Draw to Practice: A Qualitative Study Examining Factors Attracting Physicians to Rural Northern Ontario.

Introduction Physician shortages are a persisting issue in rural regions around the world, and rural Northern Ontario, Canada, is no exception. Even with significant government interventions, financial incentives, and rural-specific contracts, physician recruitment to the region remains an ongoing challenge. Refining recruitment strategies based on specific factors that attract physicians to rural practice could help address staffing shortages and, ultimately, enhance healthcare access and outcomes in rural communities. However, the draw to rural practice among physicians is poorly defined. Therefore, this study aims to bridge this knowledge gap and, in doing so, offers insight to better inform recruitment strategies for rural communities. Methodology As part of a larger qualitative study on physician retention and recruitment, semi-structured interviews were conducted with 12 physicians who had previously practiced in rural Northern Ontario communities. Interviews captured information about their individual experiences, including perspectives on factors that attracted them to establish a practice in rural Northern Ontario. Transcribed interviews were analyzed to identify recurring themes associated with the factors that affect the decision to practice in rural Northern Ontario. Results Participants described the draw to rural practice as being multifactorial and based on overlapping motivations. Key motivations described by participants could be categorized into three broad themes, including rural community connection and exposure, lifestyle and personal preferences, and career considerations. Specifically, participants emphasized the importance of pro-rural mentors and gaining firsthand experience in rural communities as important facilitators that created a connection with these areas. Interest in exploring new parts of the country, alignment with life plans, support of family, and the challenge of rural practice also played pivotal roles in the decision to pursue rural practice. Finally, the opportunity to have a broad scope of practice and serve a need in the healthcare system while receiving fair compensation within the framework of a flexible and supportive contract was also cited as a draw to practice. Conclusion The draw to rural practice is multifactorial and based on a wide array of motivations. As a result, recruitment strategies should move beyond single-pronged approaches and recognize the need to design strategies that address the multifaceted motivations and considerations that drive physicians towards rural practice. Designing and implementing recruitment approaches that consider the diverse factors influencing physicians interest in rural career paths is likely to enhance recruitment initiatives and more effectively address shortage of physicians in the region.

Internally versus externally trained residents and fellows hired as attendings at a large integrated healthcare system: a 20-year retrospective study.

BACKGROUND: There remains a question of whether graduates trained internally are different than those trained elsewhere. We examine the difference between physicians trained within our Graduate Medical Education (GME) programs versus physicians trained elsewhere. Our large integrated healthcare system is unique in addressing this objective due to its large physician labor hiring needs across different specialties of GME graduates. METHODS: A retrospective review was performed from Jan 2000 to August 2020 of Kaiser Permanente Southern California (KPSC) physicians hired: KPSC GME trained versus non-KPSC GME trained. We examined five variables: retention, leadership (current or historical), physician relations cases, member appraisal of physician and provider services survey (MAPPS) scores, and rate of board certification. Chi-square test of proportions was used for comparison, p < 0.05 was significant. RESULTS: From Jan 2000 to August 2020, 2940 residents and fellows graduated from KPSC GME programs, of which 1127 (38%) were hired on at KPSC as full time attendings. Across all five metrics (Retention 82% vs 76% (p = < 0.01), Leadership [current 13% vs 10% (p = < 0.01)or historical 17% vs 14% (p = 0.01)], Physician Relations 23% vs 26% (p = 0.04), MAPPS 75% vs 69% (p = < 0.01), and Board Certification 81% vs 74% (p = < 0.01)), KPSC outperformed non-KPSC GME-trained physicians to a statistically significant degree. CONCLUSIONS: We have shown that an internally sponsored GME program can represent an opportunity for recruitment of physicians that may have higher retention rates, higher probability of being physician leaders, decreased likelihood of physician relations issues, improved patient satisfaction, and increased rates of board certification.

Giving 200%: Workplace Flexibility and Provider Distress Among Female Physicians.

