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ABSTRACT The role of the burn surgeon in Burn Treatment Centers (BTCs) is crucial for complementing the multidisciplinary approach in the treatment of burn patients. Globally, the areas of General Surgery and Plastic Surgery are the primary surgical specialties dedicated to this function. The structuring of the Burn Patient Care Line in Minas Gerais highlighted the need to expand the “Burn Care” Field of Expertise, extending it to General Surgery. With the inevitable expansion of the Care Line, pioneered by the state of Minas Gerais, to the federal level, the need for specialized surgical training encompasses both the state context and anticipates the national scenario in the short term. Therefore, the expansion of the “Burn Care” Field of Expertise is fundamental to meeting specific demands and improving the quality of care offered to burn patients, in accordance with international standarts.

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PurposeThough utilization of medical procedures has been shown to vary considerably across the United States, similar efforts to characterize variation in the delivery of radiation therapy (RT) procedures have not been forthcoming. Our aim was to characterize variation in the delivery of common RT procedures in the Medicare population. We hypothesized that delivery would vary significantly based on provider characteristics.MethodsThe Centers for Medicare and Medicaid Services (CMS) Physician and Other Supplier Public Use File was linked to the CMS Physician Compare (PC) database by physician NPI to identify and sum all treatment delivery charges submitted by individual radiation oncologists in the non-facility-based (NFB) setting in 2016. Multivariable logistic regression analysis was carried out to determine provider characteristics (gender, practice rurality, practice region, and years since graduation) that predicted for the delivery of 3D conformal RT (3DCRT), intensity modulated RT (IMRT), stereotactic body RT (SBRT), stereotactic radiosurgery (SRS), low dose rate (LDR) brachytherapy, and high dose rate (HDR) brachytherapy delivery in the Medicare patient population. The overall significance of categorical variables in the multivariable logistic regression model was assessed by the likelihood ratio test (LRT).ResultsIn total, 1,802 physicians from the NFB practice setting were analyzed. Male gender predicted for greater LDR brachytherapy delivery (OR 8.19, 95% CI 2.58-26.05, p

BackgroundRadiation oncologists (ROs) play an important role in managing cancer pain; however, their opioid prescribing patterns remain poorly described.MethodsThe 2016 Medicare Physician Compare National Downloadable and the 2016 Medicare Part D Prescriber Data files were cross-linked to identify RO-written opioid prescriptions.ResultsOf 4,627 identified ROs, 1,360 (29.3%) wrote >10 opioid prescriptions. The average number of opioid prescriptions written was significantly (P ≤ .05) associated with the following RO characteristics: sex [13.1 ± 36.5 male vs 7.5 ± 16.9 female]; years since medical school graduation [4.5 ± 11.5 1-10 years vs 12.6 ± 26.0 11-24 years vs 13.3 ± 40.9 ≥25 years]; practice size [15.5 ± 44.6 size ≤10 vs 13.3 ± 25.9 size 11-49 vs 8.5 ± 12.7 size 50-99 vs 8.8 ± 26.9 size ≥100]; Medicare Physician Quality Reporting System (PQRS) participation [12.6 ± 31.8 yes vs 7.0 ± 35.4 no]; and practice location [17.4 ± 47.0 South vs 10.6 ± 29.4 Midwest vs 8.1 ± 13.9 West vs 6.9 ± 15.2 Northeast]. On multivariable regression modeling, male sex (RR 1.29, 95% CI 1.22-1.35, P

Introduction: The aim of this research was to explore factors influencing students at the University of Papua New Guinea (UPNG) Bachelor of Medical Imaging Science (BMIS) choice to pursue rural radiography careers. Methods: A survey and focus groups of BMIS students at the UPNG were undertaken. The survey included questions related to sociodemographic variables including gender, age, education, rural background and previous employment; and Likert-type scale questions exploring motivation for rural practice, the promotion of radiography through rural practice and the influence of birthplace and incentives to practice. Focus groups comprising convenience samples of six students each from the second, third and fourth years of study explored the promotion of rural radiography, community-based training internships, the benefits of rural practice and the influence of undergraduate training on future rural practice. Results: There were 54 responses (94.7%) to the survey with strong interest (88.9%) in rural radiography practice; 96.3% (n=52) agreed that undergraduate rural training would also act as a motivator. Rural training was a stronger incentive for females than for males (p=0.02). Not being trained in conventional non-digital film screen imaging at UPNG was a strong barrier to rural practice; while being able to give back to the community, increased professional responsibility, cheaper living, job satisfaction and cultural exchange were all viewed as positive aspects of rural practice. Most students reported a benefit to rural practice, while acknowledging a lack of contemporary imaging equipment in rural facilities. Conclusion: The study demonstrated that UPNG BMIS students would contemplate careers in rural practice and provides evidence to support dedicated undergraduate rural radiography placement. It also highlights the dichotomy in urban and rural services, which suggests the need for greater emphasis on conventional nondigital film screen radiography in the undergraduate program to best support graduates to work and, importantly, work effectively in rural communities. As most students were from rural areas these results must be tempered by the fact that students may simply be wanting to return home rather than reporting explicit rural intent. A more comprehensive study of the medical imaging profession in PNG should be undertaken to validate this study. [ABSTRACT FROM AUTHOR]

Abstract Introduction While studies have investigated influences on graduate practice locations of other health professionals, especially medicine, none have investigated practice locations of medical radiation science (MRS) graduates. This study aimed to explore factors influencing the registered principal place of practice (PPP) of diagnostic radiography, radiation therapy and nuclear medicine graduates from the University of Newcastle (UON), Australia, in their second post‐graduate year. Methods Data were extracted from the UON enrolment and clinical placement databases and linked to Australian Health Practitioners Regulation Agency (Ahpra) registration data for PPP location in 2019 for 187 graduates who completed their studies in 2017. Explanatory variables included age at enrolment, gender, MRS discipline, location of origin, socio‐economic index for location of origin, and locations and duration of undergraduate professional placements. Descriptive statistics, tests of association and logistic regression compared rural and non‐rural origin, and professional placement locations with Ahpra PPP. Results Factors related to non‐metropolitan PPP were location of origin (P = 0.002), number (P = 0.002) and duration (P = 0.007) of rural placements, and MRS discipline (P = 0.033). Controlling for other variables, location of origin and MRS discipline remained significant. Graduates of rural origin had up to 3.54 (95%CI = 1.51–8.28) times the odds of a rural PPP. Diagnostic radiography graduates had up to 5.46 (95%CI = 1.55–19.20) times the odds of nuclear medicine of a rural PPP. Conclusion To help reduce the gap between rural and metropolitan medical radiation service availability, there is a need for targeted recruitment of rural origin students. Further investigation of the effect of rural undergraduate MRS placements is justified.

