Despite family physicians' traditionally strong affinity for working in medically underserved settings most health professional shortage areas (HPSAs) are worsening with current economic and manpower trends. Postgraduate training exposure of primary care residents to a medically underserved setting such as a Community or Migrant Health Center (C/MHC) or the Indian Health Service (IHS) may be a valuable and effective strategy for increasing physician recruitment into HPSAs. Through the use of case studies of seven Western U.S. family practice residency programs (FPRs) with varying C/MHC linkages and focus groups of family practice residents and physicians with experience practicing in a medically underserved setting, a comprehensive model will be developed to explain the following questions: What attracts primary care physicians to consider working in a medically underserved area? Why do these physicians choose to stay or leave? For family practice residents what is the influences of personal characteristics, training exposure to a C/MHC, residency program philosophy, and other factors upon their decision to practice or not practice in an underserved setting? This model will be tested with surveys of currently practicing physicians in Public Health Service Regions VIII and IX C/MHCs, the Phoenix Area IHS, graduates of seven family practice residencies, and residents from five FPRs. """"""""Cases"""""""" (physicians practicing in a medically underserved setting) and """"""""Controls"""""""" (physicians not in an underserved setting) will be compared on the basis of demographic, personal training, and practice characteristics. Logistic regression will be conducted to 1) test the combination of effects of several factors to explain service to underserved populations and 2) to predict residents' career plans based on their other characteristics and experiences. It is anticipated that these finding may significantly impact both primary care residency educational strategies and policy concerning recruitment and retention of physicians for underserved areas.