Introduction: Evidence suggests that female physicians experience higher rates of burnout compared to their male counterparts and are less likely to be satisfied with work-life integration. Understanding factors related to burnout and job turnover among female physicians is particularly relevant given the nationally projected physician shortage and maldistribution of providers. It may be particularly important to explore these factors among resident physicians, as many organizations might aim to pipeline these individuals into their existing workforce. This study aimed to (a) determine prevalence estimates of access to childcare and identify specific difficulties faced by working female physicians who are parents; (b) examine associations between provider distress and workplace flexibility; (c) examine differences in resident and non-resident physicians regarding workplace flexibility and access to parental resources. Methods: Participants included 839 female medical providers who completed electronic surveys via social media. Descriptive, correlational, and linear regression analyses were used to examine associations. Results: Few providers indicated that they had access to daycare through their workplace (7.2%, n = 62), but over three quarters of the group indicated that they wished they had access to daycare (76.0%, n = 638). Stress and burnout were negatively associated with how supported female physicians felt at work. This was the case for time off for parental leave, access to a comfortable space and adequate time for breastfeeding, flexibility of the job to handle family conflicts, and amount of time available for family and professional development. Discussion: Future research might examine whether medical organizations that implement childcare facilities for working female physicians are more likely to retain and/or attract physicians to their employment.

Successful recruitment and retention of academic physicians: hiring for longevity, productivity, and leadership in hospital medicine.

BACKGROUND: Considerable resources are expended by hospitals to recruit and retain physicians that will be successful. Healthcare managers lack data to guide these decisions. In that vacuum, suppositions regarding what attributes contribute to physician success predominate. OBJECTIVES: To evaluate the relationship between candidate factors known at the time of hiring and subsequent longevity and success of physicians in an academic division of hospital internal medicine. RESEARCH DESIGN: A retrospective review of all physicians hired in an academic hospital internal medicine division. Measures of longevity, research productivity, academic promotion and division leadership roles were compared to personal and professional characteristics at the time of hiring. Success was quantified in those four domains and associations explored for between success and hiring factors. RESULTS: Female physicians had greater longevity at the institution. Physicians from the hospital region were no more likely to stay long-term as compared to those from other regions. United States medical graduates were more likely to attain leadership positions than international graduates. There was an inverse relationship between research productivity and administrative leadership. CONCLUSIONS: Factors commonly sought by academic healthcare institutions were not associated with long term success in academic hospital medicine. Less research productivity was associated with greater divisional leadership involvement, suggesting that scholarship and administrative leadership may represent separate tracks for physicians at academic institutions.

Assessing the performance of beneficiary targeting in Brazil's More Doctors Programme.

Many countries employ strategies that rest on the use of an explicitly defined set of criteria to identify underserved communities. Yet, we know relatively little about the performance of community-level targeting in large-scale health programmes. To address this gap, we examine the performance of community targeting in the More Doctors Programme (MDP). Our analysis covers all 5570 municipalities in the period between 2013 and 2017 using publicly available data. We first calculate the rate at which vulnerable municipalities enrolled in the MDP. Next, we consider two types of mistargeting: (1) proportion of vulnerable municipalities that did not have any MDP physicians (i.e. under-coverage municipalities) and (2) proportion of MDP enrolees that did not fit the vulnerability criteria (i.e. non-target municipalities). We found that almost 70% of vulnerable municipalities received at least one MDP physician between 2013 and 2017; whereas non-target municipalities constituted 33% of beneficiaries. Targeting performance improved over time. Non-target municipalities had the highest levels of socioeconomic development and greater physician availability. The poverty rate among under-coverage municipalities was almost six times that in non-target municipalities. Under-coverage municipalities had the lowest primary care physician availability. They were also smaller and more sparsely populated. We also found small differences in the political party alignments of mayors and the President between under-coverage and non-target municipalities. Our results suggest that using community-level targeting approaches in large-scale health programmes is a complex process. Programmes using these approaches may face substantial challenges in beneficiary targeting. Our results highlight that policymakers who consider using these approaches should carefully study various municipal characteristics that may influence the implementation process, including the level of socioeconomic development, health supply factors, population characteristics and political party alignments.