PurposeTo describe how distance to treatment location influences patient navigation preferences for adolescent and young adult (AYA) cancer patients and survivors.MethodsThis study is part of a statewide needs assessment to inform the development of an AYA cancer patient and survivor navigation program. Participants were recruited from outpatient oncology clinics in Utah. Eligible participants had been diagnosed with cancer between ages 15-39 and had completed at least 1 month of treatment. Participants completed a semi-structured interview on preferences for patient navigation. Summary statistics of demographic and cancer characteristics were generated. Thematic content analysis was used to describe navigation preferences among participants classified as distance (≥20 miles) and local (

BackgroundRural areas have historically struggled with shortages of healthcare providers; however, advanced communication technologies have transformed rural healthcare, and practice in underserved areas has been recognized as a policy priority. This systematic review aims to assess reasons for current providers' geographic choices and the success of training programs aimed at increasing rural provider recruitment.MethodsThis systematic review (PROSPERO: CRD42015025403) searched seven databases for published and gray literature on the current cohort of US rural healthcare practitioners (2005 to March 2017). Two reviewers independently screened citations for inclusion; one reviewer extracted data and assessed risk of bias, with a senior systematic reviewer checking the data; quality of evidence was assessed using the GRADE approach.ResultsOf 7276 screened citations, we identified 31 studies exploring reasons for geographic choices and 24 studies documenting the impact of training programs. Growing up in a rural community is a key determinant and is consistently associated with choosing rural practice. Most existing studies assess physicians, and only a few are based on multivariate analyses that take competing and potentially correlated predictors into account. The success rate of placing providers-in-training in rural practice after graduation, on average, is 44% (range 20-84%; N = 31 programs). We did not identify program characteristics that are consistently associated with program success. Data are primarily based on rural tracks for medical residents.DiscussionThe review provides insight into the relative importance of demographic characteristics and motivational factors in determining which providers should be targeted to maximize return on recruitment efforts. Existing programs exposing students to rural practice during their training are promising but require further refining. Public policy must include a specific focus on the trajectory of the healthcare workforce and must consider alternative models of healthcare delivery that promote a more diverse, interdisciplinary combination of providers.

Purpose: Maintaining a robust healthcare workforce in underserved rural communities continues to be a challenge. To better meet healthcare needs in rural areas, training programs must develop innovative ways to foster transition to, and integration into, these communities. Mountain Area Health Education Center designed and implemented a 12-month post-residency Rural Fellowship program to enhance placement, transition, and retention in rural North Carolina. Utilizing a '6 Ps' framework, the program targeted physicians and pharmacists completing residency with the purpose of recruiting and supporting their transition into the first year of rural practice., Method: To better understand Rural Fellows' experiences and the immediate impact of their Fellowship year, we conducted a semi-structured interview using a narrative technique and evaluated retention rates over time. Interviews with the eight participants, which included Fellowship alumni and current Fellows, demonstrated the impact and influence of the key curricular '6 Ps' framework., Results: An early retention rate of 100% and a long-term retention rate of 87%, combined with expressed clarity of curricular knowledge, skills, and attitudes related to the '6 Ps', demonstrate the potential and effectiveness of this Rural Fellowship model. Participants indicated the Rural Fellowship experience supports the transition to rural practice communities and expands their clinical skills., Conclusion: The Rural Fellowship program demonstrates an effective model to support early career healthcare providers as they begin practice in rural communities in western North Carolina through academic opportunities, personal growth, and professional development. Implementation of this model has demonstrated the success of a rural retention model over a 6-year period. This model has the potential to target an array of clinical providers and disciplines. We started with family medicine and have expanded to psychiatry, obstetrics, pharmacy, and nursing. This study demonstrated that this model supports clinical providers during the critical transition period from residency to practice. Targeting the most important stage of one's medical training, the commencement of professional practice, this is a scalable model for other rural-based health professions education sites where rural recruitment and retention remain a problem.

Background: Ensuring a sufficient, appropriately qualified health workforce is of global concern. Understanding the attributes that employers seek is critical in recruitment, retention, and educational design. In physiotherapy, there is a dearth of evidence on desirable attributes that employers seek from early-career physiotherapists. This study directly addresses this gap. The aims of this study were to identify the characteristics of the jobs advertised for early-career physiotherapists in Australia; determine which attributes were most desired when employing an early-career physiotherapist; and identify if there were differences in the attributes required based upon workplace location., Methods: New graduate and early-career physiotherapy job advertisements were collected for six months from 1st October 2020 until 31st March 2021 from SEEK.com.au, a large online employment marketplace that operates across ten countries in the Asia Pacific and Latin America. Job advertisements needed to specify new graduate or early-career physiotherapist eligibility and be located within Australia. Data extraction were completed using QuestionPro ® . The Modified Monash Model was used to classify rurality of job location. Job advertisements were analysed descriptively and using content analysis to identify attributes., Results: The search yielded 578 job advertisements with the greatest number collected in October 2020 (25.3%). Of the advertisements, 428 (74.0%) were in metropolitan locations (Modified Monash 1), 47 (8.1%) were in regional (Modified Monash 2), 99 (17.1%) were in rural locations (Modified Monash 3-5), and 4 (0.8%) were in remote locations (Modified Monash 6-7). Most roles were in private practice (63.3%) or aged care (21.7%). The top five attributes requested by employers were client focus, communication and interpersonal skills, team player, willingness to learn, and being able to build rapport, relationships, and networks. Academic results, resilience, and empathy were the least requested attributes. Differences in requested employability attributes increased with rurality., Conclusions: This study addresses the current knowledge about attributes sought by employers for early-career physiotherapists. The most prevalent attributes requested were client focus and communication and interpersonal skills. This exploration of attributes can help to better prepare graduates for their first roles, align expectations, and increase understanding of priorities for entry level university programs, as well as identify priorities for support during transition to practice. Desired attributes should be clearly defined by employers in recruitment and retention processes., (© 2024. The Author(s).)

Background: Health systems globally need more clinicians to work rurally and in community-based primary care. This study explores factors influencing health graduates' choice of clinical setting and geographical location during early careers, across a range of disciplines that work together to support the health of people in community-based and rural locations. Methods: Students from eight disciplines (n = 611) were recruited prior to their final year of pre-registration training. Data were collected via three electronic surveys completed at the end of participants' first, second, and third year of clinical practice. Data were managed and analyzed with Template Analysis. Findings: Similar factors influenced clinical setting and location choice but differed in relative importance for each. The nature of the job itself was the most important factor influencing clinical setting choices. A broader range of influences were important to geographical location choices including personal reasons, the nature of the job, the nature of the location, and job availability and opportunities. Regulatory or training requirements limited choices available to some clinicians, particularly those from medicine. Conclusion: A range of complex and interacting factors influenced health graduates' career choices. Findings indicate that a broad system-wide approach is needed to address community and rural health workforce needs. [ABSTRACT FROM AUTHOR]

Introduction: While studies have investigated influences on graduate practice locations of other health professionals, especially medicine, none have investigated practice locations of medical radiation science (MRS) graduates. This study aimed to explore factors influencing the registered principal place of practice (PPP) of diagnostic radiography, radiation therapy and nuclear medicine graduates from the University of Newcastle (UON), Australia, in their second post‐graduate year. Methods: Data were extracted from the UON enrolment and clinical placement databases and linked to Australian Health Practitioners Regulation Agency (Ahpra) registration data for PPP location in 2019 for 187 graduates who completed their studies in 2017. Explanatory variables included age at enrolment, gender, MRS discipline, location of origin, socio‐economic index for location of origin, and locations and duration of undergraduate professional placements. Descriptive statistics, tests of association and logistic regression compared rural and non‐rural origin, and professional placement locations with Ahpra PPP. Results: Factors related to non‐metropolitan PPP were location of origin (P = 0.002), number (P = 0.002) and duration (P = 0.007) of rural placements, and MRS discipline (P = 0.033). Controlling for other variables, location of origin and MRS discipline remained significant. Graduates of rural origin had up to 3.54 (95%CI = 1.51–8.28) times the odds of a rural PPP. Diagnostic radiography graduates had up to 5.46 (95%CI = 1.55–19.20) times the odds of nuclear medicine of a rural PPP. Conclusion: To help reduce the gap between rural and metropolitan medical radiation service availability, there is a need for targeted recruitment of rural origin students. Further investigation of the effect of rural undergraduate MRS placements is justified. [ABSTRACT FROM AUTHOR]

