Younger primary care physicians in rural areas have a higher turnover rate than their older peers, and physicians in the two groups probably move on for different reasons, according to a recent study.
Researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care tracked retention of primary care physicians -- defined as family medicine physicians, general pediatricians, geriatricians and general internal medicine physicians -- in rural areas for a study(www.annfammed.org) that was published in the July/August issue of Annals of Family Medicine.
Using data from the AMA Physician Masterfile for clinically active physicians ages 65 and younger throughout the United States, the researchers tracked movement of primary care physicians over two-year cycles between 2000 and 2014. (Physicians older than 65 were excluded from the study because data were not sufficiently reliable to determine whether they were still active in clinical practice.)
The researchers found that the biennial turnover rate among younger physicians (i.e., those ages 45 and younger) in rural areas was about twice as high (17 percent) as that of older physicians (9 percent). Physicians also were more likely to move out of rural areas if they were female, international medical graduates, not born in a rural setting or working in a community adjacent to a metropolitan area.
Overall, greater turnover was tied to factors such as lack of a nearby hospital, poor physician supply and low population. Physicians ages 46 to 65 are more likely to leave rural areas that are adjacent to an urban area, the researchers found.
But the authors noted that some physicians ages 45 and younger may begin their practice careers in rural areas while they wait for an opportunity to change settings.
"Shortly after residency, physicians may choose initial employment locations based more on availability than on preference until their preferred option becomes available," the authors wrote.
Younger family physicians were less likely to leave rural areas compared with other primary care physicians, but researchers found no such difference for older family physicians.
Although the availability of nearby health facilities, population size and physician supply were strongly linked to physicians' decisions to stay in rural areas, economic demographics, for the most part, were not.
"Somewhat surprisingly, we did not find higher rates of turnover among physicians working in poorer rural communities, measured by household income and median house prices, although higher unemployment was significantly associated with lower retention," the authors wrote. "Economic aspects appear to have only a minor role in mobility decisions of primary care physicians compared with geographic aspects of population size and hospital access."
The researchers noted that previous studies on the rural physician supply explored reasons that either aided or impeded growth in their numbers, but scant research has been conducted on the specific question of why physicians leave rural areas.
The ability to retain rural physicians in the most remote communities that lack hospitals remains one of the biggest obstacles to expanding access to care.
"Targeted policy support to rural physicians in these small and often isolated communities, who are likely struggling without a critical mass of other health professionals nearby, is needed," the authors wrote.
Initiatives such as J-1 visa waivers for international medical graduates and National Health Service Corps loan repayment and scholarship programs help attract physicians to rural areas, but keeping them there is still a challenge.
"Rural areas that can least afford to lose physicians are those dealing with difficulties of increased mobility," the authors wrote. "Improved retention of rural physicians in these communities remains a target of health policies."
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