Rural Employment of Health Care Workers: A Longitudinal Cohort Study.
health care workers
predictors of rural practice
retention
rural health
workforce
Journal
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
ISSN: 1748-0361
Titre abrégé: J Rural Health
Pays: England
ID NLM: 8508122
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
pubmed:
24
11
2020
medline:
30
10
2021
entrez:
23
11
2020
Statut:
ppublish
Résumé
Preserving and increasing the health care workforce in rural areas has become imperative due to the shortage of health care workers serving rural populations. However, limited data are available on long-term patterns of employment in rural settings among health care workers. We analyzed the National Longitudinal Survey of Youth, which enrolled a nationally representative sample of adolescents in 1979 and tracked their career outcomes through 2016. Using the US Census Bureau occupation codes, we identified participants who worked in health care occupations, and we classified their employment in rural versus urban areas. Of the 1,007 respondents (including 109 doctoral health professionals), 70% worked only in urban locations, 13% worked only in rural locations, and 17% worked in both rural and urban locations during their health care career. Rural upbringing, White race, and female gender were associated with rural employment. Among nondoctoral health professionals, lower educational attainment was associated with increased likelihood of working only in rural settings. Our study indicates the rural workforce is split between workers who are only employed in rural settings, and those who are intermittently employed in rural and urban settings. Therefore, retention of health care workers in rural settings and recruitment of workers from urban settings to practice in rural areas are important strategies for addressing the rural health care worker shortage. Rural upbringing, previously described as predictive of physician practice in rural locations, appears the strongest predictor of rural employment for both doctoral health professionals and nondoctoral health professionals.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
705-713Informations de copyright
© 2020 National Rural Health Association.
Références
Rosenblatt R. A view from the periphery, health care in rural America. N Engl J Med. 2004;351:1049-1051.
World Health Organization. Increasing Access to Health Workers in Remote and Rural Locations Through Improved Retention: Global Policy Recommendations. Geneva, Switzerland: WHO Press; 2010.
Abernathy A, Byerley J. Developing the health care workforce of the future for North Carolina. N C Med J. 2019;80:150-154.
Johnson GE, Wright FC, Foster K. The impact of rural outreach programs on medical students’ future rural intentions and working locations: a systematic review. BMC Med Educ. 2018;18:196-219.
MacQueen IT, Maggard-Gibbons M, Capra G, et al. Recruiting rural healthcare providers today: a systematic review of training program success and determinants of geographic choices. J Gen Intern Med. 2018;33:191-199.
Centers for Disease Control and Prevention. About Rural Health. https://www.cdc.gov/ruralhealth/about.html. Accessed October 15, 2019.
Crump WJ, Fricker RS, Ziegler CH, Wiegman DL. Increasing the rural physician workforce: a potential role for small rural medical school campuses. J Rural Health. 2016;32:254-259.
Gong G, Phillips SG, Hudson C, Curti D, Philips BU. Higher US rural mortality rates linked to socioeconomic status, physician shortages, and lack of health insurance. Health Aff. 2019;38:2003-2010.
Marcin JP, Shaikh U, Steinhorn RH. Addressing health disparities in rural communities using telehealth. Pediatr Res. 2016;79:169-176.
Goodfellow A, Ulloa JG, Dowling PT, et al. Predictors of primary care physician practice location in underserved urban or rural areas in the United States: a systematic literature review. Acad Med. 2016;91:1313-1321.
Shannon CK, Jackson J. Validity of medical student questionnaire data in prediction of rural practice choice and its association with service orientation. J Rural Health. 2015;31:373-381.
McGrail MR, Wingrove PM, Petterson SM, Bazemore AW. Mobility of US rural primary care physicians during 2000-2014. Ann Fam Med. 2017;15:322-328.
Crump WJ, Ziegler CH, Fricker RS. Rural medical student opinions about rural practice: does choice of college make a difference? Marshall J Med. 2018;4:48-56.
