Rural Physicians Research Articles

Characteristics of rural registered nurses and the implications for workforce policy.

Rural registered nurses (RNs) play an integral role in providing care for an underserved population with worse health outcomes than urban counterparts. However, little information is available on the profile of this workforce, which is necessary to understand the capacity of these nurses to provide quality and demanded care presently and in the future. We utilize data from the American Community Survey to provide a contemporary analysis on the supply of rural RNs in the United States. While the number of physicians serving rural populations has decreased in recent years, and rural nurse practitioners (NPs) remain in short supply, rural RNs have steadily grown in numbers at a rate comparable to urban RNs. Rural RNs are markedly less diverse than the populations they serve and only half of rural RNs had a bachelor's degree or higher compared to over 70% for urban RNs. In their supply, young rural nurses appear on pace with urban nurses to adequately replace older nurses and continue to grow the workforce, based on data through 2019. The rural RN workforce is projected to steadily grow amidst declining rural physicians and limited rural NPs. The burgeoning investments in the rural health workforce present opportunities to help diversify, increase educational access, and further rural readiness for rural RNs moving forward.

Medicare Utilization and Reimbursement Variation Between Rural and Urban Otolaryngologists.

To compare billing practices, reimbursement rates, and patient populations of otolaryngology (ORL) physicians practicing in rural and urban settings. Retrospective cross-sectional study. Medicare Provider Utilization and Payment Data: Physician and Other Supplier Data. Medicare-allowed payments, number of services, and number of patients were gathered along with patient population comorbidity statistics, including average hierarchical condition category risk scores. In 2019, 92% of the overall total 8959 ORL physicians practiced in an urban setting. These 8243 urban ORL physicians, on average, billed for 51 (interquartile range [IQR], 31-67) unique Healthcare Common Procedure Coding System (HCPCS) codes, cared for 393 (IQR, 172-535) Medicare patients, performed 1761 (IQR, 502-2070) services, and collected $139,957 (IQR, $55,527-$178,479) per provider. In contrast, the 704 rural ORL physicians, on average, billed for a greater number of unique HCPCS codes (59; IQR, 37-77; P < .001), treated more Medicare patients (445; IQR, 242-614; P < .001), and performed more services (2330; IQR, 694-2748; P < .001) but collected about the same per provider ($141,035; IQR, $56,555-$172,864; P = .426). Older age was associated with rural practice (P = .027). Among both urban and rural ORL physicians, the variety and complexity of procedures and patient comorbidity profiles were comparable. Most ORL physicians practice in large urban settings, a finding potentially related to financial sustainability and career opportunity. With an already small workforce, the aging rural ORL physician population is an identifiable weak point in the otolaryngology specialty that must be addressed with geo-specific recruitment campaigns, rural work incentivization, and the development of career advancement opportunities in rural areas.

The 2013 to 2019 Emergency Medicine Workforce: Clinician Entry and Attrition Across the US Geography

We sought to identify longitudinal trends in workforce entry and attrition among rural and urban emergency physicians, nonemergency physicians, and advanced practice providers. We performed a repeated cross-sectional analysis, from 2013 to 2019, of emergency clinicians who received reimbursement for at least 50 Evaluation and Management services [99281-99285] from Medicare part B within any study year. We calculated the emergency workforce's entry and attrition rates annually. Entry was defined as clinicians newly entering or re-entering the workforce, and attrition was defined as clinicians leaving permanently or temporarily. We stratified the analyses by rural designation and assessed the proportions and state-level changes in clinician density. In total, 82,499 unique clinicians performed at least 50 Evaluation and Management services within any of the 7 study years examined, including 47,000 emergency physicians, 9,029 nonemergency physicians, and 26,470 advanced practice providers. Emergency physicians made up a decreasing proportion of the workforce (68.1% in 2013; 65.5% in 2019), and advanced practice providers made up an increasing proportion of the workforce (20.9% in 2013; 26.1% in 2019). Annually, 5.9% to 6.8% (2,186 to 2,407) of emergency physicians newly entered and 0.8% to 1.4% (264 to 515) re-entered the workforce, whereas 3.8% to 4.9% (1,241 to 1,793) permanently left and 0.8% to 1.6% (276 to 521) temporarily left. Additionally, the total proportion of clinicians practicing in rural designations decreased, and advanced practice providers separately made up a substantially increasing proportion of the rural workforce (23.0% in 2013; 32.7% in 2019). Substantial state-level variation existed in the supply and demand of emergency clinician densities per 100,000 population. The annual rate of emergency physician attrition was collectively more than 5%, well above the 3% assumed in a recently publicized projection, suggesting a potential overestimation of the anticipated future clinician surplus. Notably, the attrition of emergency physicians has disproportionately affected vulnerable rural areas. This work can inform emergency medicine workforce decisions regarding residency training, advanced practice provider utilization, and clinician employment.

