Predicting Rural Practice and Service to Indigent Patients: Survey of Dental Students Before and After Rural Community Rotations.

Community-based clinical rotations in rural areas expose dental students to diverse patient populations, practice models, and career opportunities as well as rural culture. The aims of this study at West Virginia University were to determine the best predictors of rural practice, assess the predictive validity of students' intention to practice in a rural area before and after their rural rotations, and evaluate the relationship between students' intention to practice in a rural area and intention to provide care for indigent patients. Online survey data were submitted pre- and post-rural clinical rotation by 432 of 489 dental students over the study period 2001-12, yielding an 88% response rate. In 2013, practice addresses from the West Virginia Board of Dentistry were added to the student database. The results showed that significant predictors of rural practice site were intended rural practice choice, rural hometown, and projected greater practice accessibility for indigent patients. The likelihood of students' predicting they would choose a rural practice increased after completion of their rural rotations. After the rotations, students predicted providing greater accessibility to indigent patients; these changes occurred for those who changed their predictions to rural practice choice after the rotations and those who subsequently entered rural practice. The dental students with a rural background or a greater service orientation were also more likely to expect to enter a rural practice and actually to do so after graduation. These findings suggest that dental school curricula that include rural rotations may increase students' sensitivity to issues of indigent patients and increase students' likelihood of rural practice choice.

Validity of Medical Student Questionnaire Data in Prediction of Rural Practice Choice and Its Association With Service Orientation.

PURPOSE: The validity of medical student projection of, and predictors for, rural practice and the association of a measure of service orientation, projected practice accessibility to the indigent, were investigated. METHODS: West Virginia (WV) medical student online pre- and postrural rotation questionnaire data were collected during the time period 2001-2009. Of the 1,517 respondent students, submissions by 1,271 met the time interval criterion for inclusion in analyses. Subsequent WV licensing data were available for 461 in 2013. These 2 databases were used to assess for validity of projection of rural practice, for predictors of rural practice, and for student projected accessibility of the future practice to indigent patients. FINDINGS: There were statistically significant associations between both pre- and postrotation projections of rural practice and subsequent rural practice. The most significant independent predictors of rural practice were student rural background, reported primary care intent, prediction of rural practice and projection of greater accessibility of the future practice to indigent patients. For scoring of practice access, there were trends for higher scoring by rural students and rural practitioners, with greater pre-post increases for those with urban hometowns. CONCLUSIONS: This study demonstrates the utility of medical student questionnaires for projections of numbers of future rural physicians. It suggests that students with a rural background, rural practice intent, or greater service orientation are more likely to enter rural practice. It also suggests that students, particularly those with urban hometowns, are influenced by rural rotation experiences in forecasting greater practice accessibility and in entering rural practice.

A study of predictive validity of physician assistant students' reported practice site intent.

PURPOSE: With the downward trend in numbers of primary care physicians, it is anticipated that mid-level providers will increasingly fill the resulting void in rural health care. Recruitment of health care providers into rural areas has been historically difficult, and West Virginia has been at the forefront of developing programs to address rural recruitment. One of these programs is the West Virginia Rural Health Education Partnership, which provides rural clinical rotation opportunities for students from multiple disciplines and schools in West Virginia. This study assessed the predictive validity of physician assistant (PA) students' prediction, after completion of rural rotations, of a rural or an urban practice site and also assessed for factors associated with subsequent rural practice. METHODS: The Institutional Review Board of West Virginia University approved this study. The West Virginia Rural Health Education Partnership's electronic database, which has collected students' postrotation evaluation information since 2001, was coupled with West Virginia licensing information that included information on PA practice site(s). Data on 168 practicing West Virginia PAs who had completed rural rotation questionnaires during their clinical education were examined. Designation of a rural or an urban practice site was done using rural-urban commuting area codes. RESULTS: Student prediction of rural practice was significantly associated with subsequent rural practice (P < 0.04). Variables most predictive of rural practice were student reporting of high school hometown as rural and of West Virginia practice intent. CONCLUSIONS: This study suggests moderate predictive validity of PA student reporting on rural practice and on West Virginia practice intent; such methods may have potential in prediction of the future rural PA workforce.

The influence of payer mix and visit volume on NRMP match rates for community-based family medicine residency programs.

BACKGROUND: With declining U.S. medical student interest in family medicine, it is important to study factors that may predict for individual residency program fill rates. Predictors of family medicine residency program match rates are few, with location by region of the country being the best predictor. Using a limited database, this study evaluated whether community-based residency program match rates are associated with patient visit volume and payer status. METHODS: An existing database of characteristics of 42 community-based family medicine residency programs was analyzed for associations of match rate with patient visit volume and with insurance payer status. RESULTS: Nonsignificant correlations were calculated for match rate with the following factors: patient visit volume per provider, percentage of patient visits with no insurance or with Medicaid payment, percentage of visits with Medicare payment, and percentage of visits with private third party payers. A marginal negative association of match rate with percentage of patient visits with Medicare payment was not significant when adjusted for region of the country. CONCLUSIONS: In this study, neither patient visit volume nor payer status were predictive of match rate for community-based family medicine residency programs. Limitations to this study are acknowledged.

