Rural Primary Care Physicians Research Articles

The Role of Telemedicine in Rural Specialty Care: Priorities and Recommendations From Rural Primary Care Physicians.

The study goal was to understand telemedicine's role in improving access to rural specialty care. Other outcomes included assessing specialty availability and frequency of referrals at rural sites. This mixed methods study included surveys and semi-structured interviews of rural primary care physicians (PCPs). Survey data were analyzed with summary statistics and cross-tabulations. Interview transcripts were inductively thematically analyzed. Of the 19 PCPs who completed the survey, 37% agreed/strongly agreed current telemedicine practices connected patients to better specialty care; 90% agreed/strongly agreed it had such potential. Interviews revealed telemedicine could improve care when local specialists were unavailable and provided the most benefit in acute care settings or specialist follow-ups. Most survey respondents reported outreach specialists were highly effective in addressing rural specialty care needs. Respondents reported cardiology, general surgery, orthopedic surgery, ENT/otolaryngology, and dermatology as the most frequently referred-to specialties. In-person neurology, gastroenterology, and dermatology were unavailable in many communities. Respondents identified psychiatry as a high priority for telemedicine and discussed clinic-to-clinic visits to optimize telemedicine use. The perceived discrepancy between the current and potential roles of telemedicine in rural specialty care suggests that telemedicine may not fully align with the needs of rural patients and could be optimized for rural practice settings. While local, in-person access to specialists remains a priority, telemedicine can reduce patient burdens and improve care when in-person specialists are unavailable. Telemedicine proponents can identify high-priority areas for implementation through quantitative assessment of specialty care utilization and access as reported by PCPs.

A Comparison of Rural and Urban Primary Care Physicians’ Comfort Level of Providing Sexual Healthcare Practices to Adolescent Patients

A Comparison of Rural and Urban Primary Care Physicians’ Comfort Level of Providing Sexual Healthcare Practices to Adolescent Patients

The Future of Nursing 2020–2030: Charting a path to achieve health equity

The Future of Nursing 2020–2030: Charting a path to achieve health equity

Impact of training on primary care physicians' management of depression and anxiety disorders in rural China.

Primary care physicians (PCPs) in rural township health centers are the most easily accessible doctors to the residents in rural China, which covers 35% of the population. High prevalence of depression was reported among rural left-behind elderly and children as many workers had migrated to urban cities. This study explored mental health care provision by PCPs in rural China and the association with their training background. Rural township health centers in both developed and less developed counties of Zhejiang Province, China were chosen as the study sites. A total of 697 PCPs completed questionnaires between December 2019 and January 2020, and the number of valid questionnaires was 673, with a valid response rate of 79.3%. The rural PCPs reported a median range of seeing 1 to 5 mental health patients per week. Over two-thirds (68.2%) of the respondents had never received any training on treating common mental health disorders (depression and anxiety) while 20.3% received at most 2 days of training; 6.4% received 3 to 20 days of training; and 5.1% received over 20 days of training. PCPs with mental health training were significantly associated with better mental health care in terms of confidence and practice characteristics (e.g. having patients who brought up mental health issues, providing follow-up), while years of practice made a difference in practice but not confidence. Training is the key determinant of the practice of mental health care by the PCPs in rural China. Our findings have implications for national policy to target two-thirds of rural PCPs who received no mental health training.

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.

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.

Reach Outcomes and Costs of Different Physician Referral Strategies for a Weight Management Program Among Rural Primary Care Patients: Type 3 Hybrid Effectiveness-Implementation Trial.