ImportanceHospital-employed physicians provide primary care within the hospital or within community-based office practices. Yet, little is understood regarding the influence of hospital location and ownership on the delivery of low-value care.ObjectiveTo assess the association of hospital location and hospital ownership with the provision of low-value health services.Design, setting, and participantsThis study compared low-value service use after primary care visits at hospital-based outpatient practices from January 1, 1997, to December 31, 2011, vs community-based office practices and at hospital-owned vs physician-owned community-based office practices from January 1, 1997, to December 31, 2013. Logistic regression models adjusted for patient and health care professional characteristics and year, and weighted results were used to reflect population estimates. Results were also stratified by symptom acuity and whether a generalist physician (eg, general internist or family practitioner) was the patient's primary care provider. This study used nationally representative data from the National Ambulatory Medical Care Survey (January 1, 1997, to December 31, 2013) and the National Hospital Ambulatory Medical Care Survey (January 1, 1997, to December 31, 2011) on outpatient visits to generalist physicians. Participants were patients seen with 3 common primary care conditions, namely, upper respiratory tract infection, back pain, and headache.Main outcomes and measuresThe use of antibiotics (for upper respiratory tract infection), computed tomography or magnetic resonance imaging (for back pain and headache), radiographs (for upper respiratory tract infection and back pain), and specialty referrals (for all 3 conditions).ResultsThis study identified 31 162 visits for upper respiratory tract infection, back pain, and headache, representing an estimated 739 million US primary care visits from 1997 to 2013. Compared with visits with community-based physicians, patients in visits to hospital-based physicians were younger (mean age, 44.5 vs 49.1 years; P

IntroductionPlastic surgeons endure years of training yet remain poorly equipped to negotiate first employment contracts. Our aims were to evaluate typical plastic surgeon employment contracts and assess contract comprehensiveness. We sought elements that should be included to better preserve varied interests.MethodsA brief, anonymous, e-mailed survey was sent to California Society of Plastic Surgeons members and responses collected over 2 months. We collected information such as years in practice, geographic area, types of practices and number of surgeons within them, and legal standing of partnerships. We asked whether respondents sought legal assistance and specific elements were elaborated. We asked how content they were with their contracts while allowing commentary.ResultsOur survey generated 113 responses. 50.0% of respondents reported being in practice for at least 20 years; 2.68% had been in practice for up to 5 years. 62.5% reported being in private practice and 27.7% reported being in academia. In-state geographic distribution of respondents accounted for 85.6%, whereas 14.4% reported practicing out-of-state.Practice size was diverse, with 41.4% of respondents having worked in a group practice of 3 or more, 27.9% in partnership, and 23.4% in solo practice. For partnerships, 29.9% had made formal legal arrangements, whereas 20.6% had made informal arrangements. 74.5% of respondents did not seek legal assistance.Malpractice coverage varied from 51.6% with claims-made, to 21.7% with tail, to 33.0% with no coverage at all. 63.9% reported having no group disability policy. 26.4% reported annual income of less than US $100,000; 49.1% reported US $101,000 to US $200,000; 17.9% reported US $201,000 to US $300,000; 6.60% reported greater than US $300,000. Using a 5-point scale, 7.69% of respondents reported being "extremely dissatisfied" with their first employment contracts (score of 1), whereas 24.0% were "perfectly happy" (5).Eighty-two respondents offered advice. Common themes included seeking legal counsel; considering eventual solo practice; planning long-term; seeking mentorship; and cautioning against third party interests.ConclusionsNew plastic surgeons will find themselves employed by institutions. Seeking attorneys familiar with the profession is advisable. Lack of awareness regarding malpractice options and disability coverage are 2 areas of concern. We reveal critical contract elements that surgeons should negotiate to ensure smooth transition to practice.

PurposeDespite multiple randomized trials showing the efficacy of hypofractionated radiation therapy in early-stage breast cancer, the United States has been slow to adopt this treatment. The goal of this study was to evaluate the impact of individual radiation oncologists on the early adoption of hypofractionated radiation therapy for early-stage breast cancer.MethodsWe identified 22,233 Medicare beneficiaries with localized breast cancer that was diagnosed from 2004 to 2011 who underwent breast-conserving surgery with adjuvant radiation. Multilevel, multivariable logistic models clustered by radiation oncologist and geographic practice area were used to determine the impact of the provider and geographic region on the likelihood of receiving hypofractionated compared with standard fractionated radiation therapy while controlling for a patient's clinical and demographic covariates. Odds ratios (OR) describe the impact of demographic or clinical covariates, and the median OR (MOR) describes the relative impact of the individual radiation oncologist and geographic region on the likelihood of undergoing hypofractionated radiation therapy.ResultsAmong the entire cohort, 2333 women (10.4%) were treated with hypofractionated radiation therapy, with unadjusted rates ranging from 0.0% in the bottom quintile of radiation oncologists to 30.4% in the top quintile. Multivariable analysis found that the individual radiation oncologist (MOR 3.08) had a greater impact on the use of hypofractionation than did geographic region (MOR 2.10) or clinical and demographic variables. The impact of the provider increased from the year 2004 to 2005 (MOR 2.82) to the year 2010 to 2011 (MOR 3.16) despite the publication of long-term randomized trial results in early 2010. Male physician and radiation oncologists treating the highest volume of breast cancer patients were less likely to perform hypofractionation (P

Abstract Background More than 60% of the world’s rural population live in the Asia-Pacific region. Of these, more than 90% reside in low- and middle-income countries (LMICs). Asia-Pacific LMICs rural populations are more impoverished and have poorer access to medical care, placing them at greater risk of poor health outcomes. Understanding factors associated with doctors working in rural areas is imperative in identifying effective strategies to improve rural medical workforce supply in Asia-Pacific LMICs. Method We performed a scoping review of peer-reviewed and grey literature from Asia-Pacific LMICs (1999 to 2019), searching major online databases and web-based resources. The literature was synthesized based on the World Health Organization Global Policy Recommendation categories for increasing access to rural health workers. Result Seventy-one articles from 12 LMICs were included. Most were about educational factors (82%), followed by personal and professional support (57%), financial incentives (45%), regulatory (20%), and health systems (13%). Rural background showed strong association with both rural preference and actual work in most studies. There was a paucity in literature on the effect of rural pathway in medical education such as rural-oriented curricula, rural clerkships and internship; however, when combined with other educational and regulatory interventions, they were effective. An additional area, atop of the WHO categories was identified, relating to health system factors, such as governance, health service organization and financing. Studies generally were of low quality—frequently overlooking potential confounding variables, such as respondents’ demographic characteristics and career stage—and 39% did not clearly define ‘rural’. Conclusion This review is consistent with, and extends, most of the existing evidence on effective strategies to recruit and retain rural doctors while specifically informing the range of evidence within the Asia-Pacific LMIC context. Evidence, though confined to 12 countries, is drawn from 20 years’ research about a wide range of factors that can be targeted to strengthen strategies to increase rural medical workforce supply in Asia-Pacific LMICs. Multi-faceted approaches were evident, including selecting more students into medical school with a rural background, increasing public-funded universities, in combination with rural-focused education and rural scholarships, workplace and rural living support and ensuring an appropriately financed rural health system. The review identifies the need for more studies in a broader range of Asia-Pacific countries, which expand on all strategy areas, define rural clearly, use multivariate analyses, and test how various strategies relate to doctor’s career stages.