Reply by Authors.

No AccessUrology PracticeSpecialty1 Sep 2022Reply by Authorsis a reply to letterEditorial Commentary Tullika Garg, William D. Meeks, R. Matthew Coward, Suzanne B. Merrill, William C. Huang, and Arthur L. Burnett Tullika GargTullika Garg *Correspondence: Department of Urology, Geisinger, 100 N. Academy Ave., Mail Code 01-27, Danville, Pennsylvania 17822 telephone: 570-271-6328; FAX: 570-217-6955; email address: E-mail Address: [email protected] https://orcid.org/0000-0003-2679-7460 Departments of Urology and Population Health Sciences, Geisinger, Danville, Pennsylvania Current institution: Department of Urology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania. More articles by this author , William D. MeeksWilliam D. Meeks Data Management and Statistical Analysis, American Urological Association, Linthicum, Maryland More articles by this author , R. Matthew CowardR. Matthew Coward Department of Urology, University of North Carolina, Chapel Hill, North Carolina UNC Fertility, Raleigh, North Carolina More articles by this author , Suzanne B. MerrillSuzanne B. Merrill Colorado Urology, United Urology Group Affiliate, Denver, Colorado More articles by this author , William C. HuangWilliam C. Huang Departments of Urology and Radiology, NYU Grossman School of Medicine, New York, New York More articles by this author , and Arthur L. BurnettArthur L. Burnett Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000311.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Reply by Authors." Urology Practice, 9(5), p. 490 Reference 1. : The decline in rural medical students: a growing gap in geographic diversity threatens the rural physician workforce. Health Aff (Millwood) 2019; 38: 2011. Google Scholar © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesUrology Practice1 Jun 2022Editorial Commentary Volume 9Issue 5September 2022Page: 490-490 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tullika Garg Departments of Urology and Population Health Sciences, Geisinger, Danville, Pennsylvania *Correspondence: Department of Urology, Geisinger, 100 N. Academy Ave., Mail Code 01-27, Danville, Pennsylvania 17822 telephone: 570-271-6328; FAX: 570-217-6955; email address: E-mail Address: [email protected] Current institution: Department of Urology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania. More articles by this author William D. Meeks Data Management and Statistical Analysis, American Urological Association, Linthicum, Maryland More articles by this author R. Matthew Coward Department of Urology, University of North Carolina, Chapel Hill, North Carolina UNC Fertility, Raleigh, North Carolina More articles by this author Suzanne B. Merrill Colorado Urology, United Urology Group Affiliate, Denver, Colorado More articles by this author William C. Huang Departments of Urology and Radiology, NYU Grossman School of Medicine, New York, New York More articles by this author Arthur L. Burnett Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Expand All Advertisement PDF downloadLoading ...

To stay or not to stay: the role of sense of belonging in the retention of physicians in rural areas

ABSTRACT Rural communities across the circumpolar region and worldwide perennially suffer from physician shortages despite decades of attempting targeted strategies for recruitment. Particularly in rural Canada, financial incentives have attracted but not retained a medical workforce. Although the importance of social connection or belonging is a long-established source of well-being, such information has not infiltrated the dialogue or action on physician retention in rural areas. A physician’s sense of belonging, arising from that emotional need for social connectedness, is built via bilateral active efforts at community engagement, reciprocity, social integration of family and workplace collegiality. Links between rural upbringing, rural training opportunities and subsequent rural practice likely rest upon fostering this sense of belonging. Policymakers and recruiters might consider how to help physicians adapt, “fit in”, and consider they have “come home” when they venture off to rural settings. Empowering the community to be involved in the recruitment and retention of rural physicians may also be effective. Perhaps this approach would better address the age-old battle to retain physicians in rural Canada and around the world.