BackgroundRural residents are at high risk for obesity; however, little resources exist to address this disproportional burden of disease. Primary care may provide an opportunity to connect primary care patients with overweight and obesity to effective weight management programming.ObjectiveThe purpose of this study is to examine the utility of different physician referral and engagement processes for improving the reach of an evidence-based and technology-delivered weight management program with counseling support for rural primary care patients.MethodsA total of 5 rural primary care physicians were randomly assigned a sequence of four referral strategies: point-of-care (POC) referral with active telephone follow-up (ATF); POC referral, no ATF; a population health registry–derived letter referral with ATF; and letter referral, no ATF. For registry-derived referrals, physicians screened a list of patients with BMI ≥25 and approved patients for participation to receive a personalized referral letter via mail.ResultsOut of a potential 991 referrals, 573 (57.8%) referrals were made over 16 weeks, and 98 (9.9%) patients were enrolled in the program (58/98, 59.2% female). Differences based on letter (485/991, 48.9%) versus POC (506/991, 51.1%) referrals were identified for completion (100% vs 7%; P<.001) and for proportion screened (36% vs 12%; P<.001) but not for proportion enrolled (12% vs 8%; P=.10). Patients receiving ATF were more likely to be screened (47% vs 7%; P<.001) and enrolled (15% vs 7%; P<.001) than those not receiving ATF. On the basis of the number of referrals made in each condition, we found variations in the proportion and number of enrollees (POC with ATF: 27/190, 50%; POC no ATF: 14/316, 41%; letter ATF: 30/199; 15.1%; letter no ATF: 27/286, 9.4%). Across all conditions, participants were representative of the racial and ethnic characteristics of the region (60% female, P=.15; 94% White individuals, P=.60; 94% non-Hispanic, P=.19). Recruitment costs totaled US $6192, and the overall recruitment cost per enrolled participant was US $63. Cost per enrolled participant ranged from POC with ATF (US $47), registry-derived letter without ATF (US $52), and POC without ATF (US $56) to registry-derived letter with ATF (US $91).ConclusionsLetter referral with ATF appears to be the best option for enrolling a large number of patients in a digitally delivered weight management program; however, POC with ATF and letters without ATF yielded similar numbers at a lower cost. The best referral option is likely dependent on the best fit with clinical resources.Trial RegistrationClinicalTrials.gov NCT03690557; http://clinicaltrials.gov/ct2/show/NCT03690557

Primary care physicians’ perceptions of the role of alternative payment models in recruitment and retention in rural Alberta: a qualitative study

Background:Despite well-documented challenges in recruiting physicians to rural practice, few Canadian studies have described the role physician payment models may play in attracting and retaining physicians to rural practice. This study examined the perspectives of rural primary care physicians on the factors that attract and retain physicians in rural locations, including the role that alternative payment models (APMs) might play.Methods:This was a qualitative study involving in-depth, open-ended interviews with rural primary care physicians practising under fee-for-service (FFS) models and APMs in Alberta, Canada. Participants were recruited from the Rural Health Professions Action Plan member list (consisting of physicians practising in rural or remote locations in Alberta) and the College of Physicians and Surgeons of Alberta online database. Interviews were conducted April to June 2020, and data were analyzed using a thematic framework approach.Results:Fourteen physicians were interviewed. There were 5 themes identified: factors that attract physicians to rural practice, barriers and challenges associated with rural practice, the potential role of APMs in recruitment and retention, factors that physicians consider in deciding to change payment models, and physician perceptions of APMs compared with FFS models. Participants expressed that APMs may have some role to play in retaining rural physicians but identified professional challenges, and family-related and personal factors as key determinants. Most FFS physicians indicated that they were interested in exploring APMs provided specific concerns were addressed (e.g., clear and adequately compensated APM contracts, and physician involvement in the development of APMs).Interpretation:Primary care physicians practising in rural regions in Alberta view payment models as one consideration among many in their decision to pursue rural practice. Alternative payment model contracts designed with the input of physicians may have a role to play in attracting and retaining physicians to rural practice.

Improving Effective Mental Health Consultation for Rural Older Adults Living With Depression and Pain: Learning From the Experiences of Rural Primary Care Physicians.

