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Shortages of rural generalist physicians may be due to poor recruitment rather than retention problems

Scarcity of physicians continues to threaten health care delivery in many rural communities in the United States. The general feeling has been that underserved rural areas (Health Professional Shortage Areas, HPSAs) generally suffer from an inability to recruit a sufficient number of physicians and to retain those that they have. However, according to the authors of a recent study, recruitment, not retention, is the problem.

Previous studies of retention in underserved areas have been limited to assessments of physicians working under service obligations and in other unique situations. The new study focuses on physicians working without obligations. The researchers examined how long these physicians, who constitute the majority of practitioners in rural underserved areas, are retained within the full range of practice settings. The study was supported in part by the Agency for Healthcare Research and Quality (HS10654).

Donald E. Pathman, M.D., M.P.H., of the University of North Carolina, and his colleagues surveyed nationally representative samples of primary care physicians in 1991. The physicians had recently moved to rural HPSAs and non-HPSAs and did not have service obligations. The researchers surveyed the same physicians again in 1996 and 1997 to learn of any job changes.

The average retention duration for generalist physicians in rural HPSAs was identical to or just slightly shorter than it was for similar physicians in rural non-HPSAs. Coupled with findings of earlier studies that fewer physicians move into shortage areas, the researchers conclude that the principal dynamic leading to rural shortage areas is inadequate recruitment of physicians. This often occurs when local amenities, economies, and practice situations are unattractive. Physician retention, by contrast, appears unrelated to the amenities communities offer but instead is related to physicians' work and family situations, their satisfaction, and their relationships to their communities.

See "Retention of primary care physicians in rural health professional shortage areas," by Dr. Pathman, Thomas R. Konrad, Ph.D., Rebekkah Dann, M.S., and Gary Koch, Ph.D., in the October 2004 American Journal of Public Health 94(10), pp. 1723-1729.

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