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Recruitment and retention of primary care nurse practitioners in underserved areas: A scoping review. Nurs Outlook 2022; 70:401-416. [PMID: 35183357 PMCID: PMC9232900 DOI: 10.1016/j.outlook.2021.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/06/2021] [Accepted: 12/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The growing nurse practitioner (NP) workforce plays a critical role in primary care delivery in the United States. However, better recruitment and retention of the robust NP workforce in underserved areas are needed; evidence to inform such effort is limited. PURPOSE This scoping review aimed to examine the findings, scope, and knowledge gaps of available literature on factors associated with NP recruitment and retention in underserved areas. METHODS This review was guided by Joanna Briggs' Scoping Review Methodology and PRISMA-SCR reporting standards. Literature search for peer-reviewed and gray literature was conducted in six databases. FINDINGS A total of 22 studies met inclusion criteria. Factors associated with NP recruitment and retention in underserved areas were mapped into five themes, including factors related to: the individual NP, NP education programs/financial aid, organizations employing NPs, the communities NPs work in, and autonomous practice. Majority of the included studies were published before 2010; few used rigorous study designs and analysis methods; and few exclusively studied NPs and unique challenges facing the NP workforce. DISCUSSION Available studies demonstrate that NP recruitment and retention can be addressed by various stakeholders (e.g., educators, policy makers); however, up-to-date, methodologically rigorous, and NP-focused studies are needed.
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Gender differences in nurse practitioners: job satisfaction and patterns of care. J Am Assoc Nurse Pract 2020; 32:138-144. [PMID: 30951008 DOI: 10.1097/jxx.0000000000000207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although workforce diversity has been cited as an important workforce issue, the contemporary U.S. nurse practitioner (NP) workforce is dominated by females. Provider diversity, specifically gender, has been found to directly influence patient preference. However, lack of gender diversity in the NP workforce has never been specifically evaluated in terms of job satisfaction and patterns of care. PURPOSE The purpose of this study was to assess and evaluate NP gender, job satisfaction and practice patterns of care for U.S. clinical NPs. METHODS This study used the 2012 National Sample Survey of Nurse Practitioners (NSSNP). Participants meeting inclusion criteria totaled 8,978 NPs, of which 92.8% were female. RESULTS Although overall job satisfaction was not shown to be significantly different between genders, several patterns of care were found to be significant. Of the 11 measured patterns of care in the NSSNP, six were significantly different between genders, with a female majority indicating that they performed these services most often. In only one rendered service, performed medical procedures, did male NPs indicate that they did more than females. IMPLICATIONS FOR PRACTICE This study suggests the importance of a gender-diversified U.S. nurse practitioner workforce. This is indicated by differences highlighted in patterns of care by NP gender, which has been postulated to influence patient outcomes, including perceived quality of care and engagement in the health care process. Patient preferences for same-gender NPs, particularly patients with privacy issues, warrant further exploration.
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Chou CF, Holtzman JS, Rogers S, Chen C. The Impact of Title VII Dental Workforce Programs on Dentists' Practice Location: A Difference-in-Differences Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:442-449. [PMID: 31517681 DOI: 10.1097/acm.0000000000002974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To examine the potential impact of Health Resources and Services Administration (HRSA) funding (predoctoral [PD] and postdoctoral [PDD] programs) on dentists' practice location in the United States. METHOD The authors linked 2011-2015 data from HRSA's Electronic Handbooks to 2015 data from the American Dental Association Masterfile, dental health professional shortage areas, and rural-urban commuting area codes. They examined the associations between PD and PDD funding and dentists' practice location between 2004 and 2015 using a difference-in-differences analysis and multiple logistic regressions, adjusting for covariates. RESULTS From 2004 to 2015, 21.2% (1,588/7,506) of dentists graduated from institutions receiving PD funding and 26.8% (2,014/7,506) graduated from institutions receiving PDD funding. Among dentists graduating from institutions receiving PDD funding, after adjusting for covariates, those graduating between 2011 and 2015 were more likely to practice in a rural area than those graduating between 2004 and 2010 (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.04-3.76). The difference-in-differences approach showed that PD and PDD funding significantly increased the odds that a dentist would practice in a rural area (respectively, OR = 2.70; 95% CI = 1.31-5.79/OR = 2.84; 95% CI = 1.40-5.77). CONCLUSIONS HRSA oral health training program funding had a positive effect on dentists choosing to practice in a rural area. By increasing the number of dentists practicing in rural communities, HRSA is improving access to, and the delivery of, oral health care services to underserved and vulnerable rural populations.