Impact of Brazil's More Doctors Program on hospitalizations for primary care sensitive cardiovascular conditions.

Globally, cardiovascular diseases are the leading cause of disease burden and death. Timely and appropriate provision of primary care may lead to sizeable reductions in hospitalizations for a range of chronic and acute health conditions. In this paper, we study the impact of Brazil's More Doctors Program (MDP) on hospitalizations due to cerebrovascular disease and hypertension. We exploit the geographic variation in the uptake of the MPD and combine coarsened exact matching and difference-in-difference methods to construct valid counterfactual estimates. We use data from the Hospital Information System in Unified Health System, the MDP administrative records, the Brazilian Regulatory Agency, the Ministry of Health, and the Brazilian Institute of Geography and Statistics, covering the years from 2009 to 2017. Our analysis resulted in estimated coefficients of -1.47 (95%CI: -4.04,1.10) for hospitalizations for cerebrovascular disease and -1.20 (95%CI: -5.50,3.11) for hypertension, suggesting an inverse relationship between the MDP and hospitalizations. For cerebrovascular disease, the estimated MDP coefficient was -0.50 (95%CI: -2.94,1.95) in the year of program introduction, -5.21 (95%CI: -9.43,-0.99) and -8.21 (95%CI: -13.68,-2.75) in its third and fourth year of implementation, respectively. Our results further suggest that the beneficial impact of MDP on hospitalizations due to cerebrovascular disease became discernable in urban municipalities starting from the fourth year of implementation. We found no evidence that the MDP led to reductions in hospitalizations due to hypertension. Our results highlight that increased investment in resources devoted to primary care led to improvements in hospitalizations for selected cardiovascular conditions. However, it took time for the beneficial effects of the MDP to become discernable and the Program did not guarantee declines in hospitalizations for all cardiovascular conditions, suggesting that further improvements may be needed to enhance the beneficial impact of the MDP on the level and distribution of population health in Brazil.

Contribution of the Nelson R. Mandela School of Medicine to a socially accountable health workforce.

BACKGROUND: A socially accountable health professional education curriculum aims to produce fit-for-purpose graduates to work in areas of need. 'Fit-for-purpose' can be assessed by monitoring graduate practice attributes. AIM: The aim of this article was to identify whether graduates of 'fit-for-purpose' programmes are socially accountable. SETTING: The setting for this project was all 37 district hospitals in the KwaZulu-Natal province in Durban, South Africa. METHODS: We surveyed healthcare professionals working at district hospitals in the KwaZulu-Natal province. We compared four social accountability indicators identified by the Training for Health Network Framework, comparing medical doctors educated at the Nelson R. Mandela School of Medicine (NRMSM) with medical doctors educated at other South African and non-South African medical schools. In addition, we explored medical doctors' characteristics and reasons for leaving or staying at district hospitals. RESULTS: The pursuit of specialisation or skills development were identified as reasons for leaving in the next 5 years. Although one-third of all medical doctors reported an intention to stay, graduates from non-South African schools remained working at a district hospital longer than graduates of NRMSM or other South African schools and they held a majority of leadership positions. Across all schools, graduates who worked at the district hospital longer than 5 years cited remaining close to family and enjoyment of the work and lifestyle as motivating factors. CONCLUSION: Using a social accountability approach, this research assists in identifying areas of improvement in workforce development. Tracking what medical doctors do and where they work after graduation is important to ensure that medical schools are meeting their social accountability mandate to meet community needs.

The Challenges of Providing Interventional Radiology Services to Rural and Smaller Community Hospitals.

OBJECTIVE: Recruitment and retention of interventional radiologists for rural and smaller community hospital practices is a serious physician staffing issue. This article explores rural interventional radiology and perspectives of various stakeholders, such as rural radiology group practices, rural hospitals, interventional radiologists, public and private academic institutions, and urban health care providers, and considers the unique health care needs of rural patients. CONCLUSION: Some early solutions are evident. Collaboration among all stakeholders will be necessary to properly address the challenges.

