Medical education interventions influencing physician distribution into underserved communities: a scoping review

Abstract

Background and objective Physician maldistribution is a global problem that hinders patients’ abilities to access healthcare services. Medical education presents an opportunity to influence physicians towards meeting the healthcare needs of underserved communities when establishing their practice. Understanding the impact of educational interventions designed to offset physician maldistribution is crucial to informing health human resource strategies aimed at ensuring that the disposition of the physician workforce best serves the diverse needs of all patients and communities. Methods A scoping review was conducted using a six-stage framework to help map current evidence on educational interventions designed to influence physicians’ decisions or intention to establish practice in underserved areas. A search strategy was developed and used to conduct database searches. Data were synthesized according to the types of interventions and the location in the medical education professional development trajectory, that influence physician intention or decision for rural and underserved practice locations. Results There were 130 articles included in the review, categorized according to four categories: preferential admissions criteria, undergraduate training in underserved areas, postgraduate training in underserved areas, and financial incentives. A fifth category was constructed to reflect initiatives comprised of various combinations of these four interventions. Most studies demonstrated a positive impact on practice location, suggesting that selecting students from underserved or rural areas, requiring them to attend rural campuses, and/or participate in rural clerkships or rotations are influential in distributing physicians in underserved or rural locations. However, these studies may be confounded by various factors including rural origin, pre-existing interest in rural practice, and lifestyle. Articles also had various limitations including self-selection bias, and a lack of standard definition for underservedness. Conclusions Various educational interventions can influence physician practice location: preferential admissions criteria, rural experiences during undergraduate and postgraduate medical training, and financial incentives. Educators and policymakers should consider the social identity, preferences, and motivations of aspiring physicians as they have considerable impact on the effectiveness of education initiatives designed to influence physician distribution in underserved locations.

Association between physicians’ maldistribution and core clinical competency in resident physicians

“…13 Physician maldistribution is a global problem that hinders patients' ability to access healthcare services. 28 Physicians are geographically maldistributed, with too few physicians in rural areas. 29,30 In Japan, there is a well-documented issue of physician shortages and regional maldistribution, where approximately 90% of physicians are clustered in urban areas.…”

The impact of health resource enhancement and its spatiotemporal relationship with population health

“…Bolstering the rural obstetrician–gynecologist workforce is important to mitigate maternal morbidity and mortality in the United States. Elma et al ( 6 ) reported that physician shortage and maldistribution hinder patients' ability to access healthcare services in rural areas, which in turn contributes to a higher incidence of chronic diseases, injury, and mortality. Studies in China have shown that population health is affected by health resource distribution ( 7 – 9 ).…”

Understanding the influence of medical education on physician geographic disposition: A qualitative study of family physician perspectives in Canada

“…Several medical education policies have been reported to positively influence FP practice locations, 15 including selecting medical students from underserved areas 16–19 and/or providing medical training in underserved areas 13,16,17,20–22 . These approaches are usually justified with explanations consistent with Social Attachment Theory, which describes the influence of secure relationships on one's decision making 23 .…”