwhelmed and learning ceases. Junior doctors would like the retrievalists to spend more time explaining their actions and providing feedback. Even when both retrievalists and junior doctors are interested in teaching, it may not occur due to misunderstandings and differences in status.

Qualitative research of the team building of rural doctors in Beijing under different views

Objective To learn from various view points the team building of rural doctors in Beijing. Methods 84 village officials, rural doctors and villagers were enrolled from three townships in district H of Beijing, for an interview to learn the makeup and selection approach of rural doctors, and their recommendations on team building of these doctors. Results 76.19% of the interviewees prefer their own villagers as candidates for their rural doctor.Top three factors for their retention were their medical competence, geo-relations, and service attitude; 60.71% of the interviewees held that the village committee should be the decision maker for appointment of rural doctors; in terms of team building, senior doctors emphasize retirement conditions, while new ones prefer training opportunities. Conclusions The topmost criterion for rural doctor candidates should be their medical competence, instead of sacrificing this criterion for geo-relations.The village committee and the villagers′ congress should play a greater role of supervision and management of the rural doctors.Targeted incentives are recommended for the rural doctors in view of their retention. Key words: Beijing; Rural doctors; Team building; Qualitative research

Primary Care Doctors' Assessment of and Preferences on Their Remuneration.

Despite numerous studies on primary care doctors’ remuneration and their job satisfaction, few of them have quantified their views and preferences on certain types of remuneration. This study aimed at reporting these views and preferences on behalf of Greek doctors employed at public primary care. We applied a 13-item questionnaire to a random sample of 212 doctors at National Health Service health centers and their satellite clinics. The results showed that most doctors deem their salary lower than work produced and lower than that of private sector colleagues. Younger respondents highlighted that salary favors dual employment and claim of informal fees from patients. Older respondents underlined the negative impact of salary on productivity and quality of services. Both incentives to work at border areas and choose general practice were deemed unsatisfactory by the vast majority of doctors. Most participants desire a combination of per capita fee with fee-for-service; however, 3 clusters with distinct preferences were formed: general practitioners (GPs) of higher medical grades, GPs of the lowest medical grade, residents and rural doctors. Across them, a descending tolerance to salary-free schemes was observed. Greek primary care doctors are dissatisfied with the current remuneration scheme, maybe more than in the past, but notably the younger doctors are not intended to leave it. However, Greek policy makers should experiment in capitation for more tolerable to risk GPs and introduce pay-for-performance to achieve enhanced access and quality. These interventions should be combined with others in primary care’s new structure in an effort to converge with international standards.

Impact of a 20-year collaborative approach to increasing the production of rural doctors in Thailand.

Impact of a 20-year collaborative approach to increasing the production of rural doctors in Thailand.

Capacity building in Nepal

Healthcare providers from high-income countries often want to help underserved populations, but providing clinical care is not always a sustainable approach. Patan Academy of Health Sciences (PAHS), in Nepal, has taken an innovative approach to capacity building in healthcare. PAHS has partnered with rural family doctors from Canada to provide clinical bedside teaching to medical students in PAHS’s rural program, thereby making a sustainable contribution to healthcare in Nepal.

What do beginning students, in a rurally focused medical course, think about rural practice?

BackgroundMedical schools may select students for their attitudes towards rural medical practice, yet the rural–urban disparity in availability of medical practitioners and services has not diminished in recent times despite government initiatives and increasing numbers being trained for a career in medicine. One medical school, with a focus on rural and remote medicine, aims to select students with positive perceptions for rural medical practice. A research project collected data on the perceptions of these medical students in the first week of their medical studies.MethodsStudents completed a low stakes essay on the life and work of a rural doctor. Initially, this formed part of a literacy assessment to determine any students requiring remediation. All students were asked if they would consent to their essay being reviewed for a research project.Data was obtained from those students who consented and handed their essays in for review. The 103 student essays underwent thematic analysis and sentences were coded into three main themes of rural lifestyle, doctor role and rural practice. Second level themes were further elicited and results were quantified according to whether they were positive or negative. Positive themes included rural lifestyle, doctor role, views of doctor, impact on community, broader work and skills knowledge, and better relationships with community and patients. Negative themes included doctor’s health, pressure on doctor, family problems, greater workload, privacy and confidentiality issues, cultural issues, isolation, limited resources and financial impacts. Quantitisation of this data was used to transform essay sentences into a numerical form which allowed statistical analysis and comparison of perceptions using Z tests.ResultsNo significant differences on the number of positive and negative responses for rural lifestyle and rural practice were found. The rural doctor role had a significantly more positive than negative views. Significant differences were found for positive views of the rural doctor role and negative views of rural practice. Participants from a capital city background reported a significantly higher percentage of responses related to negative views of rural practice than their regional and rural counterparts. Students from capital city areas had significantly more negative views about the rural doctor role, especially related to workload, limited resources and isolation than students from rural and regional areas.ConclusionStudents entering medical school already have both positive and negative views about the life and work of a rural doctor. Those students from capital city areas have significantly more negative views despite being selected to enter a medical course with a rural focus based on their expressed rural perceptions. Further work is required to refine selection criteria and the year level experiences and learning opportunities which may positively influence student perceptions about rural medical practice to overcome early negative perceptions at the beginning of medical school.