Novel approaches are needed to assist rural primary care physicians (PCPs) in caring for older patients living with depression and pain who are at an elevated suicide risk. To refine and improve a model of care (PREDICTOR: Pharmacy Identification and Primary Care Intervention of Older Adults at Risk for Suicide), we conducted qualitative interviews with rural PCPs about (1) caring for seniors with depression, pain, and suicidality and (2) their favored procedures for working with psychiatric consultants and the professional characteristics desired in an effective consultant. The study utilized a best-practice approach (including double coding) for qualitative interviews with 10 PCPs practicing in rural Pennsylvania. PCPs were interviewed about 3 themes related to caring for older adults with depression, pain, and suicidal ideation and working with psychiatric consultants. The study was conducted from January 2019 to May 2019. Four primary themes emerged from the interviews. (1) Rural PCPs become comfortable managing depression in older adults out of necessity, but desire collaboration on more complex mental health care. (2) Comorbid depression and pain are universally described as related through a vicious cycle in older adults. (3) Rural PCPs experience varying comfort with prescribing opioids for pain management in older patients, but most prefer not to prescribe opioids, and some refuse to do so. (4) PCPs endorsed the PREDICTOR remote consultation model as potentially beneficial to themselves and their older patients, but strongly desired that the consultant work with them as collaborators and for a collegial professional relationship with the mental health specialist. Rural PCPs are comfortable with remote consultation for older patients living with depression but desire collegial relationships with these consultants, supporting a collaborative approach. We describe explicit plans for implementing these findings as we refine PREDICTOR, in efforts to promote PCP practice change.

Information outreach interventions to promote the information access, use and exchange in the rural areas of Pakistan

PurposeThis study is a part of the doctoral dissertation that proposes concrete measures to improve health-care information outreach program for rural health-care professionals in primary and secondary health care in Punjab, Pakistan. This study aims to report on the barriers to accessing and using online health-care information from rural settings of the Punjab province of Pakistan.Design/methodology/approachA cross-sectional survey was conducted in primary and secondary health-care settings in the Punjab province of Pakistan. The study’s population consisted of the rural primary care physicians (PCPs), who were geographically dispersed across 2,873 different remote health-care settings across Punjab. These practice settings included 2,455 basic health units, 293 rural health centers, 89 tehsil headquarter hospitals and 36 district headquarter hospitals.FindingsLimited internet access, non-availability of required equipment and lack of training facilities were identified as the main barriers. PCPs’ gender, previous enrollment in post-graduation programs and type of health-care facility were significant factors in the perceived barriers related to both “non-availability of required equipment” and “inadequate training facilities on the use of information resources”.Practical implicationsThe findings of the study hold some important practical implications for different stakeholders. This study identifies and addresses the barriers to accessing and using health-care information for PCPs in rural settings. The success of the health-care information outreach program in Punjab, Pakistan, should rely on the eradication of these barriers.Originality/valueTo the best of the authors’ knowledge, this is the first large-scale study in Pakistan that assesses the barriers and proposes ways to overcome these barriers to effectively access and use health-care information.

CME Test for Test for Likelihood of Normal ABI Increases With Physiologic Testing Referrals From Rural Primary Care Physicians

CME Test for Test for Likelihood of Normal ABI Increases With Physiologic Testing Referrals From Rural Primary Care Physicians

Likelihood of Normal ABI Increases With Physiologic Testing Referrals From Rural Primary Care Physicians

Disparities in diagnostic capabilities have been noted between rural and urban health care facilities. We believe the clinical evaluation of peripheral arterial disease (PAD) by rural physicians may be similarly affected. Patients referred for arterial physiologic testing in an urban and rural regional health care network for a consecutive 7-month period were reviewed. Patients were classified into 3 groups based on referring physician specialty: (1) vascular surgeon or vascular medicine specialist (Vasc), (2) urban primary care physician (Urban), and (3) rural primary care physician (Rural). Normal patients were defined by a posterior tibial (PT) or dorsalis pedis (DP) ankle-brachial index (ABI) of ⩾0.90, bilaterally. Abnormal patients had both PT and DP ABI &lt;0.90 in one or both extremities. Group comparisons were made for normal and abnormal patients, age (⩾65 years old), and gender. Patients with history of amputations, angioplasty, bypass graft, stent, calcification (PT or DP ABI ⩾1.30), and previous physiologic testing outside the designated period of analysis were considered a separate subclassification and analyzed separately. Emergency room referrals, inpatients, and patients with incomplete examination data were excluded from the analysis. A total of 430 patient exams were evaluated. Group-Rural had significantly greater numbers of normal ABI patients compared with Group-Urban ( P = .0028) and Group-Vasc ( P = .0000). No significant differences were noted between all groups for age and gender. Substantial disparities were noted in normal and abnormal ABI patients between rural health care physicians and their urban primary care and vascular specialist counterparts. Significantly greater numbers of normal ABI referrals by rural primary care physicians may warrant enhanced PAD diagnosis education or telemedicine alternatives.

