What Moves Physicians to Work in Rural Areas? An In-Depth Examination of Physician Practice Location Decisions

2021 ◽  
pp. 089124242110466
Author(s):  
Xiaochu Hu ◽  
Michael J. Dill ◽  
Sarah S. Conrad
Keyword(s):  
Rural Areas ◽  
Policy Development ◽  
Location Choice ◽  
The United States ◽  
Rural Practice ◽  
Location Decisions ◽  
Comprehensive Survey ◽  
Network Proximity ◽  
The One ◽  
Rural Physician

This study contributes to the current understanding of what drives physicians to practice in rural areas by analyzing new, comprehensive survey data of practicing physicians in the United States. This research confirmed that rural origin is a powerful and reliable predictor for rural practice and revealed that new and experienced physicians have different priorities regarding location choice. Physicians choosing rural practice locations are more likely to be motivated by compensation, the resemblance of the environment to the one they grew up in, patient needs, and prenegotiated service obligations or visa/immigration status. They are less likely to attribute their location choice to social network proximity. These findings have important implications for salary incentives and policy initiatives aimed at increasing the rural physician workforce. The results of this study will help decrypt the difficulties rural areas face in attracting and retaining medical and other professionals and inform policy development.

scholarly journals Student perception about working in rural United States/Canada after graduation: a study in an offshore Caribbean medical school

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 301
Author(s):  
P Ravi Shankar ◽  
Arun K Dubey ◽  
Atanu Nandy ◽  
Burton L Herz ◽  
Brian W Little
Keyword(s):  
United States ◽  
Rural Areas ◽  
Professional Growth ◽  
Student Perception ◽  
Medical Schools ◽  
The United States ◽  
Rural Practice ◽  
Growth Potential ◽  
Cultural Issues ◽  
The Government

Introduction: Rural residents of the United States (US) and Canada face problems in accessing healthcare. International medical graduates (IMGs) play an important role in delivering rural healthcare. IMGs from Caribbean medical schools have the highest proportion of physicians in primary care.  Xavier University School of Medicines admits students from the US, Canada and other countries to the undergraduate medical (MD) course and also offers a premedical program. The present study was conducted to obtain student perception about working in rural US/Canada after graduation.  Methods: The study was conducted among premedical and preclinical undergraduate medical (MD) students during October 2014. The questionnaire used was modified from a previous study. Semester of study, gender, nationality, place of residence and occupation of parents were noted. Information about whether students plan to work in rural US/Canada after graduation, possible reasons why doctors are reluctant to work in rural areas, how the government can encourage rural practice, possible problems respondents anticipate while working in rural areas were among the topics studied.Results: Ninety nine of the 108 students (91.7%) participated. Forty respondents were in favor of working in rural US/Canada after graduation. Respondents mentioned good housing, regular electricity, water supply, telecommunication facilities, and schools for education of children as important conditions to be fulfilled. The government should provide higher salaries to rural doctors, help with loan repayment, and provide opportunities for professional growth.  Potential problems mentioned were difficulty in being accepted by the rural community, problems in convincing patients to follow medical advice, lack of exposure to rural life among the respondents, and cultural issues.Conclusions: About 40% of respondents would consider working in rural US/Canada. Conditions required to be fulfilled have been mentioned above. Graduates from Caribbean medical schools have a role in addressing rural physician shortage. Similar studies in other offshore Caribbean medical schools are required as Caribbean IMGs make an important contribution to the rural US and Canadian health workforce.

scholarly journals A decision-making support model for enterprises localization strategies

2014 ◽  
Vol 16 (1) ◽  
pp. 33-59
Author(s):  
Marzia Morena ◽  
Maria Luisa Del Gatto ◽  
Anna Gornati
Keyword(s):  
Decision Making ◽  
Design Methodology ◽  
Location Choice ◽  
The Other ◽  
Location Decisions ◽  
Decision Making Process ◽  
Key Factors ◽  
Content Type ◽  
Development Scenarios ◽  
The One

Purpose – The paper aims at describing a supporting model for the decision-making process that may steer the location decisions of international businesses. This is made possible by a measurement system where the characteristics of a territory are assessed with reference to some key factors that are internationally known to investors, to the aim of spotting the best location to implement a property investment. Design/methodology/approach – The surveys analysed when producing this paper highlighted the presence of internationally renowned and shared factors that the enterprises generally take into consideration in their decision-making process, and which strongly influence the decision to locate a business in a territory to the detriment of another. By adopting and organizing these “key factors” in a systemic way, the model introduced in this paper supports enterprises in their location choice. It analyses and measures some territorial contexts (with no limits regarding their size) based on the scores assigned to these contexts after the analysis of the 12 key factors. Findings – The analysis had two outputs: on the one hand, its results allowed to check whether the areas are actually in line with the expectations and with the requirements of a potential investor, with reference to the activity that such investor is willing to promote; on the other, the identification of the characteristics of the area provides the basis to define the vocation of the areas under examination, thus helping the drawing of future development scenarios. Originality/value – The surveys analysed when producing this paper highlighted the presence of internationally renowned and shared factors that the enterprises generally take into consideration in their decision-making process, and which strongly influence the decision to locate a business in a territory to the detriment of another.