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Affiliation(s)
- Chiu-Fang Chou
- C.-F. Chou is social scientist, National Center for Health Workforce Analysis, Bureau of Health Workforce, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland. J.S. Holtzman is dental officer, Bureau of Health Workforce, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland. S. Rogers is chief, Oral Health Branch, Division of Medicine and Dentistry, Bureau of Health Workforce, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland. C. Chen is associate professor, Milken Institute School of Public Health, George Washington University, Washington, DC
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Ulrich E, Hurdelbrink J, Perepelkin J, Welter K. Financial Incentive Required for Pharmacy Students to Accept a Post-Graduation Position in Rural and Undesirable Pharmacy Settings. PHARMACY 2019; 7:E109. [PMID: 31390805 PMCID: PMC6789724 DOI: 10.3390/pharmacy7030109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/02/2019] [Accepted: 07/31/2019] [Indexed: 11/21/2022] Open
Abstract
Background: It has been estimated that in 2018, 20% of pharmacy students were unemployed following graduation. However, many pharmacy positions go vacant each year, with the majority of these positions existing in rural areas. Methods: Pharmacy students completed a one-time, anonymous, online questionnaire. Measures of interest included: subject characteristics and preference in a variety job offers. Discrete Choice Experiment methodology of questionnaire design was used and Conditional Logit models were conducted to analyze the data to determine the financial incentive required for pharmacy students to take a post-graduate job with particular traits. Conclusions: A total of 283 students completed questionnaires from Iowa, North Dakota, South Dakota, Saskatchewan, and Manitoba. The majority of subjects were female, P3 students, and from a non-rural hometown. American students would need to be paid an additional $18,738 in salary to practice in a rural area, while Canadian students would require an additional $17,156. Canadian respondents would require an additional $7125 in salary to work in a community pharmacy with a low level of patient interaction compared to a community position with a large amount of patient interaction. Overall, pharmacy student preferences in post-graduation job attributes vary significantly between states and provinces.
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Affiliation(s)
- Erin Ulrich
- College of Pharmacy and Health Sciences, Drake University, Des Moines, IA 50311, USA.
| | - Jonathan Hurdelbrink
- College of Pharmacy and Health Sciences, Drake University, Des Moines, IA 50311, USA
| | - Jason Perepelkin
- College of Pharmacy and Nutrition, University of Sakatchewan, Saskatoon, SK S7N 5C9, Canada
| | - Kelli Welter
- College of Pharmacy and Health Sciences, Drake University, Des Moines, IA 50311, USA
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Oakley LP, López-Cevallos DF, Harvey SM. The Association of Cultural and Structural Factors with Perceived Medical Mistrust Among Young Adult Latinos in Rural Oregon. Behav Med 2019; 45:118-127. [PMID: 31343964 DOI: 10.1080/08964289.2019.1590799] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although previous studies have examined the impact of medical mistrust on the health and health care seeking behaviors of diverse populations, including Latinos, limited research has explored cultural and structural factors that contribute to medical mistrust. The aim of the present study was to examine the associations between cultural and structural factors and perceived medical mistrust among a sample of young adult Latinos living in rural Oregon. We conducted in-person interviews with 499 young adult Latinos (ages 18-25). Medical mistrust was assessed using a modified version of the Group-Based Medical Mistrust Scale, which has been used with Latino populations. We included three cultural (acculturation, machismo, and familismo) and one structural (perceived everyday discrimination) variables, all measured using previously validated scales. Socio-demographic variables (eg, age, gender, income, educational level, employment) were also included in multivariable linear regression models. We found that everyday discrimination and traditional machismo values were associated with medical mistrust, the latter primarily among Latino women. It is possible that Latinos living in relatively new minority/immigrant settlement areas (such as rural Oregon) may be more vulnerable to experiencing discrimination, which in turn, may erode trust in health care providers. On the other hand, a strong ethnic identity, including the endorsement of machismo values, may serve as a protective mechanism for Latinos confronted by racial/ethnic discrimination. Culturally responsive, socio-cultural, and societal interventions are warranted to tackle the pervasive and ripple effects that racial/ethnic discrimination has on the health of Latinos and other minority populations.