ABSTRACT BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients. OBJECTIVE: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties. METHODS: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the “Study Group of Inflammatory Bowel Disease of Brazil” (GEDIIB). RESULTS: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn’s disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics “biological therapy failure” and “new drugs” were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country’s regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines. CONCLUSION: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

PurposeThe authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States.MethodIn November 2015, the authors searched databases (MEDLINE, ERIC, SCOPUS) and Google Scholar to identify published peer-reviewed studies that focused on PCPs and reported practice location outcomes that included U.S. underserved urban or rural areas. Studies focusing on practice intentions, nonphysicians, patient panel composition, or retention/turnover were excluded. They screened 4,130 titles and reviewed 284 full-text articles.ResultsSeventy-two observational or case-control studies met inclusion criteria. These were categorized into four broad themes aligned with prior literature: 19 studies focused on physician characteristics, 13 on financial factors, 20 on medical school curricula/programs, and 20 on graduate medical education (GME) programs. Studies found significant relationships between physician race/ethnicity and language and practice in underserved areas. Multiple studies demonstrated significant associations between financial factors (e.g., debt or incentives) and underserved or rural practice, independent of preexisting trainee characteristics. There was also evidence that medical school and GME programs were effective in training PCPs who locate in underserved areas.ConclusionsBoth financial incentives and special training programs could be used to support trainees with the personal characteristics associated with practicing in underserved or rural areas. Expanding and replicating medical school curricula and programs proven to produce clinicians who practice in underserved urban or rural areas should be a strategic investment for medical education and future research.

BackgroundMedical workforce shortages represent a major challenge in low- and middle-income countries, including those in Africa. Despite this, there is a dearth of information regarding the location and practice of African surgeons following completion of their training. In response to the call by the WHO Global Code of Practice on the International Recruitment of Health Personnel for a sound evidence base regarding patterns of practice and migration of the health workforce, this study describes the current place of residence, practice and setting of Ethiopian surgical residency graduates since commencement of their surgical training in Ethiopia or in Cuba.MethodsThis study presents data from a survey of all Ethiopian surgical residency training graduates since the programme's inception in 1985.ResultsA total of 348 Ethiopians had undergone surgical training in Ethiopia or Cuba since 1985; data for 327 (94.0 %) of these surgeons were collected and included in the study. The findings indicated that 75.8 % of graduates continued to practice in Ethiopia, with 80.9 % of these practicing in the public sector. Additionally, recent graduates were more likely to remain in Ethiopia and work within the public sector. The average total number of surgeons per million inhabitants in Ethiopia was approximately three and 48.0 % of Ethiopian surgeons practiced in Addis Ababa.ConclusionsEthiopian surgeons are increasingly likely to remain in Ethiopia and to practice in the public sector. Nevertheless, Ethiopia continues to suffer from a drastic surgical workforce shortage that must be addressed through increased training capacity and strategies to combat emigration and attrition.

Objectives: To determine how social factors influence career decisions of dental service providers, particularly focusing on examining the impact of dentists' origins., Methods: Online survey of Hessian panel dentists, with pairwise comparisons to a set of factors impacting their decision-making process. An Analytic Hierarchy Process examined the weighting of influencing drivers in career choice., Results: Dentists from rural backgrounds were more likely to establish practices in rural areas than those from urban origins. Origin correlated with entrepreneurial intentions and a strong association of rural origin. Dentists who grew up in rural areas were 4.19 times more likely to start a business., Conclusion: These findings may support efficient resource allocation and support for rural dental businesses., (Copyright© 2024 Dennis Barber Ltd.)

Background: The maldistribution of pharmacy services in underserved areas is a national issue. Analysis of data from the 2019 National Pharmacist Workforce Study indicated that 13.9% of pharmacists were working in a rural community. However, the percentage of people living in rural communities in the United States is 20.0%. Currently, there are 20 rural pharmacy programs in the United States, including the Rural Pharmacy Education (RPHARM) Program at University of Illinois Chicago (UIC) College of Pharmacy, which contain both didactic and experiential rural components. This research project examines the practice outcomes of the RPHARM Program graduates., Methods: Descriptive analysis was used to examine the practice outcome characteristics of RPHARM Program graduates between 2014 and 2023. The characteristics of the RPHARM graduates included the rurality of hometowns, practice locations and populations, and distance of practice locations to hometowns. Rural practice outcomes were described utilizing frequently used rural definitions. The practice locations of 54 of the 61 RPHARM graduates were used in the analysis., Results: Approximately 41% of the practicing RPHARM graduates were from rural hometowns and two-thirds were female. RPHARM graduates mostly work in either a community setting (44.4%) or a hospital setting (37.0%). Approximately 11% worked in a federal government organization and 5.6% worked in a long-term care pharmacy. When examining job location, 42.6% were working in a rural location based on Rural-Urban Commuting Area Version 3.0 and 35.2% of RPHARM graduates had always worked in a rural location. Approximately 57% of practicing RPHARM graduates are working in a location < 50 miles from their hometown, and 13% are working 50 to 100 miles from their hometown. Approximately 74% of RPHARM graduates are practicing in Illinois., Conclusions: Approximately 40% of RPHARM graduates practice in rural locations. A significant portion (35.2%) of RPHARM graduates have always practiced in rural locations, and many (57.4%) are practicing near their hometowns. Results indicate that the RPHARM Program is making meaningful contributions to increasing the rural pharmacy workforce. Due to the lack of information on rural pharmacy practice outcomes, all programs with rural pharmacy content are encouraged to track graduates' practice locations., (© 2024. The Author(s).)

Background: Like many countries, Australia is suffering from a longstanding and persistent medical workforce maldistribution with fewer doctors per capita in rural locations and a trend towards sub-specialisation. Longitudinal Integrated Clerkships (LIC), a medical education model, are more likely than other clerkship models to produce graduates who work rurally, in communities of increasing remoteness and in primary care. While this quantitative data is essential, there has been a dearth of program-specific evidence explaining this phenomenon., Methods: To address this knowledge gap, a constructivist qualitative grounded theory approach was employed to identify how the Deakin University comprehensive rural LIC influences graduates' (2011-2020) career decisions in terms of both medical specialty and geographic practice location., Results: Thirty-nine graduates participated in qualitative interviews. The Rural LIC Career Decision Making Framework was developed, postulating that an alignment of personal and program factors under the central concept of 'choosing to participate' can influence graduates' geographic and specialist career decisions, both individually and symbiotically. Once embedded in the clerkship, participation was augmented by the concepts of learning design affordance and learning in place, providing the participants with longitudinal opportunities to experience and compare medical disciplines in an integrated manner., Conclusions: The developed framework presents contextual elements of the program that were deemed influential on graduates' subsequent career decisions. The alignment of these elements with the program's mission statement has the capacity to enhance the program's rural workforce goals. Regardless of graduates' willingness to participate in the program, a transformation occurred. Transformation occurs through reflection, either challenging or confirming the graduate's pre-conceived ideas about career decisions and in turn influencing professional identity formation., (© 2024. The Author(s).)

Context: There is growing evidence supporting a shift towards 'grow your own' approaches to recruiting, training and retaining health professionals from and for rural communities. To achieve this, there is a need for sound methodologies by which universities can describe their area of geographic focus in a precise way that can be utilised to recruit students from their region and evaluate workforce outcomes for partner communities. In Australia, Deakin University operates a Rural Health Multidisciplinary Training (RHMT) program funded Rural Clinical School and University Department of Rural Health, with the purpose of producing a graduate health workforce through the provision of rural clinical placements in western and south-western Victoria. The desire to establish a dedicated Rural Training Stream within Deakin's Doctor of Medicine course acted as a catalyst for us to describe our 'rural footprint' in a way that could be used to prioritise local student recruitment as well as evaluate graduate workforce outcomes specifically for this region., Issue: In Australia, selection of rural students has relied on the Australian Statistical Geography Standard Remoteness Areas (ASGS-RA) or Modified Monash Model (MMM) to assign rural background status to medical course applicants, based on a standard definition provided by the RHMT program. Applicants meeting rural background criteria may be preferentially admitted to any medical school according to admission quotas or dedicated rural streams across the country. Until recently, evaluations of graduate workforce outcomes have also used these rurality classifications, but often without reference to particular geographic areas. Growing international evidence supports the importance of place-based connection and training, with medical graduates more likely to work in a region that they are from or in which they have trained. For universities to align rural student recruitment more strategically with training in specific geographic areas, there is a need to develop precise geographical definitions of areas of rural focus that can be applied during admissions processes., Lessons Learned: As we strived to describe our rural activity area precisely, we modelled the application of several geographical and other frameworks, including the MMM, ASGS-RA, Primary Healthcare Networks (PHN), Local Government Areas (LGAs), postcodes and Statistical Areas. It became evident that there was no single geographical or rural framework that (1) accurately described our area of activity, (2) accurately described our desired workforce focus, (3) was practical to apply during the admissions process. We ultimately settled on a bespoke approach using a combination of the PHN and MMM to achieve the specificity required. This report provides an example of how a rural activity footprint can be accurately described and successfully employed to prioritise students from a geographical area for course admission. Lessons learned about the strengths and limitations of available geographical measures are shared. Applications of a precise footprint definition are described including student recruitment, evaluation of workforce outcomes for a geographic region, benefits to stakeholder relationships and an opportunity for more nuanced RHMT reporting.