Implementing pharmacogenetic testing in rural primary care practices: a pilot feasibility study.

Aim: Assess feasibility and perspectives of pharmacogenetic testing/PGx in rural, primary care physician (PCP) practices when PCPs are trained to interpret/apply results and testing costs are covered. Methods: Participants included PCPs who agreed to training, surveys and interviews and eligible patients who agreed to surveys and testing. 51 patients from three practices participated. Results: Prestudy, no PCP had ever ordered a PGx test. Test results demonstrated gene variations in 30% of patients, related to current medications, with PCPs reporting changes to drug management. Poststudy, test cost was still a concern, but now PCPs reported practical barriers, including the utilization of PGx results over time. PCPs and patients had favorable responses to testing. Summary: PGx testing is feasible in rural PCP practices.

Analysis of Sexually Transmitted Diseases Within the Patient Population at a Student-Run Free Clinic.

Uninsured patients living in rural areas of North Carolina have been inordinately affected by the increasing prevalence of sexually transmitted diseases (STDs) in the midst of severe budget cuts to treatment programs and a shortage of rural primary care physicians. The Campbell University Community Care Clinic, a self-funded, student-run clinic, provides free health care to uninsured residents of rural Harnett County. As a relatively new clinic serving a unique population, epidemiologic research is paramount to the clinic's continued efficacy. To determine which STDs are present in this patient population and to identify demographic groups at higher risk of contracting STDs. This study was a retrospective analysis of patient medical records from March 1, 2015, to March 6, 2018. Records were evaluated to identify STD cases based on diagnostic information, such as primary diagnoses, positive laboratory results, and clinical indicators. A total of 449 patient records were analyzed, revealing an STD incidence rate of 5.3%, which represents a higher STD frequency than the national average of 2%. Our results identified human papillomavirus infection and gonorrhea as the most frequent STDs (n=7 [29.2%] and n=6 [25%], respectively), followed by chlamydia (n=4 [16.7%]), herpes simplex virus (n=4 [16.7%]), syphilis (n=2 [8.3%]), hepatitis C virus (n=2 [4.2%]), trichomoniasis (n=1 [4.2%]), and HIV (n=1 [4.2%]) infections. Among racial/ethnic groups, Hispanics had a slightly higher relative risk (RR) for STDs by a factor of 1.3 when normalized to the average frequency. Patients aged 26 to 29 and 30 to 39 years had a significantly higher RR for STDs: 2.1 and 2.0, respectively. Furthermore, female patients had an STD frequency 3 times that of male patients. This study reveals noteworthy health risks in a rural uninsured population, including a higher rate of gonorrhea compared with national rates and a higher RR for STDs in certain demographic groups. These findings form a foundation for improvements in care through earlier STD diagnoses, effective treatment, and enhanced patient education.

Periodontal Disease and Diabetes: Perceptions, Communication, and Referral Between Rural Primary Care Physicians and Dentists.