Professional development of rural doctors in China

Covered in the paper are the significance of rural doctors' professional development and their professional characteristics, as well as systematic insights on such key factors of professionalism of these doctors, as their professional qualifications, functional positioning, practicing approach, professional guarantee, professional development, social identity, professional stability, and professionalism.Based on such thoughts, the authors recommend on reforms of professional development for rural doctors by stages and levels. Key words: Rural doctors; Professional characteristics; Professional elements; Professional development

The Pre-Enrollment Medical Student Data Predictios of Pre-Clinic Failure

Objective: To identify potential pre-enrollment predictors of undergraduate medical students failure in pre-clinic class.Material and Method: A retrospective descriptive analytic study, medical students who had admitted in 2008-2012 to the Prince of Songkla University. The pre-enrollment data base was used to identify students background, high school Grade Point Average (GPA), Ordinary National Education Test (O-NET) score, and family background. The entry pathway and academic performance in the pre-clinic class were also collected and entered into analytic studies by using p-value&lt;0.050 for each significant variable.Results: Nine hundred and fifty six medical students were enrolled, 418 (43.7%) was male, 274 (28.7%) had entered via the Collaborative Project to Increase Production of Rural Doctor (CPIRD) entry pathway, and 419 (43.8) had graduated from a high school in Songkhla province. Thirty nine (4.1%) students had failed in pre-clinic course. Comparing in achievement with the failure group revealed significant differences in GPA median (interquartile range) [3.8 (3.7, 3.9) vs 3.7 (3.5, 3.8)] and O-NET score [60 (51.4, 69.0) vs 53 (43.8, 60.0)], and proportion of CPIRD entry pathway (27.4% vs 59.0%) (p-value&lt;0.001). However univariate conditional logistic regression analysis regression showed that the 10 (1%) with absent parent [odds ratio (OR)=42, 95% confidence interval (95% CI)=11.3 to 156 p-value&lt;0.001), GPA less than 3.5 (OR=5.14, 95% CI=2.47 to 10.69, p-value&lt;0.001), and O-NET score less than 50 compare with at least 60 (OR=4.34, 95% CI=1.81 to 10.40, p-value=0.001) were associated with pre-clinic failure.Conclusion: The GPA and O-NET scores, CPIRD entry pathway and absent parent were identified as significant pre-enrollment predictors of pre-clinic failure.

“The Presence of the Past”: A Historical Reading of Bizhan Najdi’s “A Plant in Quarantine”

Using flashbacks, Bizhan Najdi’s “A Plant in Quarantine” tells the story of the central character called Taher, an Iranian boy, who has been quarantined in a hospital due to abnormal spread of skin rashes after a military service physician took off a lock from the back of his right shoulder. Immediately, Taher came down with a contagious skin disease called hereditary fear by the rural doctor. This short story brings the past and present together in a peculiar manner, providing an overview of present condition actuated by past events revolving around the Tudeh Party, an Iranian Marxist political party, and the Iran-Iraq War. The analysis of this relationship and the possibility of Taher’s hereditary fear is the main focus of the paper, which can account for the role of history in this short story. For such an end, the analysis is carried out at the two levels of writer and story. The writer’s disturbed memories, which are related to fear and violence in Iran’s contemporary history, and the conditions of their emergence are explored so that the roots of the protagonist’s inherent fear might be discernible. The findings of the paper show that the unpleasant presence of the main character’s ancestral past is the cause of his predicament, introducing past as an active agent of the present. Keywords : “A Plant in Quarantine”, hereditary fear, lock, olive, “presence of the past”, history

Living their passion for upliftment – RuDASA award winners

From celebrating the work of a rare rural audiologist to lauding the selfless lifetime achievements of a veteran community change-agent, the Rural Doctors’ Association of South Africa (RuDASA) awards at its 20th annual conference in Grahamstown on 8 August showcased vocation-driven talent.

Election politics ride roughshod over clinicians, patients

Strange things happen at election time. Patient care and doctor support can come a very poor second to tub-thumping and vote-collecting – that’s if the stories of two hospital CEOs with impeccable and impressive track records, highly respected among their rural peers, can be believed. Weird as it may seem, this year’s Rural Doctors of South Africa (RuDASA) Lifetime Achiever Award recipient Dr Victor Fredlund, age 60, CEO of Mseleni Hospital, spent nearly 4 months at home on officially enforced leave (until this July). Aspirant local political candidates and unions led a charge against his withdrawal of job offers from two cleaners and his firing of a third. Head office bureaucrats insisted that the removal of the veteran stalwart from the far northern KwaZulu-Natal (KZN) hospital was ‘for his own safety’, bickering, fudging and stalling way after any perceived threat to him had evaporated. Then, seemingly at a loss over how to justify his lengthy absence, they charged him in August – for doing exactly what they’d advised him to do.

The Pennsylvania Anatomy Act of 1883: Weighing the Roles of Professor William Smith Forbes and Senator William James McKnight.

Effective Anatomical Acts transformed medical education and curtailed grave-robbing. William S. Forbes, Demonstrator of Anatomy at Jefferson Medical College in Philadelphia, authored the Pennsylvania Anatomy Act of 1867, but it was ineffective. In December of 1882, Forbes and accomplices were charged with grave-robbing. Forbes was acquitted in early 1883, but his accomplices were all convicted; nevertheless, these events precipitated a strengthened Anatomy Act in 1883. Forbes was crowned the Father of the Pennsylvania Anatomy Act and was revered by the Philadelphia medical community for his personal sacrifices for medical education; they even paid his legal fees. Over the remainder of his life, Forbes received many honors. However, there was a second major player, rural doctor William J. McKnight, a convicted grave-robber and State Senator. The evidence shows that Forbes precipitated the crisis, which was a racial powder keg, and then primarily focused on his trial, while McKnight, creatively working behind the scenes in collaboration with Jefferson, Anatomy Professor William H. Pancoast, used the crisis to draft and pass transformative legislation enabling anatomical dissection at Pennsylvania medical schools. While not minimizing Forbes suffering throughout these events, McKnight should be appropriately recognized for his initiative and contributions, which far exceeded those of Forbes.