The article reports that in many countries, for a more equitable distribution, doctors do not have complete freedom in their choice of location, but the available studies do not allow a very precise long-term assessment of the general impact of these measures considered in isolation. Topics include examines the same applies to other provisions such as financial incentives.

Background: Doctor shortages in remote areas of Indonesia are amongst challenges to provide equitable healthcare access. Understanding factors associated with doctors' work location is essential to overcome geographic maldistribution. Focused analyses of doctors' early-career years can provide evidence to strengthen home-grown remote workforce development.Method: This is a cross-sectional study of early-career (post-internship years 1–5) Indonesian doctors, involving an online self-administered survey on demographic characteristics, and; locations of upbringing, medical clerkship (placement during medical school), internship, and current work. Multivariate logistic regression was used to test factors associated with current work in remote districts.Results: Of 3,176 doctors actively working as clinicians, 8.9% were practicing in remote districts. Compared with their non-remote counterparts, doctors working in remote districts were more likely to be male (OR 1.5,CI 1.1–2.1) or unmarried (OR 1.9,CI 1.3–3.0), have spent more than half of their childhood in a remote district (OR 19.9,CI 12.3–32.3), have completed a remote clerkship (OR 2.2,CI 1.1–4.4) or internship (OR 2.0,CI 1.3–3.0), currently participate in rural incentive programs (OR 18.6,CI 12.8–26.8) or have previously participated in these (OR 2.0,CI 1.3–3.0), be a government employee (OR 3.2,CI 2.1–4.9), or have worked rurally or remotely post-internship but prior to current position (OR 1.9,CI 1.2–3.0).Conclusion: Our results indicate that building the Indonesian medical workforce in remote regions could be facilitated by investing in strategies to select medical students with a remote background, delivering more remote clerkships during the medical course, deploying more doctors in remote internships and providing financial incentives. Additional considerations include expanding government employment opportunities in rural areas to achieve a more equitable geographic distribution of doctors in Indonesia.

Background: As of 2020, 20% of people residing in the United States of America (U.S.) lived in rural communities. Despite rural residents tending to be older, poorer, and having greater disease burden than their urban counterparts, the number of rural primary care providers continues to decline. Nearly 66% of U.S. Primary Care Health Professional Shortage Areas are designated as rural. Pharmacists can help address this shortage of rural primary care providers, often serving as providers of first-contact care; however, only 12% of U.S. pharmacists practice in rural communities. To help address this gap, in 2022 an elective Rural Pharmacy course was created at the University of Minnesota College of Pharmacy by a faculty member who has rural practice experience., Methods: The course combines formal lectures, guest presentations by rural pharmacists and student interviews with additional rural pharmacists. For the 42 students enrolled in the course in 2022 and 2023, non-parametric statistics were used to compare the percentage of students who were raised in rural communities or who otherwise had extensive exposure to rural, and compare student interest ratings (1 to 7) about practicing/living rural at the beginning and end of the course. Students also wrote end-of-course reflection papers, commenting on the course and their interviews with rural pharmacists., Results: Across both years, 45% of the enrolled students had previous experience in rural communities. The net change in Rural Interest scores among students completing both questionnaires was + 5 in 2022 and + 2 in 2023, both non-significant differences. The largest shifts in student interest were from "Not Sure" at the start of the course to "Interested" or "Not Interested" at the end of the course, and from "Interested" to "Very Interested." In their reflection papers nearly 60% of students reported being most impressed by their interviews with rural pharmacists., Conclusions: A course addressing the benefits and challenges of practicing pharmacy in rural communities was well-received by pharmacy students. Even students who have little interest in living in a rural community can benefit from being introduced to rural culture, enabling them to provide more culturally-responsive care for patients from rural communities., (© 2024. The Author(s).)

Purpose/objectives: This research aimed to identify factors that affect dental students' attitudes toward participation in rural clinical outplacements (RCOP) in Australia, and to suggest strategies that will increase students' desire to attend RCOP in the future., Methods: Dental students from the nine dental schools in Australia were invited to an online survey on their willingness to participate in an RCOP and the factors that influence this willingness. These factors were grouped into themes of education, personal and health, social, financial, and information-related., Results: The study had an estimated response rate of 10% with 202 responses. More than two-thirds (68%) of students were willing to participate in an RCOP. Students who grew up in a rural area were significantly more likely to be willing to attend an RCOP, compared to those from urban settings. Attitudes toward the anticipated educational experience of RCOP were positive, while factors related to finances and pre-existing information were of concern to students. Educational, personal/health-related, and social factors had significant impacts on participants' willingness to attend RCOP., Conclusion: Overall, despite students holding negative opinions on certain social and financial factors, their positive attitudes toward other factors outweighed these. Universities should aim to further promote the educational benefits of RCOP to improve students' attitudes prior to attending RCOP. In-depth qualitative analysis is required to explore students' concerns regarding RCOP and longitudinal research is warranted to monitor students' attitudes toward RCOP and rural work over time., (© 2024 The Authors. Journal of Dental Education published by Wiley Periodicals LLC on behalf of American Dental Education Association.)

Background and Objectives: Factors associated with physician practice choice include residency location, training experiences, and financial incentives. How length of training affects practice setting and clinical care features postgraduation is unknown., Methods: In this Length of Training Pilot (LoTP) study, we surveyed 366 graduates of 3-year (3YR) and 434 graduates of 4-year (4YR) programs 1 year after completion of training between 2013 and 2021. Variables assessed included reasons for practice setting choice, practice type, location, practice and community size, specialty mix, and clinical care delivery features (eg, integrated behavioral health, risk stratified care management). We compared different length of training models using χ2 or Fisher's exact tests for categorical variables and independent samples, and t test (unequal variances) for continuous variables., Results: Response rates ranged from 50% to 88% for 3YR graduates and 68% to 95% for 4YR graduates. Scope of practice was a predominant reason for graduates choosing their eventual practice, and salary was a less likely reason for those completing 4 years versus 3 years of training (scope, 72% vs 55%, P=.001; salary, 15% vs 22%, P=.028). Community size, practice size, practice type, specialty mix, and practice in a federally designated underserved site did not differ between the two groups. We found no differences in patient-centered medical home features when comparing the practices of 3YR to 4YR graduates., Conclusions: Training length did not affect practice setting or practice features for graduates of LoTP programs. Future LoTP analyses will examine how length of training affects scope of practice and clinical preparedness, which may elucidate other elements associated with practice choice.