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Affiliation(s)
- Lisa P Oakley
- a College of Public Health and Human Sciences, Oregon State University
| | | | - S Marie Harvey
- a College of Public Health and Human Sciences, Oregon State University
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MacQueen IT, Maggard-Gibbons M, Capra G, Raaen L, Ulloa JG, Shekelle PG, Miake-Lye I, Beroes JM, Hempel S. Recruiting Rural Healthcare Providers Today: a Systematic Review of Training Program Success and Determinants of Geographic Choices. J Gen Intern Med 2018; 33:191-199. [PMID: 29181791 PMCID: PMC5789104 DOI: 10.1007/s11606-017-4210-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/22/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rural areas have historically struggled with shortages of healthcare providers; however, advanced communication technologies have transformed rural healthcare, and practice in underserved areas has been recognized as a policy priority. This systematic review aims to assess reasons for current providers' geographic choices and the success of training programs aimed at increasing rural provider recruitment. METHODS This systematic review (PROSPERO: CRD42015025403) searched seven databases for published and gray literature on the current cohort of US rural healthcare practitioners (2005 to March 2017). Two reviewers independently screened citations for inclusion; one reviewer extracted data and assessed risk of bias, with a senior systematic reviewer checking the data; quality of evidence was assessed using the GRADE approach. RESULTS Of 7276 screened citations, we identified 31 studies exploring reasons for geographic choices and 24 studies documenting the impact of training programs. Growing up in a rural community is a key determinant and is consistently associated with choosing rural practice. Most existing studies assess physicians, and only a few are based on multivariate analyses that take competing and potentially correlated predictors into account. The success rate of placing providers-in-training in rural practice after graduation, on average, is 44% (range 20-84%; N = 31 programs). We did not identify program characteristics that are consistently associated with program success. Data are primarily based on rural tracks for medical residents. DISCUSSION The review provides insight into the relative importance of demographic characteristics and motivational factors in determining which providers should be targeted to maximize return on recruitment efforts. Existing programs exposing students to rural practice during their training are promising but require further refining. Public policy must include a specific focus on the trajectory of the healthcare workforce and must consider alternative models of healthcare delivery that promote a more diverse, interdisciplinary combination of providers.
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Affiliation(s)
- Ian T MacQueen
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Veterans Affairs/Robert Wood Johnson Clinical Scholars Program, UCLA, Los Angeles, CA, USA
| | - Gina Capra
- National Association of Community Health Centers, Bethesda, MD, USA
| | - Laura Raaen
- Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, 90407, USA
| | - Jesus G Ulloa
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Veterans Affairs/Robert Wood Johnson Clinical Scholars Program, UCLA, Los Angeles, CA, USA
- Department of Surgery, UCSF Medical School, San Francisco, CA, USA
| | - Paul G Shekelle
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, 90407, USA
| | - Isomi Miake-Lye
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jessica M Beroes
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Susanne Hempel
- Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, 90407, USA.
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
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Abstract
Physician assistant (PA) educational programs were created in the 1960s to prepare a new type of health care practitioner. Physician assistant programs began as experiments in medical education, and later, they proved to be highly successful in preparing capable, flexible, and productive clinicians. The growth of PA educational programs in US medical education-stimulated by grants, public policy, and anticipated shortages of providers-has gone through 3 distinct phases. At present, such programs are in the midst of the third growth spurt that is expected to continue beyond 2020, as a large number of colleges and universities seek to sponsor PA programs and attain accreditation status. Characteristics of these new programs are described, and the implications of the current expansion of PA education are examined.
