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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: 68] [Impact Index Per Article: 11.3] [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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Pfarrwaller E, Audétat MC, Sommer J, Maisonneuve H, Bischoff T, Nendaz M, Baroffio A, Junod Perron N, Haller DM. An Expanded Conceptual Framework of Medical Students' Primary Care Career Choice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1536-1542. [PMID: 28379931 DOI: 10.1097/acm.0000000000001676] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
In many countries, the number of graduating medical students pursuing a primary care career does not meet demand. These countries face primary care physician shortages. Students' career choices have been widely studied, yet many aspects of this process remain unclear. Conceptual models are useful to plan research and educational interventions in such complex systems.The authors developed a framework of primary care career choice in undergraduate medical education, which expands on previously published models. They used a group-based, iterative approach to find the best way to represent the vast array of influences identified in previous studies, including in a recent systematic review of the literature on interventions to increase the proportion of students choosing a primary care career. In their framework, students enter medical school with their personal characteristics and initial interest in primary care. They complete a process of career decision making, which is subject to multiple interacting influences, both within and outside medical school, throughout their medical education. These influences are stratified into four systems-microsystem, mesosystem, exosystem, and macrosystem-which represent different levels of interaction with students' career choices.This expanded framework provides an updated model to help understand the multiple factors that influence medical students' career choices. It offers a guide for the development of new interventions to increase the proportion of students choosing primary care careers and for further research to better understand the variety of processes involved in this decision.
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Affiliation(s)
- Eva Pfarrwaller
- E. Pfarrwaller is lecturer, Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland. M.-C. Audétat is senior lecturer, Primary Care Unit and Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland. J. Sommer is professor of primary care medicine and head, Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland. H. Maisonneuve is primary care physician and senior lecturer, Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland. T. Bischoff is professor of primary care medicine and former head, Institute of General Practice, University of Lausanne, Lausanne, Switzerland. M. Nendaz is professor of internal medicine and medical education, Unit of Development and Research in Medical Education and General Internal Medicine Service, Faculty of Medicine, University of Geneva, Geneva, Switzerland. A. Baroffio is professor of medical education, Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland. N. Junod Perron is primary care physician and senior lecturer, Division of Primary Care Medicine, Geneva University Hospitals, and Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland. D.M. Haller is primary care physician and senior lecturer, Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland, and clinical associate professor, Department of General Practice, University of Melbourne, Melbourne, Australia
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Deutsch T, Hönigschmid P, Frese T, Sandholzer H. Early community-based family practice elective positively influences medical students' career considerations--a pre-post-comparison. BMC FAMILY PRACTICE 2013; 14:24. [PMID: 23433217 PMCID: PMC3605291 DOI: 10.1186/1471-2296-14-24] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 02/13/2013] [Indexed: 12/30/2022]
Abstract
Background Demographic change and recruitment problems in family practice are increasingly threatening an adequate primary care workforce in many countries. Thus, it is important to attract young physicians to the field. The purpose of the present study was to examine the effect of an early community-based 28-h family practice elective with one-to-one mentoring on medical students’ consideration of family practice as a career option, their interest in working office-based, and several perceptions with regard to specific aspects of a family physician’s work. Methods First- and second-year medical students completed questionnaires before and after a short community-based family practice elective, consisting of a preparatory course and a community-based practical experience with one-to-one mentoring by trained family physicians. Results We found a significantly higher rate of students favoring family practice as a career option after the elective (32.7% vs. 26.0%, p = 0.039). Furthermore, the ranking of family practice among other considered career options improved (p = 0.002). Considerations to work office-based in the future did not change significantly. Perceptions regarding a family physician’s job changed positively with regard to the possibility of long-term doctor-patient relationships and treatment of complex disease patterns. The majority of the students described identification with the respective family physician tutor as a professional role model and an increased interest in the specialty. Conclusions Our results indicate that a short community-based family practice elective early in medical education may positively influence medical students’ considerations of a career in family practice. Furthermore, perceptions regarding the specialty with significant impact on its attractiveness may be positively adjusted. Further research is needed to evaluate the influence of different components of a family practice curriculum on the de facto career decisions of young physicians after graduation.
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Affiliation(s)
- Tobias Deutsch
- Department of Primary Care, Leipzig Medical School, Philipp-Rosenthal-Str. 55, Leipzig 04103, Germany.
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