Experience of Primary Care Physicians in the Aube Department, France, Regarding the COVID-19 Crisis

Background: General practitioners (GPs) played a decisive role during the COVID-19 epidemic, particularly in the identification and care of patients at home. This study aimed to describe the primary care physicians’ perceptions of the COVID-19 crisis and to guide future decisions regarding measures to prolong, abrogate, or improve upon methods for crisis management. Methods: This is a cross-sectional study based on a 30-item questionnaire aiming to investigate how primary care physicians (GPs) working in the rural Aube Department experienced the COVID-19 crisis. Results: Among the 152 respondents, 60.5% were not satisfied with the level of information from authorities during the crisis. By multivariate analysis, a feeling of having been adequately informed (OR 21.87, 95%CI 4.14–115.53) and a feeling that non-COVID-19-related diseases were adequately managed (OR 6.42, 95%CI 1.07–38.51) were both significantly associated with an overall satisfaction with the management of the crisis. Conclusion: This study about rural primary care physicians in Eastern France highlights some of the weaknesses of the French healthcare system in terms of the provision of primary care during the epidemic. A leading cause of dissatisfaction was that the information relayed by the health authorities about the disease and its management largely overlooked the primary care providers, many of whom had to rely on traditional media to obtain information.

Lessons Learned as Thomas Jefferson University's Rural Physician Shortage Area Program (PSAP) Approaches the Half-Century Mark.

To help increase the supply and retention of rural family physicians, Thomas Jefferson University initiated the Physician Shortage Area Program (PSAP) in 1974. The program selectively admits medical school applicants who both grew up in a rural area and plan to practice in a rural area. During medical school, PSAP students have ongoing mentoring and rural clinical experiences. As the program now approaches the half-century mark, this commentary summarizes several important lessons learned. First, outcomes research is critical, and program leaders have been able to publish 15 papers and a book about the PSAP and its outcomes. Second, these studies have shown that the program has been highly successful, with PSAP graduates 8.5-9.9 times more likely to enter rural family medicine than their peers, and that the PSAP contributed 12% of all rural family physicians in Pennsylvania. Other similar medical school rural programs have had comparable success, with more than half of all graduates combined (including PSAP graduates) practicing rural. Third, long-term retention has a multiplicative impact. Long-term retention of PSAP graduates in rural family medicine was greater than 70% after 20-25 years. Fourth, research has shown that the admissions component accounted for approximately three-quarters of the PSAP's success. Three factors available at the time of matriculation (rural background, plans for rural practice, and plans for family medicine) identified almost 80% of all Jefferson graduates in rural practice 3 decades later. Having a peer group with similar backgrounds, mentoring, and the rural curriculum were also very important. Fifth, wanting to live rural appears key to the rural practice decision. Finally, given that medical school programs like the PSAP produce substantial increases in the supply and retention of rural physicians while requiring modest resources, medical schools can have a critical role in addressing the rural physician shortage.

Teams of rural physicians matter: Testing a framework of team effectiveness.

To examine how rural physician team effectiveness predicts outcomes of team performance, team commitment, and intentions to stay. Surveys measuring team climate, team efficacy, and team performance were sent to rural physician team members. Surveys measuring team performance were sent to external observers in supervisory positions. Northern Ontario communities. Rural physicians and external observers, the latter including hospital chief executive officers, family health team executive directors, and clinic managers. Total scale scores were generated using mean substitution. Cronbach α was used to assess internal consistencies of team member-level measures. Team-level measures were created by averaging the responses across team members, and intraclass correlation coefficients for each scale of each team of 2 or more members were calculated to yield a measure of rating consistency. A t test was used to assess the possible difference between team performance ratings by team members and external observers. Team-level relationships within the team effectiveness model were assessed using mediated regression, and generalized estimating equations were used to assess the relationships in the model between team-level (team efficacy) and individual-level (affective team commitment and intentions to stay) variables to address the nonindependence of these data. Overall, 70 rural physicians from 26 Rural and Northern Physician Group Agreement communities with 2 or more physicians and 25 external observers from 19 of the 26 Rural and Northern Physician Group Agreement communities participated in the study. The findings showed that team climate (composed of decision making, communication, and conflict resolution measures) positively predicted team efficacy, which in turn positively predicted team performance. This fully mediated set of relationships held whether team performance was rated by the physicians themselves or by the external observers. Team efficacy significantly predicted affective team commitment (b value=0.69, standard error=0.08, Wald =13.89, P<.001) in the first analysis and intentions to stay (b value=0.34, standard error=0.15; Wald =5.42, P=.020) in the second analysis. However, when the other variables impacting physician retention were added to the model in predicting intentions to stay, team efficacy did not predict it above and beyond these additional predictors. The findings support initiatives that attempt to enhance physician team effectiveness in rural physician teams by influencing team decision making, communication, and conflict resolution to improve team performance, physician attitudes, and commitment.