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Affiliation(s)
- James F Cawley
- James F. Cawley, MPH, DHL(Hon), PA-C, is a professor in the Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC. P. Eugene Jones, PhD, PA-C, is a professor and chair of the Department of Physician Assistant Studies, University of Texas Southwestern Medical Center, Dallas, Texas. Anthony A. Miller, MEd, PA-C, is a professor and director of the Division of Physician Assistant Studies, Shenandoah University, Winchester, Virginia. Venetia L. Orcutt, PhD, PA-C, is an associate professor in the Department of Physician Assistant Studies, University of Texas Southwestern Medical Center, Dallas, Texas
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Bauer J, Reinhard J, Boll M, Groneberg D. Geospatial analysis and distribution patterns of home nursing care in a metropolitan area - a large-scale analysis. J Nurs Manag 2016; 25:37-45. [PMID: 27730723 DOI: 10.1111/jonm.12426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 11/28/2022]
Abstract
AIMS This study focuses on home nursing care distribution in an urban setting in Germany. BACKGROUND A shortage of nursing care workforce is present in Germany. METHODS A geospatial analysis was performed to examine distribution patterns at the district level in Frankfurt, Germany (n = 46 districts) and factors were analysed influencing the location choice of home nursing care providers (n = 151). Furthermore, within the analysis we focused on the population aged over 65 years to model the demand for nursing care. RESULTS The analysis revealed a tendency of home nursing care providers to be located near the city centre (centripetal distribution pattern). However, the demand for care showed more inconsistent patterns. Still, a centripetal distribution pattern of demand could be stated. Compared with the control groups (e.g. acute hospitals and pharmacies) similar geographical distribution patterns were present. However, the location of home nursing care providers was less influenced by demand compared with the control groups. CONCLUSION The supply of nursing care was unevenly distributed in this metropolitan setting, but still matched the demand for nursing care. IMPLICATION FOR NURSING MANAGEMENT Due to the rapidly changing health care environments policy, regulations must be (re-)evaluated critically to improve the management and delivery of nursing care provision.
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Affiliation(s)
- Jan Bauer
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt/Main, Germany
| | - Julia Reinhard
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt/Main, Germany
| | - Michael Boll
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt/Main, Germany
| | - David Groneberg
- Institute of Occupational, Social and Environmental Medicine, Goethe University, Frankfurt/Main, Germany
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Amalba A, van Mook WNKA, Mogre V, Scherpbier AJJA. The effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in rural communities in Ghana. BMC MEDICAL EDUCATION 2016; 16:79. [PMID: 26931412 PMCID: PMC4774102 DOI: 10.1186/s12909-016-0602-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/17/2016] [Indexed: 05/22/2023]
Abstract
BACKGROUND Career choices and placements of healthcare professionals in rural areas are a major problem worldwide, and their recruitment and retention to these areas have become a challenge to the health sector. The purpose of this study was to investigate the effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in a rural area. METHOD This cross sectional survey was conducted among 56 pioneering graduates that followed a Problem Based Learning/Community Based Education and Service (PBL/COBES) curriculum. Using a mixed methods approach, open-and closed-ended questionnaire was administered to 56 graduates. Cross tabulation using Chi-square test were used to compare findings of the quantitative data. All qualitative data analysis was performed using the principles of primary, secondary and tertiary coding. RESULTS All 56 graduates answered and returned the questionnaire giving a 100 % response rate. 57.1 % (32) of them were male. Majority of them lived in towns (41.1 %) and cities (50 %) prior to medical school. A significant number of graduates (53.6 %,) from the cities, without any female or male predominance said COBES had influenced their choice of specialty. Again, a significant proportion of graduates from the towns (60.9 %,) and cities (67.8 %,), indicated that COBES had influenced them to work in the rural area. However, there was no significant difference between males and females from the towns and cities regarding the influence of COBES to work in the rural area. Qualitative data supported the finding that COBES will influence graduates willingness to work in the rural area CONCLUSION The majority of graduates from the towns and cities in Ghana, with a male predominance, indicated that COBES may have influenced their choice of specialty and willingness to practice in the rural areas despite their town or city based upbringing.
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Affiliation(s)
- Anthony Amalba
- University for Development Studies (UDS), School of Medicine and Health Sciences (SMHS), Tamale, Ghana.
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, P. O. Box 1883, Tamale, Ghana.
| | | | - Victor Mogre
- University for Development Studies (UDS), School of Medicine and Health Sciences (SMHS), Tamale, Ghana.