Introduction: Current strategies to address shortages of rural doctors focus on developing a pipeline for rural generalist practice. Limited research has explored how doctors' professional journey engenders the skills required to practice rurally., Objective: This paper analyses how rural general practitioners' clinical pathway informs their scope of practice and future retention., Design: Qualitative thematic analysis using semi-structured telephone interviews. Twenty-one general practitioners appointed in their local health district of Murrumbidgee and Southern New South Wales, Australia, within the past 10 years. Participants comprised 10 Australian medical graduates (AMG) and 11 international medical graduates (IMG)., Findings: AMGs and IMGs contrasted how their pathway into rural practice, and capacity to work rurally, informed their scope of practice. Australian medical graduates' familiarity with rural areas was consolidated through congruous experiences, including at rural clinical schools. Paradoxically, the fluency of their training limited the amount of unsupervised experience and confidence AMGs gained. Together with a focus on work-life balance, this limited many to providing mainstream general practice, precluding extending their scope of practice. International medical graduates described disseminated experiences, often unsupervised in high-volume contexts. However, a lack of professional opportunities prevented them from extending their scope of practice., Discussion: IMG and AMG motivation and pathway for working rurally differ. Respective cohorts have concerns regarding requisite skills and knowledge for rural practice, which incorporates opportunity and recognition. Entry points for training should be variable to allow consideration of life stage, prior skill development and extension of scope of practice., Conclusion: Doctors' scope of practice is informed by their pathways into rural practice. Australian medical graduates may not gain adequate competence during expedited training programs to confidently undertake extended clinical activities. International medical graduates, however lacked the opportunities and support, to utilise their expertise in rural practice. Complementarily utilising the expertise and commitment of both AMGs and IMGs may synergistically address workforce shortages., (© 2024 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Introduction: Internationally the medical workforce is suffering from a persistent geographic and specialist maldistribution. Longitudinal models of rural medical education such as longitudinal integrated clerkships (LIC) have been one of the strategies employed to redress this issue., Aim: To map and synthesise the evidence on the medical workforce outcomes of rural LIC graduates, identifying gaps in the literature to inform future research., Methods: This review followed Arksey and O'Malley's methodological steps. Databases searched included Medline, CINAHL Complete (EBSCOhost), Scopus, Embase (Elsevier), and ISI Web of Science., Results: A total of 9045 non-duplicate articles were located, 112 underwent a full review, with 25 articles meeting the inclusion criteria. Studies were commonly cohort-based (84%), with data collected by database tracking and data linkage (52%). Five themes were identified to summarise the studies: (i) Overall geographic workforce outcomes (ii) influence of non-LIC medical training, (iii) remaining in region and level of rurality, (iv) medical speciality choice and rurality, and (v) selection and preferences., Conclusion: Synthesis of the evidence related to workforce outcomes of rural LIC graduates provides directions for future rural medical workforce planning and research. While rural LIC graduates were found to be more likely to work rurally and in primary care specialities compared to graduates from other training pathways there is evidence to suggest this can be enhanced by strategically aligning selection and training factors.

Background: The excellent project "LandArztMacher" is an attempt to work against the predicted shortage of rural doctors in Germany with diverse approaches., Method: "LandArztMacher" is a clinical traineeship with four weeks of practical training in general practices and clinics in the Bavarian countryside, accompanied by joint professional teaching. Participants were asked before and after the internship about the topics "importance of an internship in rural areas"; "attractiveness of rural areas" (scale: 0/no agreement to 10/full agreement). Ideas about the tasks of a general practitioner were assessed (scale: 0/no idea at all to 100/exact idea). The present study is a repeated cross-sectional study. The median is reported as the location measure and the interquartile range as the dispersion measure., Results: Participants (n=363, 74% female, n=267, age: range 19-46 years, mean: 23.2 years, SD: 2.41 years) from the clinical section of the medical studies considered an internship in the rural area before and after the internship very important (median: 8 and 9, respectively) and could well imagine working in the countryside (median: 7 and 8, respectively). Their attitude towards the cultural offerings or the infrastructure did not change (median: 6 in each case). After the internship, the students had a more precise idea of what a general practitioner tasks are (median: 65 and 90, respectively)., Summary: A well-structured four-week rural internship can enhance the appeal of future rural employment through individual supervision and collaborative training., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

BackgroundAnnual chlamydia screening is recommended for adolescent and young adult females and targeted screening is recommended for women ≥26 years based on risk. Although screening levels have increased over time, adherence to these guidelines varies, with high levels of adherence among Title X family planning providers. However, previous studies of provider variation in screening rates have not adjusted for differences in clinic and client population characteristics.MethodsAdministrative claims from the California Family Planning, Access, Care, and Treatment (Family PACT) program were used to (1) examine clinic and client sociodemographic characteristics by provider group-Title X-funded public sector, non-Title X public sector, and private sector providers, and (2) estimate age-specific screening and differences in rates by provider group during 2009.ResultsAmong 833 providers, Title X providers were more likely than non-Title X public sector providers and private sector providers to serve a higher client volume, a higher proportion of clients aged ≤25 years, and a higher proportion of African American clients. Non-Title X public providers were more likely to be located in rural areas, compared with Title X grantees and private sector providers. Title X providers had the largest absolute difference in screening rates for young females vs. older females (10.9%). Unadjusted screening rates for young clients were lower among non-Title X public sector providers (54%) compared with private sector and Title X providers (64% each). After controlling for provider group, urban location, client volume, and percent African American, private sector providers had higher screening rates than Title X and non-Title X public providers.ConclusionsScreening rates for females were higher among private providers compared with Title X and non-Title X public providers. However, only Title X providers were more likely to adhere to screening guidelines through high screening rates for young females and low screening rates for older females.

This article deals with the ideology of medical professionals in order to understand the meanings attributed to their profession, taking Thompson's theory as a starting point and centering on the categories of autonomy, norms and values, and social recognition. Twenty-four semi-structured interviews were conducted with medical professionals in Amecameca, a municipality in the State of Mexico, from March to October 2019, in four sectors of service provision: public institutional, private institutional, private practice, and mixed practice. The analysis of meanings expressed by medical professionals with respect to each category of interest reveals that medical professionals are conditioned by the structure of state control and by the commodified economy, where private forms of medical practice are more highly regarded. In the ideological conformation of the medical profession, there remains a practical component imbued with a liberal romanticism in an extinct scenario that still exists today, without being articulated to more general social processes. [ABSTRACT FROM AUTHOR]

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PurposeThe adequacy of the urologist work force in absolute numbers and relative distribution is unclear. To develop effective policies addressing the needs of an aging population we must better understand the urologist work force. We assessed the geographic distribution of urologists throughout the United States at the county level and determined the county characteristics associated with increased urologist density.Materials and methodsCounty level data from the Department of Health and Human Services Area Resource File and the United States Census were analyzed in this ecological study. Logistic regression and ordinal logistic regression models were built to identify predictors of urologist density, defined as the number of urologists per 100,000 individuals. National patterns of urologist density were mapped graphically at the county level.ResultsOverall 63% of the counties in the United States lack a urologist. Based on multivariate models urologists were less likely to be found in nonmetropolitan counties (OR 0.57, 95% CI 0.46-0.72) and rural counties (OR 0.03, 95% CI 0.02-0.06) than in metropolitan counties, which confirmed visually mapped models. Patterns of urologist density also appeared to be influenced by climate and county education levels rather than by traditional socioeconomic measures. Urologists younger than 45 years old were 3 times less likely to be located in nonmetropolitan and rural counties than their older counterparts.ConclusionsThe uneven distribution of urologists throughout the United States is likely to worsen as younger physicians continue to cluster in urban areas. Governing bodies must consider this distribution in their calls for increasing the number of training positions.

