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

Rabinowitz, Howard K.; Diamond, James J.; Markham, Fred W.; Hazelwood, Christina E.

doi:10.1001/jama.281.3.255

Cited by 207 publications

(185 citation statements)

References 26 publications

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“…Of 21 different programs (described in 26 papers), 15 were primary care courses added to the conventional curriculum. [49][50][51][52][53][55][56][57][58][59][63][64][65][66][68][69][70][71][72] The remaining six programs were special curricula or medical schools focusing on primary care and/or rural health. 47,48,54,[60][61][62] , Contrary to the studies on clerkships, the most frequently studied outcomes of longitudinal programs were career choices after graduation (n=15).…”

Section: Impact Of Interventions On Primary Care Specialty Choicementioning

confidence: 99%

Impact of Interventions to Increase the Proportion of Medical Students Choosing a Primary Care Career: A Systematic Review

et al. 2015

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BACKGROUND: Increasing the attractiveness of primary care careers is a key step in addressing the growing shortage of primary care physicians. The purpose of this review was to (1) identify interventions aimed at increasing the proportion of undergraduate medical students choosing a primary care specialty, (2) describe the characteristics of these interventions, (3) assess the quality of the studies, and (4) compare the findings to those of a previous literature review within a global context. METHODS: We searched MEDLINE, EMBASE, ERIC, CINAHL, PsycINFO, The Cochrane Library, and Dissertations & Theses A&I for articles published between 1993 and February 20, 2015. We included quantitative and qualitative studies reporting on primary care specialty choice outcomes of interventions in the undergraduate medical curriculum, without geographic restrictions. Data extracted included study characteristics, intervention details, and relevant outcomes. Studies were assessed for quality and strength of findings using a five-point scale. RESULTS: The review included 72 articles reporting on 66 different interventions. Longitudinal programs were the only intervention consistently associated with an increased proportion of students choosing primary care. Successful interventions were characterized by diverse teaching formats, student selection, and good-quality teaching. Study quality had not improved since recommendations were published in 1995. Many studies used cross-sectional designs and non-validated surveys, did not include control groups, and were not based on a theory or conceptual framework. DISCUSSION: Our review supports the value of longitudinal, multifaceted, primary care programs to increase the proportion of students choosing primary care specialties. Isolated modules or clerkships did not appear to be effective. Our results are in line with the conclusions from previous reviews and add an international perspective, but the evidence is limited by the overall low methodological quality of the included studies. Future research should use more rigorous evaluation methods and include long-term outcomes.

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Section: Impact Of Interventions On Primary Care Specialty Choicementioning

confidence: 99%

Impact of Interventions to Increase the Proportion of Medical Students Choosing a Primary Care Career: A Systematic Review

et al. 2015

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“…[6][7][8][9][10][11][12] Although each of these factors is important, many are interrelated, few data are available regarding their relative importance and interdependence, and no information is available regarding the impact of multiple factors. For example, while studies have shown that minority physicians are much more likely than their nonminority peers to practice in underserved areas (12% vs 6%), 6 these absolute differences are relatively small, and little is known of the relative importance of providing minority students vs other students with educational experiences in underserved areas or with financial support.…”

mentioning

confidence: 99%

The impact of multiple predictors on generalist physicians' care of underserved populations

Rabinowitz

Diamond²,

Veloski³

et al. 2000

Am J Public Health

189

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A B S T R A C TObjectives. This study examined the relative and incremental importance of multiple predictors of generalist physicians' care of underserved populations.Methods. Survey results from a 1993 national random sample of 2955 allopathic and osteopathic generalist physicians who graduated from medical school in 1983 or 1984 were analyzed.Results. Four independent predictors of providing care to underserved populations were (1) being a member of an underserved ethnic/minority group, (2) having participated in the National Health Service Corps, (3) having a strong interest in practicing in an underserved area prior to attending medical school, and (4) growing up in an underserved area. Eighty-six percent of physicians with all 4 predictors were providing substantial care to underserved populations, compared with 65% with 3 predictors, 49% with 2 predictors, 34% with 1 predictor, and 22% with no predictors. Sex, family income when growing up, and curricular exposure to underserved populations during medical school were not independently related to caring for the underserved.Conclusions. A small number of factors appear to be highly predictive of generalist physicians' care for the underserved, and most of these predictive factors can be identified at the time of admission to medical school. (Am J Pub-

