The Impact of Title VII Dental Workforce Programs on Dentists' Practice Location: A Difference-in-Differences Analysis.

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.

Addressing the unequal geographic distribution of specialist doctors in indonesia: the role of the private sector and effectiveness of current regulations.

As in many countries, the geographic distribution of the health workforce in Indonesia is unequal, with a concentration in urban and more developed areas, and a scarcity in rural and remote areas. There is less information on the distribution of specialist doctors, yet inequalities in their distribution could compromise efforts to achieve universal coverage by 2014. This paper uses data from 2007 and 2008 to describe the geographic distribution of specialist doctors in Indonesia, and to examine two key factors that influence the distribution and are targets of current policies: sources of income for specialist doctors, and specialist doctor engagement in private practice. The data demonstrates large differences in the ratio of specialist doctors to population among the provinces of Indonesia, with higher ratios on the provinces of the islands of Java, and much lower ratios on the more remote provinces in eastern Indonesia. Between 65% and 80% of specialist doctors' income derives from private practice in non-state hospitals or private clinics. Despite regulations limiting practice locations to three, most specialists studied in a provincial capital city were working in more than three locations, with some working in up to 7 locations, and spending only a few hours per week in their government hospital practice. Our study demonstrates that the current regulatory policies and financial incentives have not been effective in addressing the maldistribution of specialist doctors in a context of a growing private sector and predominance of doctors' income from private sources. A broader and more integrated policy approach, including more innovative service delivery strategies for rural and remote areas, is recommended.

Malpractice burden, rural location, and discontinuation of obstetric care: a study of obstetric providers in Michigan.

CONTEXT: It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis. PURPOSE: This study examined whether higher malpractice burden on obstetric providers was associated with an increased likelihood of discontinuing obstetric care and whether there were rural-urban differences in the relationship. METHODS: Data on 500 obstetrician-gynecologists and family physicians who had provided obstetric care at some point in their career (either currently or previously) were obtained from a statewide survey in Michigan. Statistical tests and multivariate regression analyses were performed to examine the interrelationship among malpractice burden, rural location, and discontinuation of obstetric care. FINDINGS: After adjusting for other factors that might influence a physician's decision about whether to stop obstetric care, our results showed no significant impact of malpractice burden on physicians' likelihood to discontinue obstetric care. Rural-urban location of the practice did not modify the nature of this relationship. However, family physicians in rural Michigan had a nearly 4-fold higher likelihood of withdrawing obstetric care when compared with urban family physicians. CONCLUSIONS: The higher likelihood of rural family physicians to discontinue obstetric care should be carefully weighed in future interventions to preserve obstetric care supply. More research is needed to better understand the practice environment of rural family physicians and the reasons for their withdrawal from obstetric care.

The ties that bind. What you should know about the operational, ethical issues of restrictive covenants.

Restrictive covenants--also called noncompete clauses--in physician contracts can be a contentious issue, sometimes inspiring litigation. They pose many questions for medical practice administrators. Are restrictive covenants really necessary to protect a medical group? Are they ethical? Does their use deny medical care to patients? And how do they apply to medical practice administrators? This article reviews restrictive covenants from all these perspectives and provides a worksheet to figure your practice's protectable interests.

[German experience of planning medical installations]. / L'expérience Allemande de planification des installations médicales.

Since the 19th century, Germany has adopted the Bismarckian model: the medical doctors in private practice provide ambulatory care to the insured people (nearly all the population) and are paid by (public) insurers on a fee-for-service basis. The country introduced in 1993 a large-scale reform composed of several steps: (i) delimitation of geographic areas having similar characteristics; (ii) calculation for each area various physician/population ratios, each related to a specialty; (iii) if the ratio of a specialty in an area exceeds the average national ratio (of the specialty) by 10% or more, the doctors of the specialty are not allowed to set up their office in the area; (iv) if the ratio of a specialty in an area is lower than the average national ratio by 10% the area is "open". After a decade, one can say that the reform has succeeded in curbing the growth in the numbers of medical doctors. Today, there is nearly no possibility for a medical specialist to set up a private office, unless he/she accepts to practice as GPs or to succeed to an other colleague of his specialty. As a matter of fact, many areas are still open to GPs. The medical profession is aging and the young graduates are not motivated to set up office. The country may possibly go down from oversupply in the 80's to medical manpower shortage in the next decade.