Prevalence rate and risk factors of human cystic echinococcosis: A cross-sectional, community-based, abdominal ultrasound study in rural and urban north-central Chile.

BackgroundCystic echinococcosis (CE) caused by Echinococcus granulosus sensu lato (s.l.) is a neglected and underdiagnosed parasitic zoonosis that has a significant socioeconomic impact on rural communities relying on livestock farming. CE is endemic across Latin America, including Chile, where the Coquimbo region exhibits a relatively high record of hospital-based human cases and infected animals. However, the incidence of hospitalized CE cases may underestimate the real burden of infection in a population, since the majority of cases never reach medical attention or official disease records.Methodology/Principal findingsIn 2019, a cross-sectional, community-based study was conducted with the objectives of estimating for the first time the prevalence of human abdominal CE using abdominal ultrasound (US) screening in volunteers residing in urban and rural localities of the Monte Patria municipality located in Limarí province, Coquimbo region, Chile, and identifying the risk factors associated with human infection. Pre-screening activities included a 16-h lecture/hands-on training aimed at rural physicians that focused on the diagnosis of CE by US, based on current WHO recommendations. A total of 2,439 (~8% of municipality inhabitants) people from thirteen target localities were screened by abdominal US in June-July 2019. We found an overall CE prevalence of 1.6% (95% CI 1.1–2.2) with a significantly higher likelihood of infection in rural localities, older age classes and people drinking non-potable water; 84.6% of infected volunteers were newly diagnosed with CE. Cysts were either in active or inactive stages in equal proportions; active cysts were detected in all age classes, while 95.7% of inactive cysts occurred in >40 years-old subjects.Conclusions/SignificanceThis is the first US survey aimed at detecting human infection caused by Echinococcus granulosus s.l. in Chile. Our findings indicate a high CE prevalence in the area, and contribute to define the demographic and behavioral risk factors promoting the transmission of the parasitic infection within target communities. Our results support the implementation of cost-effective strategies for the diagnosis, treatment and control of CE, and the need to improve the epidemiological surveillance system in Chile.

Psychological Impacts of the COVID-19 Pandemic on Rural Physicians in Ontario: A Qualitative Study.

Frontline rural physicians in Canada are vulnerable to the psychological impacts of the COVID-19 pandemic considering their high pre-pandemic burnout rates as compared to their urban counterparts. This study aims to understand the psychological impacts of the COVID-19 pandemic on rural family physicians engaged in full-time primary care practice in Ontario and the stressors behind any identified challenges. Recruitment combined purposive, convenience, and snowball sampling. Twenty-five rural physicians participated in this study. Participants completed a questionnaire containing Patient Health Questionnaire-2 (depression), General Anxiety Disorder-2 (anxiety), and Perceived Stress Scale-4 (stress) screening as well as questions exploring self-reported perceptions of change in their mental health, followed by a semi-structured virtual interview. Quantitative data showed an overall increase in self-reported depression, anxiety, and stress levels. Thematic analysis revealed seven qualitative themes including the positive and negative psychological impacts on rural physicians, as well as the effects of increased workload, infection risk, limited resources, and strained personal relationships on the mental health of rural physicians. Coping techniques and experiences with physician wellness resources were also discussed. Recommendations include establishing a rapid locum supply system, ensuring rural representation at decision-making tables, and taking an organizational approach to support the mental health of rural physicians.