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“…On the other hand, in certain predominantly rural counties the number of physicians per 100 000 inhabitants was smaller than 150. This uneven distribution of physicians is not characteristic only of Croatia, but it is also evident in many other countries (2)(3)(4)(5)(6)(7)(8)(9)(10)29). Unlike in other countries, the salaries of Croatian physicians cannot be an explanation for uneven distribution of physicians between richer and poorer counties (32)(33)(34).…”

Section: Discussionmentioning

confidence: 99%

“…In England and Wales, uneven distribution of general practitioners (GP) was found, with minimum changes over the twenty-year period of observation (2). In the USA, almost 20% of population that lives in rural regions is covered by only 9% of physicians, which presents a serious long-lasting problem (3)(4)(5). Many other countries have the same problem, such as France, Greece, Australia, Japan, and Chile (6)(7)(8)(9)(10)(11).…”

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confidence: 99%

Influence of Urbanization Level and Gross Domestic Product of Counties in Croatia on Access to Health Care

et al. 2008

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Aim To examine the association of counties' urbanization level and gross domestic product (GDP) per capita on the access to health care.Methods Counties were divided in two groups according to the urbanization level and GDP per capita in purchasing power standards. The number of physicians per 100 000 inhabitants, the number of physicians in hospitals in four basic specialties, physicians' workload, average duration of working week, the average number of insurants per general practice (GP) team, and the number of inhabitants covered by one internal medicine outpatient clinic were compared between predominantly urban and predominantly rural counties and between richer and poorer counties. Our study included only GP teams and outpatient clinics under the contract with the Croatian Institute for Health Insurance. Data on physicians were collected from the Ministry of Health and Social Welfare, the Croatian Institute for Health Insurance, the Croatian Institute for Public Health, and the Croatian Medical Chamber. Data on the contracts with the Croatian Institute for Health Insurance and health care services provided under these contracts were obtained from the database of the Institute, while population and gross domestic product data were obtained from the Database of the Croatian Institute for Statistics. World Health Organization Health for All Database was used for the international comparison of physician's data.Results There was no significant difference in the total number of physicians per 100 000 inhabitants between predominantly urban and predominantly rural counties (206.9 ± 41.0 vs 175.4 ± 30.3; P = 0.067, t test) nor between richer and poorer counties (194.5 ± 49.8 vs 187.7 ± 25.3; P = 0.703, t test). However, there were significantly fewer GPs per 100 000 inhabitants in rural than urban counties (49.0 ± 5.5 vs 56.7 ± 4.6; P = 0.003, t test). GPs in rural counties had more insurants than those working in urban counties (1.749.8 ± 172.8 vs 1.540.7 ± 106.3; P = 0.004, t test). The working week of specialists in the four observed specialties in hospitals was longer than the recommended 48 hours a week. ConclusionThe lack of physicians, especially in primary health care can lead to a reduced access to health care and increased workload of physicians, predominantly in rural counties, regardless of the counties' GDP. 385Access to health care is achieved by even distribution of health care institutions and health workers across the country (1). Many countries encounter the problem of uneven regional distribution of physicians. In England and Wales, uneven distribution of general practitioners (GP) was found, with minimum changes over the twenty-year period of observation (2). In the USA, almost 20% of population that lives in rural regions is covered by only 9% of physicians, which presents a serious long-lasting problem (3-5). Many other countries have the same problem, such as France, Greece, Australia, Japan, and Chile (6-11). Uneven distribution is mostly a result of migration of physicians (11).In Croati...

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

Cited by 207 publications

References 26 publications

Impact of Interventions to Increase the Proportion of Medical Students Choosing a Primary Care Career: A Systematic Review

Impact of Interventions to Increase the Proportion of Medical Students Choosing a Primary Care Career: A Systematic Review

The impact of multiple predictors on generalist physicians' care of underserved populations

Influence of Urbanization Level and Gross Domestic Product of Counties in Croatia on Access to Health Care

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