Background and objective.Connections between oral health and systemic disease, specifically diabetes, are well described in the literature. Screening strategies for diabetes in dental settings and dental screenings in diabetes care settings exist. The purpose of this study was to evaluate the communication and referral patterns between dentists and physicians in a rural state with respect to recognition of dental disease and diabetes.Methods.Surveys were sent to the members of the North Dakota Academy of Family Physicians, the North Dakota Medical Association, and the North Dakota Dental Association.Results.Overall, 85 responses were collected, with 100% of responding physicians and dentists answering “yes” to a perceived link between oral and systemic health. Physician respondents tended to make a referral for dental evaluation in patients with prediabetes or diabetes more often than dentists referred patients with periodontal disease to physicians.Conclusion.Awareness of the link between dental disease and diabetes and of the need for referral is higher among physicians than among dentists. Opportunity exists to improve awareness and increase referrals.

Telegerontology as a Novel Approach to Address Health and Safety by Supporting Community-Based Rural Dementia Care Triads: Randomized Controlled Trial Protocol.

BackgroundTelegerontology is an approach using videoconferencing to connect an interdisciplinary team in a regional specialty center to patients in rural communities, which is becoming increasingly practical for addressing current limitations in rural community-based dementia care.ObjectiveUsing the remotely-delivered expertise of the Telegerontology dementia care team, we aim to enhance the caregiver/patient/physician triad and thereby provide the necessary support for the person with dementia to “age in place.”MethodsThis is a cluster randomized feasibility trial with four rural regions in the province of Newfoundland and Labrador, Canada (2 regions randomly assigned to “intervention” and 2 to “control”). The study population includes 22 “dementia triads” that consist of a community-dwelling older Canadian with moderate to late dementia, their family caregivers, and their Primary Care Physician (PCP). Over the 6-month active study period, all participants will be provided an iPad. The intervention is intended as an adjunct to existing PCP care, consisting of weekly Skype-based videoconferencing calls with the Telegerontology physician, and other team members as needed (occupational therapist, physical therapist etc). Control participants receive usual community-based dementia care with their PCP. A baseline (pre-) assessment will be performed during a home visit with the study team. Post intervention, 6- and 12-month follow-up assessments will be collected remotely using specialized dementia monitoring applications and Skype calls. Primary outcomes include admission to long-term care, falls, emergency room visits, hospital stays, and caregiver burden.ResultsResults will be available in March of 2018.ConclusionsResults from this study will demonstrate a novel approach to dementia care that has the potential to impact both rural PCPs, family caregivers, and people with dementia, as well as provide evidence for the utility of Telegerontology in models of eHealth-based care.

The Road to Rural Primary Care: A Narrative Review of Factors That Help Develop, Recruit, and Retain Rural Primary Care Physicians.

To examine the literature documenting successes in recruiting and retaining rural primary care physicians. The authors conducted a narrative review of literature on individual, educational, and professional characteristics and experiences that lead to recruitment and retention of rural primary care physicians. In May 2016, they searched MEDLINE, PubMed, CINAHL, ERIC, Web of Science, Google Scholar, the Grey Literature Report, and reference lists of included studies for literature published in or after 1990 in the United States, Canada, or Australia. The authors identified 83 articles meeting inclusion criteria. They synthesized results and developed a theoretical model that proposes how the findings interact and influence rural recruitment and retention. The authors' proposed theoretical model suggests factors interact across multiple dimensions to facilitate the development of a rural physician identity. Rural upbringing, personal attributes, positive rural exposure, preparation for rural life and medicine, partner receptivity to rural living, financial incentives, integration into rural communities, and good work-life balance influence recruitment and retention. However, attending medical schools and/or residencies with a rural emphasis and participating in rural training may reflect, rather than produce, intention for rural practice. Many factors enhance rural physician identity development and influence whether physicians enter, remain in, and thrive in rural practice. To help trainees and young physicians develop the professional identity of a rural physician, multifactorial medical training approaches aimed at encouraging long-term rural practice should focus on rural-specific clinical and nonclinical competencies while providing trainees with positive rural experiences.

