A Mathematical Model: What factors influence the choice of residency graduates to serve in Medically Underserved Areas or Health Professional Shortage Areas?

Background: Physician mal-distribution needs to be addressed to improve equitable access to needed medical care.

Purpose: The purpose of this study was to construct a mathematical model to determine the factors that are linked to medical graduates' choice to practice in medically underserved areas (MUAs) and health professional shortage areas (HPSAs).

Methods: Graduate medical education exit surveys were conducted in 2009 and 2010 (n=279) that measured demographic characteristics, perceptions of demand, debt, future plans, salary and factors affecting their selection of practice location.

Results: Respondents who expected to earn less than $199,999 were 3.45 {95% CI: 1.23, 9.71} times as likely to start their practice in an MUA/HPSA; respondents who were offered no or one employment/practice position were 4.85 {95% CI: 1.78, 13.21} times as likely to start their practice in an MUA/HPSA. The Hosmer and Lemeshow Goodness-of-Fit test (χ2: 6.21; d.f.: 8; p-value: 0.62) indicated the variables in our model provided a good fit. The average difference between the maximum likelihood estimate standard errors and bootstrap standard deviations were 0.017 indicating very little difference in the MLE estimates and bootstrap estimates.

Conclusions: Graduates starting their practices in areas of need expect lower salaries and had fewer opportunities to practice elsewhere. Finding factors that are linked to decisions regarding where to practice medicine could help policy makers develop strategies to improve the attractiveness of practicing in areas where physicians are most needed. Such strategies would include increased salary, better recruitment benefits and retention programs.