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

Abstract

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-

A National Long-term Outcomes Evaluation of U.S. Premedical Postbaccalaureate Programs Designed to Promote Health care Access and Workforce Diversity

“…22,23 This study expands on the previous work of Rabinowitz and colleagues by examining the scope of physician specialties beyond that of generalist practice. 10 As a whole, whether they were primary care physicians or not, the PBP physicians were significantly more likely to be providing care for underserved patients by practicing in federally designated underserved areas, serving in practices where 40% or more of the patients are medically indigent or uninsured, or practicing in institutional settings that enable access to healthcare services for underserved and vulnerable populations.…”

“…10 The Rabinowitz survey identified four independent predictors of a physician’s intention to provide care for underserved populations. These include: 1) being a member of an underserved racial/ethnic group, 2) participating in the National Health Services Corps, 3) having a strong interest in practicing in an underserved area before attending medical school, and 4) growing up in an underserved area.…”

“…Most (86%) of the generalist physicians in the Rabinowitz study who had confirmed all four predictor characteristics, were found later to be providing substantial care to underserved communities. 10 …”

“…These predictors included membership in an underserved ethnic or minority group, participation in the National Health Services Corps (NHSC), expression of strong interest in practicing in an underserved area prior to medical school, and personal experience of growing up in an underserved area. 10 …”

Precommitting to Serve the Underserved

“…Many studies have examined the impact of conditional scholarships on the supply of physicians in underserved areas (Brooks et al 2002; Holmes 2005; Pathman, Konrad, and Ricketts 1992; 1994; Pathman et al 2006; Rabinowitz et al 2000; Singer et al 1998). They show that conditional scholarship programs have placed substantial numbers of physicians and other health workers in such areas (Bärnighausen and Bloom 2009a), and that they could substantially contribute to the attainment of population health goals (Bärnighausen and Bloom 2009d).…”