scholarly journals Procedural Telementoring in Rural, Underdeveloped, and Austere Settings: Origins, Present Challenges, and Future Perspectives

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Juan P. Wachs ◽  
Andrew W. Kirkpatrick ◽  
Samuel A. Tisherman
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
The United States ◽  
Rural Practice ◽  
Annual Review ◽  
Publication Date ◽  
Future Perspectives ◽  
Medical Assistance ◽  
Residency Programs ◽  
Rural Settings

Telemedicine is perhaps the most rapidly growing area in health care. Approximately 15 million Americans receive medical assistance remotely every year. Yet rural communities face significant challenges in securing subspecialist care. In the United States, 25% of the population resides in rural areas, where less than 15% of physicians work. Current surgery residency programs do not adequately prepare surgeons for rural practice. Telementoring, wherein a remote expert guides a less experienced caregiver, has been proposed to address this challenge. Nonetheless, existing mentoring technologies are not widely available to rural communities, due to a lack of infrastructure and mentor availability. For this reason, some clinicians prefer simpler and more reliable technologies. This article presents past and current telementoring systems, with a focus on rural settings, and proposes a set of requirements for such systems. We conclude with a perspective on the future telementoring systems and the integration of artificial intelligence within those systems. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 23 is June 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals Putting the (R) Ural in Preceptorship

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Deirdre Jackman ◽  
Florence Myrick ◽  
Olive Yonge
Keyword(s):  
Nursing Students ◽  
Rural Areas ◽  
Nursing Student ◽  
Role Model ◽  
Rural Practice ◽  
Rural Setting ◽  
Rural Nursing ◽  
Important Approach ◽  
Research Gap ◽  
The One

Rural nursing is recognized as a unique health care domain. Within that context, the preceptorship experience is purported to be an important approach to preparing safe and competent rural practitioners. Preceptorship is the one-to-one pairing of a nursing student with a professional nurse who assumes the mandate of teacher and role model in a designated clinical/contextual setting, in this case the rural setting. A research gap exists in the literature in which rural preceptorship is specifically explored. The purpose of this paper is to review preceptorship in relation to preparing nursing students specifically for the rural setting. Understanding how preceptorship as an educational model can prepare nursing students to transition to rural practice is an important endeavor. An authentic rural preceptorship may serve to influence the recruitment and retention needs for registered nurses in rural areas. A greater understanding of rural preceptorship serves to illustrate the appropriate support, socialization and contextual competence required to prepare nursing students for rural nursing practice. This paper's review may serve to highlight the research that currently exists related to rural preceptorship and where additional research can contribute to further understanding and development for authentic rural nursing preparation.

scholarly journals Student perception about working in rural United States/Canada after graduation: a study in an offshore Caribbean medical school

F1000Research ◽  
2015 ◽  
Vol 3 ◽  
pp. 301 ◽  
Author(s):  
P Ravi Shankar ◽  
Arun K Dubey ◽  
Atanu Nandy ◽  
Burton L Herz ◽  
Brian W Little
Keyword(s):  
United States ◽  
Rural Areas ◽  
Professional Growth ◽  
Student Perception ◽  
Medical Schools ◽  
The United States ◽  
Rural Practice ◽  
Growth Potential ◽  
Cultural Issues ◽  
The Government

Introduction: Rural residents of the United States (US) and Canada face problems in accessing healthcare. International medical graduates (IMGs) play an important role in delivering rural healthcare. IMGs from Caribbean medical schools have the highest proportion of physicians in primary care.  Xavier University School of Medicines admits students from the US, Canada and other countries to the undergraduate medical (MD) course and also offers a premedical program. The present study was conducted to obtain student perception about working in rural US/Canada after graduation.  Methods: The study was conducted among premedical and preclinical undergraduate medical (MD) students during October 2014. The questionnaire used was modified from a previous study. Semester of study, gender, nationality, place of residence and occupation of parents were noted. Information about whether students plan to work in rural US/Canada after graduation, possible reasons why doctors are reluctant to work in rural areas, how the government can encourage rural practice, possible problems respondents anticipate while working in rural areas were among the topics studied.Results: Ninety nine of the 108 students (91.7%) participated. Forty respondents were in favor of working in rural US/Canada after graduation. Respondents mentioned good housing, regular electricity, water supply, telecommunication facilities, and schools for education of children as important conditions to be fulfilled. The government should provide higher salaries to rural doctors, help with loan repayment, and provide opportunities for professional growth.  Potential problems mentioned were difficulty in being accepted by the rural community, problems in convincing patients to follow medical advice, lack of exposure to rural life among the respondents, and cultural issues.Conclusions: About 40% of respondents would consider working in rural US/Canada. Conditions required to be fulfilled have been mentioned above. Graduates from Caribbean medical schools have a role in addressing rural physician shortage. Similar studies in other offshore Caribbean medical schools are required as Caribbean IMGs make an important contribution to the rural US and Canadian health workforce.

