This study's objective is to supply much needed information about and understanding of current physicians in rural health manpower shortage areas (HMSAs), with an emphasis on physicians in the National Health Service Corps (NHSC, Corps). The study will assist Congress, rural communities, and the Corps in planning policies to increase the availability of physicians in rural America.
The specific aims are: (1) to describe a recent entry cohort of rural physicians, comparing NHSC and non-NHSC physicians; (2) to understand the determinants of recruitment and retention of physicians recently locating in medically-underserved, rural communities; (3) to assess the impact present governmental policies and private initiatives have on the retention of these rural physicians, (4) to recommend future effective retention policies for NHSC and non-NHSC physicians; and (5) to clarify conceptual and methodological issues involved in measuring physician retention. The study will be carried out over the period from October 1, 1990 to December 31, 1991. The study's principal research methods will be statistical analyses of mail survey data from approximately 2800 rural primary care physicians located in HMSAs, principally small, remote, rural communities. Physician rosters will be obtained from the NHSC and the AMA. Physicians to be studied are: 1) an entry cohort beginning rural practice through the NHCS's various recruitment programs in the years 1987-89; and 2) an entry cohort of non-NHSC rural physicians beginning rural practice in 1987-88, matched for specially distribution, age, and """"""""rurality"""""""" of practice. Data to be collected emphasize information required to describe rural physicians' demographics, work motivations, content of clinical practice, and retention plans. A detailed theoretical model of the determinants of rural physician retention will be presented, applied and tested. The study design allows a separate focus on the NHSC physician subgroup throughout the various analyses. Further, NHSC physicians among the Corps' several recruitment programs (scholarship, loan repayment, volunteer) will be compared on their characteristics, experiences in practice, their opinions and reactions to the NHSC, and their retention.