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Vick B. Analyzing Rural Versus Urban Differences in Career Dissatisfaction and Plans to Leave Among Pennsylvanian Physicians. J Rural Health 2015; 32:164-75. [PMID: 26334927 DOI: 10.1111/jrh.12139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE This study estimates whether physicians in rural Pennsylvania have higher odds of career dissatisfaction and plans to leave patient care in the next 6 years, compared to their urban counterparts. Rural-urban differences were estimated across specific subgroups of physicians (gender, race, and specialty) and with regard to specific sources of career dissatisfaction. METHODS The 2012 Pennsylvania Health Workforce Survey of Physicians allowed for analysis of 17,444 physicians younger than 55 years old actively practicing patient care. Multivariate, logistic regression was performed to estimate the associations with 2 outcome areas: career dissatisfaction and plans to leave patient care in the next 6 years. Controls included rural setting, age, sex, race, work hours, specialty, and practice characteristics. RESULTS Over 12% of under-55 physicians are dissatisfied with their careers and over 18% report plans to leave patient care in the next 6 years. Rural physicians in Pennsylvania have 18.6% higher odds of reporting career dissatisfaction and 29.5% higher odds of leaving patient care in the next 6 years (P < .01 for each) versus their urban counterparts. CONCLUSIONS Rates of dissatisfaction and potential attrition among younger physicians are not insignificant, with a stronger association with rural practice. Given the large number of rural health shortage areas, better understanding this association is important to health care providers and policy makers. Regression results suggest that higher rural odds are related more to physician work (i.e., stress, practice demands, and lack of autonomy) and family situations and less related to income concerns.
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Affiliation(s)
- Brandon Vick
- Department of Economics, Indiana University of Pennsylvania, Indiana, Pennsylvania
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Puddey IB, Mercer A, Playford DE, Riley GJ. Medical student selection criteria and socio-demographic factors as predictors of ultimately working rurally after graduation. BMC MEDICAL EDUCATION 2015; 15:74. [PMID: 25890081 PMCID: PMC4407300 DOI: 10.1186/s12909-015-0359-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/30/2015] [Indexed: 05/25/2023]
Abstract
BACKGROUND We have previously demonstrated that both coming from a rural background and spending a year-long clinical rotation in our Rural Clinical School (RCS) have independent and additive effects to increase the likelihood of medical students practicing rurally following graduation. The current study assesses the extent to which medical school selection criteria and/or the socio-demographic profile of medical students may further facilitate or hamper the selection of students ultimately destined for the rural medical workforce. METHODS The study comprised 729 students, admitted from secondary school since 1999 and having graduated by 2011, whose actual workplace location in 2014 was classified as either urban or rural using the Australian Health Practitioner Regulation Agency database. Selection factors on entry (score from a standardised interview, percentile scores for the 3 components of the Undergraduate Medicine and Health Sciences Admission Test (UMAT) and prior academic performance as assessed by the Australian Tertiary Admissions Rank) together with socio-demographic factors (age, gender, decile for the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD)), were examined in relation to ultimate rural destination of practice. RESULTS In logistic regression, those practicing in a rural location in 2014 were more likely to have come from the lower 6 IRSAD deciles (OR 2.75, 95% CI 1.44, 5.23, P = 0.002), to be older (OR 1.86, 95% CI 1.09, 3.18, p = 0.023) and to have a lower UMAT-3 (Non-verbal communication) score (OR 0.98, 95% CI 0.97, 0.99, P = 0.005). After further controlling for either rural background or RCS participation, only age and UMAT-3 remained as independent predictors of current rural practice. CONCLUSIONS In terms of the socio-demographic profiles of those selected for medical school entry from secondary school, only older age weakly augmented the selection of graduates likely to ultimately work in a rural destination. Among the selection factors, having achieved higher scores in UMAT-3 tended to mitigate this outcome. The major focus in attempts to grow the rural medical workforce should therefore remain on recruiting medical students from a rural background together with providing maximal opportunity for prolonged immersion in rural clinical environments during their training.
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Affiliation(s)
- Ian B Puddey
- Faculty Office, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Annette Mercer
- Faculty Office, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Denese E Playford
- School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Geoffrey J Riley
- School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
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Abstract
PURPOSE This exploratory study focuses on the American Association of Nurse Anesthetists. It sheds light on the process by which men gain access to leadership positions in a female-dominated setting. It also expands the narrative of the professional association's history. CONCLUSIONS As soon as men became eligible for membership in 1947, they gained access to leadership positions in disproportionate numbers and at a faster pace than women at the national level and in a number of states. The specific pattern of findings is consistent with volitional relational practices, suggesting that women facilitated the integration and empowerment of male colleagues who constituted a small minority in the association. MANAGEMENT IMPLICATIONS The paper discusses the need to understand and manage the interactions between relational practices that are gendered female and views of leadership as male-gendered.