scholarly journals Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud

2020 ◽  
Vol 17 (24) ◽  
pp. 9223
Author(s):  
Ryan I. Logan ◽  
Heide Castañeda
Keyword(s):  
United States ◽  
Health Disparities ◽  
Community Health ◽  
Social Services ◽  
Community Health Workers ◽  
Rural Areas ◽  
Policy Development ◽  
Health Workers ◽  
The United States ◽  
Rural Populations

Rural populations in the United States are faced with a variety of health disparities that complicate access to care. Community health workers (CHWs) and their Spanish-speaking counterparts, promotores de salud, are well-equipped to address rural health access issues, provide education, and ultimately assuage these disparities. In this article, we compare community health workers in the states of Indiana and Texas, based on the results of two separate research studies, in order to (1) investigate the unique role of CHWs in rural communities and (2) understand how their advocacy efforts represent a central form of caregiving. Drawing on ethnographic, qualitative data—including interviews, photovoice, and participant observation—we analyze how CHWs connect structurally vulnerable clients in rural areas to resources, health education, and health and social services. Our primary contribution to existing scholarship on CHWs is the elaboration of advocacy as a form of caregiving to improve individual health outcomes as well as provoke structural change in the form of policy development. Finally, we describe how CHWs became especially critical in addressing disparities among rural populations in the wake of COVID-19, using their advocacy-as-caregiving role that was developed and well-established before the pandemic. These frontline workers are more vital than ever to address disparities and are a critical force in overcoming structural vulnerability and inequities in health in the United States.

Populism in Place: The Economic Geography of the Globalization Backlash

2021 ◽  
pp. 1-31
Author(s):  
J. Lawrence Broz ◽  
Jeffry Frieden ◽  
Stephen Weymouth
Keyword(s):  
Rural Areas ◽  
Global Financial Crisis ◽  
The United States ◽  
International Order ◽  
Industrial Workers ◽  
Electoral Success ◽  
Institutional Differences ◽  
Service Oriented ◽  
The One ◽  
The Global Financial Crisis

Abstract A populist backlash to globalization has ushered in nationalist governments and challenged core features of the Liberal International Order. Although startling in scope and urgency, the populist wave has been developing in declining regions of wealthy countries for some time. Trade, offshoring, and automation have steadily reduced the number of available jobs and the wages of industrial workers since at least the 1970s. The decline in manufacturing employment initiated the deterioration of social and economic conditions in affected communities, exacerbating inequalities between depressed rural areas and small cities and towns, on the one hand, and thriving cities, on the other. The global financial crisis of 2008 catalyzed these divisions, as communities already in decline suffered deeper and longer economic downturns than metropolitan areas, where superstar knowledge, technology, and service-oriented firms agglomerate. We document many of these trends across the United States and Europe, and demonstrate that populist support is strongest in communities that experienced long-term economic and social decline. Institutional differences in labor markets and electoral rules across developed democracies may explain some of the variation in populists’ electoral success. Renewed support for the Liberal International Order may require a rejuvenation of distressed communities and a reduction of stark regional inequalities.

International Telesupervision: The Clinical Fellowship Experience

2017 ◽  
Vol 2 (11) ◽  
pp. 73-78
Author(s):  
David W. Rule ◽  
Lisa N. Kelchner
Keyword(s):  
Graduate Students ◽  
Clinical Supervision ◽  
Rural Areas ◽  
The United States ◽  
Speech Language Pathology ◽  
Access To Services ◽  
East African ◽  
The World ◽  
Language Pathology ◽  
National Certification

Telepractice technology allows greater access to speech-language pathology services around the world. These technologies extend beyond evaluation and treatment and are shown to be used effectively in clinical supervision including graduate students and clinical fellows. In fact, a clinical fellow from the United States completed the entire supervised clinical fellowship (CF) year internationally at a rural East African hospital, meeting all requirements for state and national certification by employing telesupervision technology. Thus, telesupervision has the potential to be successfully implemented to address a range of needs including supervisory shortages, health disparities worldwide, and access to services in rural areas where speech-language pathology services are not readily available. The telesupervision experience, potential advantages, implications, and possible limitations are discussed. A brief guide for clinical fellows pursuing telesupervision is also provided.

From Scarcity to Abundance: Achieving Quality-Assured Mass Higher Education

2011 ◽  
Vol 15 (2) ◽  
Author(s):  
Peter P. Smith
Keyword(s):  
Higher Education ◽  
Knowledge Economy ◽  
Good Practice ◽  
The United States ◽  
The Other ◽  
Secondary System ◽  
Mass Higher Education ◽  
Post Secondary ◽  
One Year ◽  
The One

The United States is in a bind. On the one hand, we need millions of additional citizens with at least one year of successful post-secondary experience to adapt to the knowledge economy. Both the Gates and Lumina Foundations, and our President, have championed this goal in different ways. On the other hand, we have a post-secondary system that is trapped between rising costs and stagnant effectiveness, seemingly unable to respond effectively to this challenge. This paper analyzes several aspects of this problem, describes changes in the society that create the basis for solutions, and offers several examples from Kaplan University of emerging practice that suggests what good practice might look like in a world where quality-assured mass higher education is the norm.

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