The Prescription Pattern in the Treatment of Acute Insomnia among Rural Physicians as per the NICE Guidelines

The Prescription Pattern in the Treatment of Acute Insomnia among Rural Physicians as per the NICE Guidelines

Performance on the American Board of Physical Medicine and Rehabilitation certifying examinations: Rural and urban physicians.

Over 60 million people in the United States live in a rural community making up approximately 20% of the population. Data are minimal about the physiatrists who serve this rural population, their performance on certification examinations and how the American Board of Physical Medicine and Rehabilitation (ABPM&R) serves their ongoing educational, assessment, and practice needs. To compare the performance of rural and urban physicians on the Part I, Part II, and maintenance of certification (MOC) examinations along with subspecialty preference and continuance of primary certification. Retrospective cross-sectional study. Board-eligible PM&R physicians and certified diplomates of the ABPM&R. Physicians who participated in an initial certification or maintenance of certification examination with the ABPM&R between 2010 and 2019. Comparisons of physician pass rates, mean scaled scores (aggregates), and program pass rates on ABPM&R certifying examinations were completed. Cross-reference to national database and ABPM&R practice site zip codes provided sociogeographic linkage. Not applicable MAIN OUTCOME MEASURES: Physician mean scaled scores, pass rates, subspecialty preferences, and primary certification status. There were no meaningful differences in performance on the ABPM&R Part I, II, and MOC examinations between rural and urban physiatrists. Most common subspecialty is the pain medicine certification whose diplomates most frequently drop their primary certification. Pediatric rehabilitation medicine certification is rare in rural localities and a health care disparity. The study found no meaningful differences in the performance of rural and urban physicians on the ABPM&R certifying examinations.

Family Medicine and Emergency Redeployment: Unrealized Potential.

Discussions of scope of practice among family physicians has become a crucial topic amidst the COVID-19 pandemic, coupled with new attention to residency training requirements. Family medicine has seen a gradual narrowing of practice due to a host of issues, including physician choice, expanding scope of practice from physician assistants and nurses, an increased emphasis on patient volume, clinical revenue, and residency training competency requirements. We sought to demonstrate the flexibility of the family medicine workforce as shown through their scopes of practice, and argue that this is indication of their potential for redeployment during emergencies. This study computes scopes of practice for 78,416 family physicians who treat Medicare beneficiaries. We used Evaluation and Management (E/M) codes in Medicare's 2017 Part-B public use file to calculate volumes of services done across six sites of service per physician. We aggregated counts and proportions of physicians and the E/M services they provided across sites of practice to characterize scope, and performed a separate analysis on rural physicians. The study found most family physicians practicing at a single site, namely, the ambulatory clinic. However, family physicians in rural areas, where need is greater, exhibit broader scope. This suggests that a significant number of family physicians have capacity for COVID-19 deployment into other settings, such as emergency rooms or hospitals. Family physicians are a potential resource for emergency redeployment, however the current breadth of scope for most family physicians is not aligned with current residency training requirements and raises questions about the future of family medicine scope of practice.

Job satisfaction of graduates of rural oriented medical students training project in Jiangsu Province, China: a cross-sectional study

BackgroundThe Chinese government has worked out the “Rural Oriented Medical Students Training Project” to address physician maldistribution, which attempted to train physicians for rural areas. The present study attempted to evaluate the job satisfaction of the graduates of this project in Jiangsu Province, China.MethodsOnline questionnaires were sent to the graduates of the “Rural Oriented Medical Students Training Project” (group A) and their colleagues, who were rural physicians recruited from different sources (group B). The study was approved by the Ethics Committee of Xuzhou Medical University, and the approval number was 2,018,057. Information on demographic characteristics, work conditions, and self-reported satisfaction was collected to compare the satisfaction differences between the two recruited rural physicians using the Chi-square test and Mann–Whitney U test. Additionally, factors correlated to the satisfaction of group A were assessed using multivariate linear regression. Statistical analysis was performed using SPSS 23.0 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered statistically significant.ResultsGroup A exhibited moderate satisfaction (2.81 ± 0.687). The satisfaction score from the highest to the lowest was for occupational ecology, life satisfaction, stress, competency, and internal environment. Positive factors related to the satisfaction of group A were area, monthly income, working hours per week, professional title, and post.ConclusionThe satisfaction of the graduates of the “Rural Oriented Medical Students Training Project” was moderate. Factors related to satisfaction included economic incentives, workload, and professional confidence. Possible solutions for increasing satisfaction should consist of economic support and possible ways to improve the professional identification of these graduates.