BackgroundThe University of California, Los Angeles (UCLA)/Charles R. Drew University Medical Education Program was developed to train physicians for practice in underserved areas. The UCLA/Drew Medical Education Program students receive basic science instruction at UCLA and complete their required clinical rotations in South Los Angeles, an impoverished urban community. We have previously shown that, in comparison to their UCLA counterparts, students in the Drew program had greater odds of maintaining their commitment to medically disadvantaged populations over the course of medical education.ObjectiveTo examine the independent association of graduation from the UCLA/Drew program with subsequent choice of physician practice location. We hypothesized that participation in the UCLA/Drew program predicts future practice in medically disadvantaged areas, controlling for student demographics such as race/ethnicity and gender, indicators of socioeconomic status, and specialty choice.DesignRetrospective cohort study.ParticipantsGraduates (1,071) of the UCLA School of Medicine and the UCLA/Drew Medical Education Program from 1985-1995, practicing in California in 2003 based on the address listed in the American Medical Association (AMA) Physician Masterfile.MeasurementsPhysician address was geocoded to a California Medical Service Study Area (MSSA). A medically disadvantaged community was defined as meeting any one of the following criteria: (a) federally designated HPSA or MUA; (b) rural area; (c) high minority area; or (d) high poverty area.ResultsFifty-three percent of UCLA/Drew graduates are located in medically disadvantaged areas, in contrast to 26.1% of UCLA graduates. In multivariate analyses, underrepresented minority race/ethnicity (OR: 1.57; 95% CI: 1.10-2.25) and participation in the Drew program (OR: 2.47; 95% CI: 1.59-3.83) were independent predictors of future practice in disadvantaged areas.ConclusionsPhysicians who graduated from the UCLA/Drew Medical Education Program have higher odds of practicing in underserved areas than those who completed the traditional UCLA curriculum, even after controlling for other factors such as race/ethnicity. The association between participation in the UCLA/Drew Medical Education Program and physician practice location suggests that medical education programs may reinforce student goals to practice in disadvantaged communities.

Rural family medicine residencies and practices continue to have difficulty attracting applicants and practitioners. Students facing decisions about rural training or practice may be deterred by negative stereotypes or a lack of understanding about rural experience. Renewed efforts to foster students' interest and influence students' intent toward rural practice are sorely needed. The authors report one such innovative strategy that used literary sources, many written by rural physicians, to trigger discussion and reflection among a group of 11 medical students who volunteered in 2004 to participate in a two-day retreat sponsored by The Ohio State University College of Medicine Rural Health Scholars program. Participants first attended a presentation designed to help them understand the relevance of textual study of narratives by and about country doctors to their own experiences (during rural clerkships) in rural practice and as a vehicle for clarifying their concerns and questions. Through small-group study and discussion of excerpts from these texts, participants identified notable characteristics of rural inhabitants and their physicians; distinctive attitudes toward illness and medical care; and stresses and rewards of rural practice. They also wrote poems and essays in response to prompts about rural doctoring. Students used reading and writing as triggers to better comprehend and reflect on intangibles such as the nature of small-town life, relative professional isolation, and the unique aspects of the doctor-patient relationship in rural practice. Quantitative and qualitative evaluations suggest that this literature-based approach was enjoyable and stimulating for students, provided useful insights, and reinforced their interest in rural practice.

Introduction Physician shortages are a persisting issue in rural regions around the world, and rural Northern Ontario, Canada, is no exception. Even with significant government interventions, financial incentives, and rural-specific contracts, physician recruitment to the region remains an ongoing challenge. Refining recruitment strategies based on specific factors that attract physicians to rural practice could help address staffing shortages and, ultimately, enhance healthcare access and outcomes in rural communities. However, the draw to rural practice among physicians is poorly defined. Therefore, this study aims to bridge this knowledge gap and, in doing so, offers insight to better inform recruitment strategies for rural communities. Methodology As part of a larger qualitative study on physician retention and recruitment, semi-structured interviews were conducted with 12 physicians who had previously practiced in rural Northern Ontario communities. Interviews captured information about their individual experiences, including perspectives on factors that attracted them to establish a practice in rural Northern Ontario. Transcribed interviews were analyzed to identify recurring themes associated with the factors that affect the decision to practice in rural Northern Ontario. Results Participants described the draw to rural practice as being multifactorial and based on overlapping motivations. Key motivations described by participants could be categorized into three broad themes, including rural community connection and exposure, lifestyle and personal preferences, and career considerations. Specifically, participants emphasized the importance of pro-rural mentors and gaining firsthand experience in rural communities as important facilitators that created a connection with these areas. Interest in exploring new parts of the country, alignment with life plans, support of family, and the challenge of rural practice also played pivotal roles in the decision to pursue rural practice. Finally, the opportunity to have a broad scope of practice and serve a need in the healthcare system while receiving fair compensation within the framework of a flexible and supportive contract was also cited as a draw to practice. Conclusion The draw to rural practice is multifactorial and based on a wide array of motivations. As a result, recruitment strategies should move beyond single-pronged approaches and recognize the need to design strategies that address the multifaceted motivations and considerations that drive physicians towards rural practice. Designing and implementing recruitment approaches that consider the diverse factors influencing physicians interest in rural career paths is likely to enhance recruitment initiatives and more effectively address shortage of physicians in the region., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, DeMiglio et al.)

Background: Medical internship is a key transition point in medical training from student to independent (junior) doctor. The national Regional Training Hubs (RTH) policy began across Australia in late 2017, which aims to build medical training pathways for junior doctors within a rural region and guide students, interns and trainees towards these. This study aims to explore preferencing and acceptance trends for rural medical internship positions in Queensland. Moreover, it focuses on internship preference and acceptance outcomes prior to and following the establishment of RTHs, and their association with key covariates such as rural training immersions offered by medical schools., Methods: Data from all applicants to Queensland Health intern positions between 2014-2021 were available, notably their preference order and location of accepted internship position, classified as rural or metropolitan. Matched data from Queensland's medical schools were added for rural training time and other key demographics. Analyses explored the statistical associations between these factors and preferencing or accepting rural internships, comparing pre-RTH and post-RTH cohorts., Results: Domestic Queensland-trained graduates first preferencing rural intern positions increased significantly (pre-RTH 21.1% vs post-RTH 24.0%, p = 0.017), reinforced by a non-significant increase in rural acceptances (27.3% vs 29.7%, p = 0.070). Rural interns were more likely to have previously spent ≥ 11-weeks training in rural locations within medical school, be rurally based in the year applying for internship, or enrolled in the rural generalist pathway., Conclusions: The introduction of the RTH was associated with a moderate increase of graduates both preferencing and accepting a rural internship, though a richer understanding of the dominant reasons for and against this remain less clear. An expansion of graduates who undertook longer periods of undergraduate rural training in the same period did not diminish the proportion choosing a rural internship, suggesting there remains an appetite for these opportunities. Overall, domestic graduates are identified as a reliable source of intern recruitment and retention to rural hospitals across Queensland, with entry to the rural generalist pathway and extended rural placement experiences enhancing uptake of rural practice., (© 2024. The Author(s).)

