Younger PCPs less likely to stay in rural areas

Physicians aged 45 and younger in nonmetropolitan areas were almost twice as likely to leave these rural areas compared with physicians aged 46 to 65, according to research recently published in Annals of Family Medicine.

“Although considerable research has identified factors that facilitate or impede supply of physicians in rural areas, macro-level empirical evidence of observed rural mobility of physicians — notably, which are more likely to move and why — is limited,” Matthew R. McGrail, PhD, School of Rural Health, Monash University, Victoria, Australia, and colleagues wrote. “Additionally, the frequencies with which specific rural physicians move over short periods of time, including moves driven by factors influenced by political cycle (as in the 2-year window that we have studied), are less explored.”

Researchers created seven 2-year mobility periods from 2000 to 2014 for every clinically active U.S. physician in AMA’s Physician Masterfile. The biennial periods were merged with county level rurality, physician supply, economic characteristics, key demographic measures and individual physician characteristics. They then determined mobility rates of physicians by rurality; linear regression models of county-level rural nonretention or departure); and logit models of physicians leaving rural practice.

McGrail and colleagues found that of the 1.4 million biennial location pairings of U.S. primary care physicians analyzed, biennial turnover was about 17% among physicians aged 45 and younger, compared with 9% among physicians aged 46 to 65, with little difference between rural and metropolitan groups. County-level physician mobility was higher for counties without a hospital (absolute increase = 5.7%), that had a smaller population, and had lower primary care physician supply, but area level economic and demographic factors had little impact.

In addition, women physicians (OR = 1.24 for those aged 45 or younger; OR = 1.46 for those aged 46 to 65) and physicians born in a metropolitan area (OR = 1.75 for those aged 45 or younger; OR = 1.56 for those aged 46 to 65) were more likely to leave rural practice.

Researchers also noted that physicians located in areas with poorer supply (measured by physician–to-population ratio) were also significantly more likely to leave rural areas (OR = 0.77 for younger physicians; OR = 0.75 for older physicians).

“Our study provides national-level evidence that enables rural health workforce planners and policymakers to better understand which characteristics are most strongly associated with physician geographic mobility each year, how often moves occur, and where physicians might move to and from,” McGrail and colleagues wrote. “In addition, the strengths of key community-level push and pull factors have been measured against observed mobility behavior.”

Researchers stated that their findings may help guide rural health policies and workforce planning and incentives, and highlight the specific needs of the most vulnerable communities.

Rural health care was identified as an area of concern by the CDC, which reported earlier this year that there is an increased risk for death from heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke in nonmetropolitan areas compared to urban ones. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.