Northern Ontario's Rural Physician Teams: Who, why and for how long.

This study examines the state of Rural and Northern Physician Group Agreement (RNPGA) physician teams in rural Northern Ontario in terms of demographics, intent to stay, length of stay, number of physicians relative to the RNPGA-designated complement and perceptions of various workplace and community factors. Data were based on a survey mailed, in 2018, to Ontario physicians in RNPGA communities having a designated complement of 2 or more physicians. Physicians reported on aspects of the work environment, community and intentions to stay. Sixty-five percent of all practices and 91.7% of those with a designated complement of 2 physicians were at or above their government-designated complement. Intent to stay was higher in groups below complement. The mean length of stay was 11.3 years. More physicians were male (58.7%). Older physicians were more represented in smaller practice groups. Physicians reported positive ratings on several aspects of their work environment, community and intentions to stay. Length of stay in the community was related to strong family ties and was a predictor of intent to stay. Many physicians had neither strong family ties (65.3%) nor a rural upbringing (57.3%). The results show positive outcomes in terms of: high intentions to stay, satisfaction with workplace and community factors, and full recruitment into RNPGA groups designated for a complement of two physicians. Further research is needed to understand the role of family ties to length of stay, and the role of level of physician complement and group size in retention and recruitment.

Income, workload, and any other factors associated with anticipated retention of rural doctors?

The turnover of rural doctors, including doctors who leave clinical practice in rural areas, may disrupt the continuity of care. Though strategies had been formulated to address the problems associated with low retention rates, they proved to be unrewarding. This study aimed to investigate how we could anticipate the loss of rural doctors to facilitate their retention in advance. We conducted a cross-sectional survey and collected data from rural doctors in Jiangsu Province. Research on the employment status of target admission graduates in Jiangsu. Multi-stage stratified sampling methods were employed to select the respondents in this study. We selected 722 rural physicians, who represented all the rural physicians from Northern, Central, and Southern Jiangsu. Factors affecting anticipated rural retention (odds ratios (OR)). The anticipated rural retention rate was 72.8% for the 722 respondents from Jiangsu province. Economically developed work areas (ORCentral JS = 0.501, ORSouthern JS = 0.475), a higher monthly income (OR 3000∼ = 0.584, OR6000∼ = 0.255), and an advanced rank among counterparts (OR = 0.507) were protective factors for anticipated rural retention. Risk factors involved the monthly expenditure, mainly for socialization with others (OR = 1.856), working hours of more than 50 hours/week (OR = 2.076), assignment of outpatient work (OR = 1.991), and filing work (OR = 1.544) as the main tasks on a daily basis. A combination of strategies, including the strengthening of economic incentive as well as the ability to deal with a heavy workload, could increase the recruitment and retention rate in Jiangsu Province.

Systemic challenges and resiliency in rural family practice

The objective of our study was to understand how Canadian rural family physicians (RFPs) define and use resilience strategies to maintain their roles as generalists and resist burnout, while also understanding how organisational supports and systems may play a role. This was a qualitative study of RFPs with at least 1 year of experience working in rural Canada. Data were collected via semi-structured, in-depth interviews using a grounded theory approach. The participant recruitment process involved purposive and theoretical sampling, and was stopped when theoretical saturation was reached. RFPs identified the following five themes related to resilience: (1) powerlessness, (2) strained work/life balance, (3) colleagues as supportive or straining, (4) living under the microscope and (5) compassion fatigue or empathy. Strategies to enhance resilience were identified at personal, community and organisational levels by participants. Enhancing RFPs' awareness of the specific individual and organisational strategies, as well as system-oriented solutions to maintain resilience, is of benefit to RFPs and rural and remote communities across Canada.