Bureau of Labor Statistics. National Survey of Youth; 1979. Available at: https://www.nlsinfo.org/content/cohorts/nlsy79/intro-to-the-sample/sample-design-screening-process. Accessed November 21, 2019.
Bureau of Labor Statistics. National Survey of Youth; 1979. Available at: https://www.nlsinfo.org/content/cohorts/nlsy79/other-documentation/codebook-supplement/nlsy79-appendix-6-urban-rural-and. Accessed December 13, 2019.
Tumin D, Li SS, Kopp BT, et al. The effect of the affordable care act dependent coverage provision on patients with cystic fibrosis. Pediatr Pulmonol. 2017;52:458-466.
Patel A, Knox RJ, Logan A, Summerville K. Area Health Education Center (AHEC) programs for rural and underrepresented minority students in the Alabama Black Belt. Arch Public Health. 2017;75:32.
Redford LJ. Building the rural healthcare workforce: challenges-and strategies-in the current economy. Generations. 2019;43:71-75.
Taylor JD, Kiovsky RD, Kayser A, Kelley A. Does an AHEC-sponsored clerkship experience strengthen medical students' intent to provide care for medically underserved patients? J Commun Health. 2015;40:1173-1177.
Knoerl E, Haleem, M, Wistar C. New York state dental workforce resources and incentive programs. N Y State Dent J. 2012;78:20-24.
Eidson-Ton WS, Rainwater J, Hilty D, et al. Training medical students for rural, underserved areas: a rural medical education program in california. J Health Care Poor Underserved. 2016;27:1674-1688.
Kandrack R, Martsolf GR, Reid RO, Friedberg MW. Primary care physician migration patterns and their implications for workforce distribution. J Gen Intern Med. 2019;34:1108-1109.
McGrail MR, Wingrove PM, Petterson SM, Bazemore AW. Mobility of US rural primary care physicians during 2000-2014. Ann Fam Med. 2017;15:322-328.
Frogner BK, Skillman SM. Pathways to middle-skill allied health care occupations. Issues Sci Technol. 2016;33:52-57.
Giani M, Fox HL. Do stackable credentials reinforce stratification or promote upward mobility? An analysis of health professions pathways reform in a community college consortium. J Voc Educ Train. 2017;69:100-122.
Shipman SA, Wendling A, Jones KC, Kovar-Gough I, Orlowski JM, Phillips J. The decline in rural medical students: a growing gap in geographic diversity threatens the rural physician workforce. Health Aff. 2019;38:2011-2018.
Barned H, Richards MR, McHugh MD, Martsolf G. Rural and nonrural primary care physician practices increasingly rely on nurse practitioners. Health Aff. 2018;37:908-914.
National Rural Health Association. National rural health association policy brief. https://www.ruralhealthweb.org/NRHA/media/Emerge_NRHA/Advocacy/Policy%20documents/04-09-18-NRHA-Policy-Physician-Assistants-Modernize-Laws-to-Improve-Rural-Access.pdf. Accessed September 30, 2020.
Benitez J, Coplan B, Dehn RW, Hooker RS. Payment source and provider type in the US healthcare system. JAAPA. 2015;28:46-53.
United States Department of Agriculture. Rural America at a glance. https://www.ers.usda.gov/webdocs/publications/90556/eib-200.pdf. Accessed September 30, 2020.
Xierali IM, Nivet MA. The racial and ethnic composition and distribution of primary care physicians. J Health Care Poor Underserved. 2018;29:556-570.
James CV, Moonesinghe R, Wilson-Frederick SM, Hall JE, Penman-Aguilar A, Bouye K. Racial/ethnic health disparities among rural adults-United States, 2012-2015. MMWR Surveill Summ. 2017;66(23):1-9.
Kelly-Blake K, Garrison NA, Fletcher FE, et al. Rationales for expanding minority physician representation in the workforce: a scoping review. Med Educ. 2018;52:925-935.