3. Reality
Shortage Designations :
• Medically Underserved Areas (MUAs)
• Medically Underserved Populations (MUPs)
• Health Professional Shortage Areas (HPSA)
4. How Big ?
82 million living in Health Professional Shortage Areas
14 million living in Medically Underserved Areas
4 million being designated as Medically underserved populations
(Health Resources & Services Administration, 2020)
6. PICOTQuestion
How do financial incentives, demographic factors, and educational
programs characteristics’ compare in their ability to influence
physician’s choice to practice in medically underserved areas?
P: Physicians
I: financial incentives, demographic factors, and educational programs
characteristics’
C: absence of positive factors
O: choice of medically underserved areas as a area of practice
T: not determined
11. Review
Process
Reviewed abstracts of 10: chose 5 (relevance and level of
evidence)
Full-text analysis of articles
3 articles (level of evidence, relatedness to PICOT question,
publication year, and sample size).
12. Study #1
Metanalysis and systematic review
Whether medical student clinical education experiences in rural
areas, MUAs, and HPSAs influence their ultimate practice location
and specialty
Meta-analysis: Level I
Systematic review: Level 2a (systematic review of cohorts)
(RaymondGuilbault andVinson, 2017)
13. Study #1:
Results
“ Undergraduate medical students training in rural or underserved
areas are about three times as likely to practice in those areas as
their peers (RR = 2.94; 95% CI = 2.17, 4.00” (p. 150)
Characteristics that make one training program more successful
than another need further studying
14. Study #2
Systematic review
Factors associated with providers’ choice of geographic area of
practice (rural underserved vs other locations)
Success rate of training programs attempting to recruit rural
providers.
Level of evidence: 2a -3a (heterogenous observational)
MacQueen, Maggard-Gibbons,Capra, Raaen, Ulloa, Shekelle,
Miake-Lye, Beroes, and Hempel, 2018)
15. Study #2:
Results
Provider characteristics rural training experience, financial
aspects, and training-based interventions
Inconsistent/weak evidence, including financial factors
Strongest: background of being raised in a rural area.
16. Study #3
Systematic review
Factors most strongly associated with primary care
physicians (PCPs) choice of underserved areas as
practice location
Level of evidence: 2a -3a (heterogenous observational)
(Goodfellow, Ulloa, Dowling,Talamantes,Chheda, Bone,
and Moreno, 2016)
17. Study #3:
Results
Personal characteristics and background, financial factors, medical
school curricula, and GME programs
Background, ethnic-identification and language matching
increased the likelihood of practice in such an area.
Exposure of students has a positive influence on practice location
(true over a long period of time –decades)
Financial factors: inconclusive
18. ClinicalDecisionfor PracticeChange
Financial Factors:
- Evidence was contradicting
- Loan repayment programs demonstrated the highest
retention rate
- Health professional education financing models rather than
incentives
•
22. References
1. Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health.The
Milbank quarterly, 83(3), 457–502. https://doi.org/10.1111/j.1468-0009.2005.00409.x
2. Shi, L., Macinko, J., Starfield, B., Xu, J., Regan, J., Politzer, R., &Wulu, J. (2004). Primary care, infant
mortality, and low birth weight in the states of the USA. Journal of epidemiology and community health,
58(5), 374–380. https://doi.org/10.1136/jech.2003.013078
3. Emery, J. D., Shaw, K.,Williams, B., Mazza, D., Fallon-Ferguson, J.,Varlow, M., &Trevena, L. J. (2014).The
role of primary care in early detection and follow-up of cancer. Nature reviews. Clinical oncology, 11(1),
38–48. https://doi.org/10.1038/nrclinonc.2013.212
4. Friedberg, M.W., Hussey, P. S., & Schneider, E. C. (2010). Primary care: a critical review of the evidence on
quality and costs of health care. Health affairs (Project Hope), 29(5), 766–772.
https://doi.org/10.1377/hlthaff.2010.0025
5. Shi, L., Starfield, B., Politzer, R., & Regan, J. (2002). Primary care, self-rated health, and reductions in
social disparities in health. Health services research, 37(3), 529–550. https://doi.org/10.1111/1475-6773.t01-
1-00036
23. References
6. Ferrante, J. M., Lee, J. H., McCarthy, E. P., Fisher, K. J., Chen, R., Gonzalez, E. C., Love-Jackson, K., &
Roetzheim, R. G. (2013). Primary care utilization and colorectal cancer incidence and mortality among
Medicare beneficiaries: a population-based, case-control study. Annals of internal medicine, 159(7), 437–446.
https://doi.org/10.7326/0003-4819-159-7-201310010-00003
7. Health Resources and Services Administration. (December, 2020). Retrieved from:
https://data.hrsa.gov/topics/health-workforce/shortage-areas
8. Raymond Guilbault, R.W., &Vinson, J. A. (2017). Clinical medical education in rural and underserved areas
and eventual practice outcomes: A systematic review and meta-analysis. Education for health (Abingdon,
England), 30(2), 146–155. https://doi.org/10.4103/efh.EfH_226_16
9. MacQueen, I.T., Maggard-Gibbons, M.,Capra,G., Raaen, L., Ulloa, J. G., Shekelle, P. G., Miake-Lye, I.,
Beroes, J. M., & Hempel, S. (2018). Recruiting Rural Healthcare ProvidersToday: a Systematic Review of
Training Program Success and Determinants of GeographicChoices. Journal of general internal medicine,
33(2), 191–199. https://doi.org/10.1007/s11606-017-4210-z
10. Goodfellow,A., Ulloa, J. G., Dowling, P.T.,Talamantes, E., Chheda, S., Bone, C., & Moreno,G. (2016).
Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United
States: A Systematic Literature Review. Academic medicine : journal of the Association of American Medical
Colleges, 91(9), 1313–1321. https://doi.org/10.1097/ACM.0000000000001203