A gender-based study of attitudes and practice characteristics of rural physicians in West Virginia.

Physician gender can affect the numbers of future rural health care providers since female physicians are less likely to enter rural practice, but the proportion of female U.S. medical students is increasing. This survey study of rural West Virginia physicians who were trained in the U.S. obtained information on demographics and prior practice intent, working time, practice characteristics, and satisfaction with practice and community for female vs. male physicians. Female physicians were more likely to report pre-existing intent to work in underserved areas and having higher proportions of Medicaid and uninsured patients, but fewer work hours and on-call services and less likelihood of providing hospital services. Initiatives to help address the shortage of rural providers could include residency program and community initiatives to address work flexibility and personal and spouse concerns for female physicians.

Techniques for reducing anesthetic injection pain: an interdisciplinary survey of knowledge and application.

BACKGROUND: The authors conducted a study that considered family physicians' and dentists' knowledge and application of techniques to reduce the pain associated with anesthetic injections. They also assessed practitioners' discomfort with patients' injection pain and needle anxiety/phobia. METHODS: The authors designed a questionnaire about awareness and use of 10 techniques for reducing pain of anesthetic injection and mailed it to 2,000 randomly selected family physicians and general dentists. They analyzed the data to examine differences between disciplines regarding awareness and use of techniques, reasons for not using techniques, number of injections given per week, and predictive value of certain demographic variables on reported use of individual techniques and on practitioner reactions to patients' pain and anxiety. RESULTS: The response rate was 35 percent. The authors used the chi2 test for differences between disciplines' awareness of and use or nonuse of techniques, Wilcoxon testing to assess differences between disciplines' median values of number of weekly injections and logistic regression to study demographic variables' predictive values (P = .01). General dentists give more injections than do family physicians. Differences existed between disciplines' awareness and use of eight of 10 techniques. Disciplines reported cost and time issues as reasons for not using some techniques. Number of years in practice and age were associated with use of six techniques. Dentists reported feeling greater personal effects of patients' pain and needle anxiety/phobia than did family physicians. CONCLUSIONS: Those not using pain-lessening techniques inaccurately identified time and cost as problems, suggesting that respondents may be less familiar with these techniques than otherwise reported. Further study is recommended. CLINICAL IMPLICATIONS: Pain reduction techniques for anesthetic injection cost little to implement, are not time liabilities, and can lessen avoidable pain and reduce the incidence of needle phobia.

A comparative assessment of West Virginia's financial incentive programs for rural physicians.

CONTEXT: Financial incentive programs are increasingly being used as a strategy to recruit physicians to underserved rural areas. Critical evaluation of state-supported programs is often lacking but is necessary to determine their efficacy and to improve outcomes. PURPOSE: The purpose of this study was to assess 4 service-contingent programs in West Virginia, a state with critical physician shortages. METHODS: Survey instruments were developed to evaluate the effectiveness of these programs and to document the practice environments and career paths of obligated allopathic and osteopathic physicians compared with a control group of nonobligated rural practitioners. Data were also collected from physicians who were recipients of multiple incentive programs and from obligated physicians who had defaulted. FINDINGS: Responses from more than 60% of surveyed physicians indicated that the typical respondent was a married white male who was a midcareer family practice physician. Obligated physicians were more likely than nonobligated physicians to have graduated from a West Virginia medical school and residency program, to be influenced by financial factors in their career decisions, to provide care to uninsured patients, and to work in offices that offered sliding fee scales. Both groups of physicians demonstrated similar retention patterns, reported a high degree of job satisfaction, and expressed a need for more practice management training. CONCLUSIONS: Although these financial incentive programs were found to be effective in recruiting primary care physicians to medically underserved areas of the state, the financial support of these programs was found to be too modest, and improved marketing of the programs was indicated.

A community development approach to rural recruitment.

Programs designed to empower rural communities for health care provider recruitment have usually focused on the health care sector without aggressively addressing broader community development issues. The Recruitable Community Project (RCP) in West Virginia includes community education on recruiting and also assessments of and recommendations to rural communities on broad-based community development, aiming to enhance communities' recruiting potential. The project provides multidisciplinary university-based planning assistance programs for small communities, involving collaborative community visits. The project also uses a project manager as a "community encourager" who participates in community education and in the formulation of sustained community recruiting efforts. From August 1999 through August 2001, 7 underserved rural communities completed the RCP organizational processes and hosted planning assistance teams. Members of community recruitment boards gave high marks to the RCP process, its planning assistance teams, and its usefulness in establishing community ties to state and academic agencies. Since working with the RCP, the 7 communities have recruited 27 providers, success possibly stimulated by their RCP involvement (data current as of September 2002). This model of community training and development to empower rural communities to better recruit health professionals shows early promise. This model could be broadened to include more collaboration of community development and health science disciplines programs for recruitment and retention efforts.