O Programa Mais Médicos: uma avaliação do impacto sobre indicadores de saúde do Brasil

A escassez de médicos e os desequilíbrios geográficos destes profissionais são problemas em sistemas de saúde de diversos países. Em 2013, no Brasil, verificava-se uma razão de dois médicos por mil habitantes e uma distribuição desigual destes nas regiões do país. Para reverter este cenário, foi instituído o Programa Mais Médicos para o Brasil, estruturado em três eixos: o provimento emergencial de profissionais médicos denominado de Projeto Mais Médicos (PMM); o investimento na Rede de Serviços Básicos de Saúde; e o desenvolvimento da formação médica no Brasil. A presente tese busca analisar o impacto do PMM para o Brasil na atenção básica da saúde...

The shortage of physicians and the geographical imbalances of these professionals are problems in health systems in different countries. In 2013, in Brazil, there was a ratio of two physicians per thousand inhabitants and an unequal distribution of these in the regions of the country. To reverse this scenario, the Medical Doctors Program for Brazil was established, structured in three axes: the emergency provision of medical professionals called the More Medical Project (PMM); the investment in the Network of Basic Health Services; and the development of medical training in Brazil. The present thesis aims to analyze the impact of the PMM for Brazil on basic halth care...

Assessing Idaho Rural Family Physician Scope of Practice Over Time.

CONTEXT: An important consideration determining health outcomes is to have an adequate supply of physicians to address the health needs of the community. PURPOSE: The purpose of this investigation was to assess scope of practice factors for Idaho rural family physicians in 2012 and to compare these results to findings from a 2007 study. METHODS: The target population in this study was rural family physicians in Idaho counties with populations of fewer than 50,000. Identical surveys and methods were utilized in both 2007 and 2012. RESULTS: The physician survey was mailed to 252 rural physicians and was returned by 89 for a response rate of 35.3%. Parametric and nonparametric statistical analyses were conducted to analyze the 2012 results and to assess changes in scope of practice across the time periods. DISCUSSION: The percentage of rural family physicians in Idaho in 2012 who provided prenatal care, vaginal deliveries, and nursing home care was significantly lower than the results from the 2007 survey. Female physicians were more likely to provide prenatal care and vaginal deliveries than males in 2012. Male physicians were more likely to provide emergency room coverage and esophagogastroduodenoscopy or colonoscopy services than females in 2012. Younger physicians were found to be more likely to provide inpatient admissions and mental health services in 2012 than older physicians. Employed physicians were more likely to provide cesarean delivery, other operating room services and emergency room coverage in 2012 than nonemployed physicians. Further research is needed to assess the root causes of these changes.

The general surgery workforce shortage is worse when assessed at county level.

BACKGROUND: Multiple studies have documented a significant decrease in the general surgery workforce in the United States, both rural and urban, for the past 3 decades. This 11-year study evaluates the Texas general surgery workforce at both the state and local level in 2002 and 2012. METHODS: Data were obtained from the Texas Medical Board, the United States Census Bureau/Texas State Library and Archives Commission, and the Texas Department of State Health Services for 2002 and 2012. A benchmark target of 7 general surgeons per 100,000 population was used. RESULTS: During the study period, the Texas population increased 21%, and actively practicing physicians increased 44%. All surgical specialists increased by 26%. General surgeons increased 4%; however, the number of general surgeons per 100,000 population decreased 14% (from 6.7 to 5.8/10(5)). Using the total Texas population for 2012, an additional 329 general surgeons are needed by benchmark standards. However, when analyzed by individual county population, 449 additional general surgeons are needed in the individual counties. These effects were greater in the nonmetropolitan areas of Texas where per capita general surgeons decreased by 21%. CONCLUSIONS: The absolute increase in Texas general surgeons over the past decade has not kept pace with an increase in the Texas population. The general surgery workforce deficit based on the Texas state population underestimates the local workforce shortage, particularly in the nonmetropolitan areas of Texas.