Examining inequities in physician workforce: An application of sociological theory and insight to the problem of physician recruitment and retention in rural Michigan.

摘要

It has long been recognized that access to adequate health care is not equal for all individuals in the United States. One measure of adequate access to health care is the ratio of population-to-primary care physicians in a given geographic area. An unequal distribution of physicians between metropolitan and many rural and inner-city areas has been generally acknowledged and extensively researched. However, scant attention has been given to explain the inequity of physicians observed among rural counties themselves.; This study investigates the physician workforce inequities observed in rural Michigan and seeks an explanation of the problem of physician recruitment and retention using sociological theory and insight. The problem is examined within the context of “push/pull” theory, which is frequently used to explain why people move from one area to another. The research approach was guided by social psychological concepts of decision-making to better understand the underlying cognitive processes in a physician's practice location decision.; The secondary data analyzed were collected in a statewide survey of 2,167 licensed rural physicians and in face-to-face interviews with 22 recruiters that represented 27 of Michigan's 59 rural hospitals. The survey was conducted in the summer of 2000 and funded by the Michigan Department of Community Health. Three major questions and one hypothesis were advanced in this secondary study: (1) Do rural Michigan communities come together and act to solve this problem? (2) Can county-level socio-demographic characteristics, which may influence a physician's decision to practice in one rural Michigan county over another, be identified? (3) Do physicians and recruiters place different levels of importance on the economic, psychological and sociological recruitment and retention variables measured in this study? And, (4) the hypothesis and a priori assumption in this research effort is that groupings of interrelated variables can used to identify five underlying values, posited by the literature and the research team, was tested.; The data was qualitatively and quantitatively analyzed to determine the answers to the research questions and to test the hypothesis. No evidence was found that the rural Michigan counties in this study acted to solve the problem. Multiple regression analysis identified six count-level variables that may influence a physician's practice location decision. A non-parametric test of significance indicated that the differences in the two group's ratings of the variables measured are significantly different. Exploratory factor analysis rejected the hypothesis.; The overarching objective of this study was to extend the literature and knowledge on the difficult task of recruiting physicians into underserved rural areas and keeping them there, with specific implications and practical applications for the state of Michigan.