Overcoming Barriers to Implementing Electronic Health Records in Rural Primary Care Clinics

Medicare-eligible physicians at primary care practices (PCP) that did not implement an electronic health record (EHR) system by the end of 2015 face stiff penalties. One year prior to the 2015 deadline, approximately half of all primary clinics have not implemented a basic EHR system. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants’ experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the southeastern region of Missouri. Participant perceptions were elicited regarding overcoming barriers to implementing EHRs systems as manadated by federal legislation. Interview questions were transcribed and processed through qualitative software to discern themes of how rural PCP physicians and physician assistants might overcome barriers to implementing electronic health records. Through the exploration of the narrative segments, 4 emergent themes were common among the participants including (a) limited finances to support EHRs, (b) health information exchange issues, (c) lack of business education, and (d) lack of change management at rural medical practices. This study may provide rural primary care physicians and administrators with strategies to promote the adoption of EHRs, provide cost efficient business services, and improve change management plans.

The Canadian Otolaryngology-Head and Neck Surgery Workforce in the Urban-Rural Continuum: Longitudinal Data from 2002 to 2013.

Objectives To evaluate the proportion of otolaryngology-head and neck surgery (OHNS) providers who are rural versus urban based from 2002 to 2013. Secondary objective was to present perspectives of rural primary care providers on unmet needs for OHNS services. Study Design Mixed methods database analysis and prospective survey. Setting National administrative database. Subjects and Methods The Canadian Medical Association OHNS provider Masterfile and the Statistics Canada postal code file were used to determine provincial, urban, rural, and Aboriginal group care coverage. The Society of Rural Physicians of Canada was surveyed to explore care delivery and unmet needs for OHNS and audiology. Descriptive statistics and linear regression were used to describe results. Results Ontario and Quebec had the largest annual OHNS physician growth (6.38 providers/year; r2 = 0.94) versus stagnant growth in the territories. The clear majority of OHNS providers are in urban centers, and rural OHNS coverage is decreasing annually (-0.33 providers/year, r2 = 0.28). There are no OHNS providers in 485 population centers where Aboriginal groups are located. A survey of 40 rural primary care providers reported that OHNS care is most commonly delivered through seasonal visits to a local facility, with otology (hearing loss, chronic ear disease) and rhinology (nonmalignant nasal or sinus conditions) as the most frequently reported unmet needs. Conclusion From 2002 to 2013, OHNS coverage showed a trend for urban consolidation. Most Aboriginal groups may have decreased access to care, as there are no OHNS providers in 485 population centers where reserves are located. There is an unmet need for specialized OHNS services reported by rural primary care physicians, especially otology and rhinology.

Mobility of US Rural Primary Care Physicians During 2000-2014.

Despite considerable investment in increasing the number of primary care physicians in rural shortage areas, little is known about their movement rates and factors influencing their mobility. We aimed to characterize geographic mobility among rural primary care physicians, and to identify location and individual factors that influence such mobility. Using data from the American Medical Association Physician Masterfile for each clinically active US physician, we created seven 2-year (biennial) mobility periods during 2000-2014. These periods were merged with county-level "rurality," physician supply, economic characteristics, key demographic measures, and individual physician characteristics. We computed (1) mobility rates of physicians by rurality; (2) linear regression models of county-level rural nonretention (departure); and (3) logit models of physicians leaving rural practice. Biennial turnover was about 17% among physicians aged 45 and younger, compared with 9% among physicians aged 46 to 65, with little difference between rural and metropolitan groups. County-level physician mobility was higher for counties that lacked a hospital (absolute increase = 5.7%), had a smaller population size, and had lower primary care physician supply, but area-level economic and demographic factors had little impact. Female physicians (odds ratios = 1.24 and 1.46 for those aged 45 or younger and those aged 46 to 65, respectively) and physicians born in a metropolitan area (odds ratios = 1.75 and 1.56 for those aged 45 or younger and those aged 46 to 65, respectively) were more likely to leave rural practice. These flndings provide national-level evidence of rural physician mobility rates and factors associated with both county-level retention and individual-level departures. Outcomes were notably poorer in the most remote locations and those already having poorer physician supply and professional support. Rural health workforce planners and policymakers must be cognizant of these key factors to more effectively target retention policies and to take into account the additional support needed by these more vulnerable communities.