What Moves Physicians to Work in Rural Areas? An In-Depth Examination of Physician Practice Location Decisions

This study contributes to the current understanding of what drives physicians to practice in rural areas by analyzing new, comprehensive survey data of practicing physicians in the United States. This research confirmed that rural origin is a powerful and reliable predictor for rural practice and revealed that new and experienced physicians have different priorities regarding location choice. Physicians choosing rural practice locations are more likely to be motivated by compensation, the resemblance of the environment to the one they grew up in, patient needs, and prenegotiated service obligations or visa/immigration status. They are less likely to attribute their location choice to social network proximity. These findings have important implications for salary incentives and policy initiatives aimed at increasing the rural physician workforce. The results of this study will help decrypt the difficulties rural areas face in attracting and retaining medical and other professionals and inform policy development.

Follow-up care delivery in community-based hypertension and type 2 diabetes management: a multi-centre, survey study among rural primary care physicians in China

BackgroundFollow-up care is crucial but challenging for disease management particularly in rural areas with limited healthcare resources and clinical capacity, yet few studies have been conducted from the perspective of rural primary care physicians (PCPs). We assessed the frequency of follow-up care delivered by rural PCPs for hypertension and type 2 diabetes – the two most common long-term conditions.MethodsWe conducted a multi-centre, self-administered survey study built upon existing general practice course programmes for rural PCPs in four provinces. Information on follow-up care delivery were collected from rural PCPs attending centralised in-class teaching sessions using a set of close-ended, multiple choice questions. Binary logistic regression analysis was performed to examine physician-level factors associated with non-attainment of the target frequency of follow-up care for hypertension and type 2 diabetes, respectively. The final sample consisted of rural PCPs from 52 township-level regions. The Complex Samples module was used in the statistical analysis to account for the multistage sample design.ResultsThe overall response rate was 91.4%. Around one fifth of PCPs in rural practices did not achieve the target frequency of follow-up care delivery (18.7% for hypertension; 21.6% for type 2 diabetes). Higher education level of physicians, increased volume of daily patients seen, and no provision of home visits were risk factors for non-attainment of the target frequency of follow-up care for both conditions. Moreover, village physicians with less working experiences tended to have less frequent follow-up care delivery in type 2 diabetes management.ConclusionsEfforts that are solely devoted to enhancing rural physicians’ education may not directly translate into strong motivation and active commitment to service provision given the possible existence of clinical inertia and workload-related factors. Risk factors identified for target non-attainment in the follow-up care delivery may provide areas for capacity building programmes in rural primary care practice.

Association of professional pre-qualifications, study success in medical school and the eligibility for becoming a physician: A scoping review.

BackgroundLiterature, individual experiences and common considerations suggest that prior professional qualification can be an advantage for later career development. For instance, in Germany, professional pre-qualification has been honored by medical faculties in selection procedures for several years. However, a systematic evaluation of this relationship lacks. This scoping review summarizes existing literature and addresses the role of prior professional pre-qualifications on objective or subjective study success and the choice of a specialization.MethodsThe scoping review was performed oriented on the PRISMA guidelines. PsycINFO and PubMed databases were searched for relevant studies that included data of medical students with and without professional pre-qualifications. To answer the underlying research questions, this scoping review also includes studies that examine professional pre-qualifications in association with non-cognitive "soft" criteria.Results and further directions1055 items were identified and reviewed by two independent reviewers with final 11 studies were included for this scoping review. The results of identified studies that report possible effects of prior pre-professional qualifications are inconclusive but suggest that prior professional qualifications tend not to have rather an advantage on study success. Medical school success for students with prior professional qualifications tended to be below average in the preclinical setting, and there were no differences in the clinical setting compared with students without prior professional qualifications. The influence of professional pre-qualifications has not yet been adequately studied without the moderator variable “waiting time” and “A-levels grade”. The scoping review indicates insufficient number of articles stating a co-relation of prior pre-qualifications and subjective data. Again, the results found are not sufficient to state a clear relationship between professional pre-qualifications and the choice of a specific speciality preference. However, professional pre-qualifications, both in medicine and as "practical experience in rural areas", tend to be beneficial for the choice of becoming a rural physician. Large-scale cross-sectional and longitudinal studies are needed to investigate the influence of professional pre-qualifications on different study trajectory parameters.