Introduction: The shortfall in medical workers in rural and remote Australia has led to health discrepancies in these regions. The University of Wollongong's medical program was designed to encourage graduates to work in these regions to address this shortfall., Objective: To compare rural and regional locations of work and choices of speciality between University of Wollongong's graduates and graduates from all Australian universities., Design: We conducted a longitudinal analysis on data available from the Medical Schools Outcome database, with graduate exit surveys linked to registrations of location and speciality. Rural and remote locations were identified as MM2-7 regions using the Modified Monash Model. In total, 716 graduates from the University of Wollongong and 26 915 graduates from all Australian medical schools completed the MSOD exit survey in 2010-2021 and registered with the Australian Health Practitioner Regulation Agency in 2022. The main outcome was the relative likelihood (relative risk) of cohorts working in rural and regional areas and of cohorts choosing general practice as their speciality., Findings: University of Wollongong's medical graduates were 1.51 times or 51% more likely to work in regional or rural areas (RR 1.51, 95% CI 1.34 to 1.71, p < 0.0001). Respondents who were 10 or more years post graduation were 1.57 times or 57% more likely to specialise in general practice than all other Australian medical graduates (RR 1.57 95% CI: 1.40 to 1.79, p < 0.0001)., Discussion: The University of Wollongong's medical school is producing graduates to meet Australia's rural health workforce needs. This may be due to a higher intake of rural students, and a higher percentage of students taking rural placements., Conclusions: Rural health workforce needs can be addressed through rural-focussed education strategies., (© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Introduction: Disparities between metropolitan and non-metropolitan health workforce must be addressed to reduce inequities in health care access. Understanding factors affecting early career practitioners' choice of practice location can inform workforce planning., Objective: To investigate influences on rural practice location preferences of recent graduates., Design: Cross-sectional analysis linked university enrolment, Graduate Outcomes Survey (GOS) and Australian Health Professional Regulation Agency (Ahpra) principal place of practice (PPP) for 2018 and 2019 nursing and allied health graduates from two Australian universities. Chi-squared tests and logistic regression compared rural versus urban PPP and locational preference., Findings: Of 2979 graduates, 1295 (43.5%) completed the GOS, with 63.7% (n = 825) working in their profession and 84.0% of those (n = 693) in their preferred location. Ahpra PPP data were extracted for 669 (81.1%) of those working in their profession. Most reported influences were 'proximity to family/friends' (48.5%), 'lifestyle of the area' (41.7%) and 'opportunity for career advancement' (40.7%). Factors most influential for rural PPP were 'cost of accommodation/housing' (OR = 2.26, 95% CI = 1.23-4.17) and 'being approached by an employer' (OR = 2.10, 95% CI = 1.12-3.92). Having an urban PPP was most influenced by 'spouse/partners employment/career' (OR = 0.53, 95% CI = 0.30-0.93) and 'proximity to family/friends' (OR = 0.41, 95% CI = 0.24-0.72)., Discussion: While the findings add strength to the understanding that graduates who originated from a rural area are most likely to take up rural practice in their preferred location, varied social and professional factors are influential on decision-making., Conclusions: It is imperative to recruit students from non-metropolitan regions into health professional degrees, as well as addressing other influences on choice of practice location., (© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Objective: To determine the distinct influences of rural background and rural residency training on rural practice choice among family physicians., Data Sources and Study Setting: We used a subset of The RTT Collaborative rural residency list and longitudinal data on family physicians from the American Board of Family Medicine National Graduate Survey (NGS; three cohorts, 2016-2018) and American Medical College Application Service (AMCAS)., Study Design: We conducted a logistic regression, computing predictive marginals to assess associations of background and residency location with physician practice location 3 years post-residency., Data Collection/extraction Methods: We merged NGS data with residency type-rural or urban-and practice location with AMCAS data on rural background., Principal Findings: Family physicians from a rural background were more likely to choose rural practice (39.2%, 95% CI = 35.8, 42.5) than those from an urban background (13.8%, 95% CI = 12.5, 15.0); 50.9% (95% CI = 43.0, 58.8) of trainees in rural residencies chose rural practice, compared with 18.0% (95% CI = 16.8, 19.2) of urban trainees., Conclusions: Increasing rural programs for training residents from both rural and urban backgrounds, as well as recruiting more rural students to medical education, could increase the number of rural family physicians., (© 2023 Health Research and Educational Trust.)

Introduction: There is now strong evidence to support the positive impact of place-based medical education on the recruitment and retention of the rural health workforce in Australia. Much of this work, however, has been undertaken in the context of 'extended rural clinical placement' - students undertaking part of their medical degree in a rural location. Until recently, there were only a few places in Australia in which students could undertake the entirety of their medical degree in a rural area. With the introduction of the Murray-Darling Medical Schools Network (MDMSN) initiative, this dynamic is changing. The MDMSN is part of the Stronger Rural Health Strategy and builds on the Australian Government's existing Rural Health Multidisciplinary Training Program to establish a network of rurally based medical programs in the Murray-Darling region. The MDMSN offers a unique opportunity to explore the effect of complete rural immersion during medical school on subsequent rural practice. This article describes the establishment of a research collaboration intended to ensure the harmonisation of research data collection from the outset of the MDMSN program., Methods: The MDMSN research collaboration is a longitudinal, multi-university program of work to explore the effect of rurally based medical school programs in the Murray-Darling region. Initially it has been agreed that administrative student data will be collected from existing university datasets to help characterise this novel student cohort. Each university will then distribute an entry survey to all first-year MDMSN students. The survey will collect demographic information as well as information regarding rural background, preferences and future practice intention. Questions have been aligned with and adapted from the Medical Schools Outcomes Database survey, the Australian Bureau of Statistics, and from the literature. This information will be combined with graduate information from the Australian Health Practitioner Regulation Agency., Results: The MDMSN research collaboration will work toward the co-design of research projects, to facilitate and progress multi-site research addressing nationally relevant research questions. Early research efforts are focused on our ability to better understand the new cohort of students embarking on rurally based medical education, their practice intentions and realisation. Subsequent work of the collaboration may lead to deeper understanding of the rural student experience, any effect of 'place', changes in student professional identity over time, and their relationship to subsequent rural practice., Conclusion: The MDMSN research collaboration is a proactive initiative that brings together data and experience from five new rurally based medical programs, and answers calls for multi-institution and longitudinal studies. It is uniquely placed to capture the impact of the MDMSN program, including the effect of complete rural immersion on the future practice location of these graduates. Ultimately, the combined research efforts of the MDMSN research collaboration will add knowledge to address the known rural workforce maldistribution, particularly how to attract and retain medical workforce.

Introduction: Addressing the imbalance of the health workforce between metropolitan and rural areas requires a clear understanding of trends in choices of work location of health care staff., Objective: Here, we provide an automated and highly reproducible protocol to examine the location of health care workers over multiple years using medical graduates as a case study., Design: Data linkage cohort study. The study cohort examined was University of Wollongong Medical graduates from 2010 to 2021 who were registered to practice in Australia. The main outcome measure was graduate location of practice in Modified Monash regsions MM1 or MM2-7 across multiple postgraduate years. This protocol used R Markdown., Findings: An automated and reproducible protocol was used to analyse choices of work location for the University of Wollongong's medical graduates. Over 90% of graduates were registered with AHPRA. Around 25%-30% of graduates were found to work in MM2-7 regions across their careers, exceeding the national average., Discussion: The protocol presented allows for a fast and reproducible analysis of work location by region for health care workers. This will allow comparisons of outcomes between universities or health professions., (© 2023 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

The high cost of dental education and consequent loan burdens contribute to the shortage of pediatric dental providers in rural areas (RAs). Economic incentives are meant to recruit practitioners to RAs. The aim of this study was to assess the ability of government subsidized loan repayment programs (GSLRPs) to recruit pediatric specialists to practice in RAs. A 26‐item questionnaire was emailed to all 921 pediatric dental residents across the U.S. in 2015 for a cross‐sectional study of factors influencing their choice of practice location. The instrument included information about GSLRPs, enabling the study to serve as a quasi‐experiment on the level of funding needed to make GSLRPs effective. A total of 169 residents responded, for an 18% response rate; 74% of respondents were women and 86% had student loan debt. Among the respondents, 40.6% said they would like to practice in RAs, but only 4.1% actually intended to do so. Over one‐third initially reported interest in GSLRPs for practicing in RAs. However, after being informed that the average GSLRP is $30,000 annually, one‐third of those lost interest. Although 14.2% said no amount would convince them to consider practice in an RA, over half (53.3%) indicated willingness to consider it if the GSLRP were $40,000‐$60,000. These results suggest that current GSLRP levels are insufficient to induce pediatric dentists to practice in RAs. [ABSTRACT FROM AUTHOR]