Mobility of US Rural Primary Care Physicians During 2000–2014

Abstract

PURPOSE 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. METHODSUsing 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 countylevel "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. RESULTSBiennial 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 arealevel 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.CONCLUSIONS These findings 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. Ann Fam Med 2017;15:322-328. https://doi.org/10.1370/afm.2096. INTRODUCTIONR ural populations continue to experience relative shortages of the supply of primary care physicians, 1 with associated links to poorer health.2 Difficulties of both recruitment and retention of physicians in rural areas, which greatly contribute to experienced shortages, are well acknowledged. 3,4 There are many reasons for this ongoing workforce supply disparity, including professional, economic, infrastructural, political, educational, and sociocultural aspects. 5 Although considerable research has identified factors that facilitate or impede supply of physicians in rural areas, macro-level empirical evidence of observed rural mobility of physiciansnotably, which are more likely to move and why-is limited.6-9 Additionally, the frequencies with which specific rural physicians move over ...

Widespread recent increases in county-level heart disease mortality across age groups

“…Enhancing secondary prevention will require younger adults to engage with the health care system, preparing both for the increased health care needs of an aging population. These same efforts, when focused outside of large urban centers, will need to overcome lower access to care in these communities [25,26]. …”

Forecasting Limited Access to Urology in Rural Communities: Analysis of the American Urological Association Census

“…3 As of 2016, there were 1,995 counties in the United States without a single urologist, so this burden is especially concentrated in rural areas. 4,5 Rural America's population grew by about 0.3% from 2010 to 2015 and was estimated as 46.2 million residents in 2015. 6 These rural communities face unique challenges in terms of access to health care services.…”

Counseling Strategies to Improve Nutrition Care for Rural Appalachian Patients

“…10,11 Inconsistencies in the concentration of access to dietitians among rural areas 12,13 and recruitment of health professionals to these settings remain challenging. 14 Appropriate health services remain an issue for rural Appalachian people and warrant investigation of ways to improve preventative health behaviors among this population. Multiple factors have been shown to play a role in the diet-related behaviors of rural Appalachian residents including accessibility and resources for health care, sociocultural characteristics, health beliefs, and traditional dietary patterns.…”