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Affiliation(s)
- Margarete Arndt
- Graduate School of Management, Clark University, Worcester, MA
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O'Connor A, Wellenius G. Rural-urban disparities in the prevalence of diabetes and coronary heart disease. Public Health 2012; 126:813-20. [PMID: 22922043 DOI: 10.1016/j.puhe.2012.05.029] [Citation(s) in RCA: 189] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 03/14/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To examine the rural-urban differences in the prevalence of diabetes and coronary heart disease, and the extent to which they are explained by the presence of established risk factors including poverty. STUDY DESIGN Cross-sectional study of more than 214,000 respondents using data from the US Centers for Disease Control and Prevention's (CDC's) 2008 Behavioral Risk Factor Surveillance System. METHODS Logistic regression models were utilized; prevalence odds ratios with corresponding confidence intervals and P-values are provided. RESULTS The crude prevalence rates of diabetes and coronary heart disease were 8.6% (P = 0.001) and 38.8% (P < 0.001) higher among respondents living in rural areas compared with urban areas, respectively. The higher prevalence in rural areas of many of the common risk factors for these conditions, including poverty (P < 0.001), obesity (P < 0.001) and tobacco use (P < 0.001), may contribute to these findings. After controlling for these and other risk factors, the prevalence of diabetes was lower among respondents living in rural areas [prevalence odds ratio (POR) = 0.94, P = 0.032], but the prevalence of coronary heart disease was higher (POR = 1.09, P = 0.011). CONCLUSIONS The higher prevalence of diabetes and coronary heart disease in rural populations in the USA presents a formidable public health challenge. It exacerbates many of the pre-existing rural health disparities, including a lack of access to financial resources and primary care providers.
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Affiliation(s)
- A O'Connor
- Department of Community and Family Medicine, Dartmouth Medical School, Maine Dartmouth Family Medicine Residency, 4 Sheridan Drive, Fairfield, ME 04937, USA.
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Henry LR, Hooker RS, Yates KL. The role of physician assistants in rural health care: a systematic review of the literature. J Rural Health 2010; 27:220-9. [PMID: 21457316 DOI: 10.1111/j.1748-0361.2010.00325.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE A literature review was performed to assess the role of physician assistants (PAs) in rural health care. Four categories were examined: scope of practice, physician perceptions, community perceptions, and retention/recruitment. METHODS A search of the literature from 1974 to 2008 was undertaken by probing the electronic bibliographic databases of English language literature. Criterion for inclusion was original data published on rural PAs. Each paper was assessed and assigned to the four categories. FINDINGS A total of 51 papers were identified; 28 papers had a primary focus on research and specified PAs in a rural setting. Generally, the literature suggests that PAs provide cost-efficient and supplemental medical services to underserved rural populations and that these services are valued. It also appears that rural PAs possess a larger scope of practice than urban PAs. This broad range of skills and procedures may be necessary to match the extensive health care needs of underserved rural populations. Over a 35-year period of examination, the literature improved in numbers of PAs studied and the quality of research. However, the lack of longitudinal studies was considered a shortcoming of rural health PA observational research. CONCLUSIONS Through this review, some insights about the role of PAs emerged. Overall, they seem well adapted to rural health. Important issues regarding the recruitment and retention of PAs to rural populations also emerged. Improvement in enabling legislation contributes to the utilization of PAs in America.
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Affiliation(s)
- Lisa R Henry
- Anthropology Department, University of North Texas, Denton, Texas 76203, USA.
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Singer J. Urban and Rural Health Care Environments: Factors Affecting New Graduates' Choice for Employment. J Med Imaging Radiat Sci 2008; 39:173-174. [DOI: 10.1016/j.jmir.2008.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lindsay S. The Care–tech Link: An Examination of Gender, Care and Technical Work in Healthcare Labour. GENDER WORK AND ORGANIZATION 2008. [DOI: 10.1111/j.1468-0432.2007.00387.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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