Availability of physicians is one of the cornerstones of health services and studies of rural health care often document inadequate access-to physicians. However, second office locations and hospital consulting practices will often alter the availability of physician services; but, the exact effect of these practices is unknown. The purpose of this study is to determine the extent to which the availability of physician services in non-metropolitan areas is enhanced through outreach activities (second offices and hospital-based consultations) of metropolitan-based physicians and through the reallocation of physician time between sites. It will also examine the factors associated with these types of outreach activities. The state of Missouri and its counties (including the independently incorporated City of St. Louis) will be the site for this research. Data will be collected about physician, practice, hospital, and county characteristics. Sources of data will include a survey conducted annually by the Missouri Center for Health Statistics and a hospital survey designed for the purposes of this study. Multi-variate analysis will be used to identify factors behind the differences in availability of services. If factors associated with outreach practice locations can be identified, then policies designed to increase availability of physician services in non-metropolitan counties can incorporate these factors, increasing their probability of success.
