Factors Influencing physician assistant practice location in the United States

Introduction: Currently, certain rural areas of the country suffer from inadequate access to health care providers. Efforts have been made on a national level to recruit individuals from rural areas, who desire careers as health care providers, in the hopes that they will return upon graduation. This 2009 study focused on the physician assistant (PA) profession's endeavors in this effort. The purpose was to determine the number of PAs from rural areas (graduates of non-urban high schools) who returned to a non-urban area after graduation and the factors that influenced their first practice location choice. Methodology: A cross-sectional survey used a random sample of 2,000 practicing PAs from the United States. Results: The response rate was 16% (n=312). Forty-seven percent reported graduating from a non-urban (<50,000 population) community high school, yet 32.1 percent reported their first job to be in a non-urban community setting. Chi-square analyses revealed six factors of significance (p<.05) in relationship with demographic variables in determining their first job, including: benefits and incentive programs offered by employer (more important for younger PAs, minorities and those not working in federally qualified health centers (FQHCs); hours of work required per week (more important for females, younger PAs, and those with master degrees); significant other support of location (more important for males, older PAs and those who were married); medically underserved designation of practice site (more important for minorities and those working in primary care and FQHCs); quality of surrounding schools (for their children) (more important for males, older PAs, non-minorities, and those who were married); and quality of life for the entire family (more important for older and married PAs and those not working in FQHCs). Conclusion: Nearly one-half of respondents self-identified as graduating from a non-urban community high school, yet only one-third practiced in a similar community upon graduation. Many factors other than an individual's community size prior to PA training were related to first job selection. Existing efforts focusing on recruiting PA students from rural areas, in the hopes that they will return after graduation, may be futile in this profession.