Mobility of US Rural Primary Care Physicians During 2000–2014

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Figure 1
Biennial mobility rate of primary care physicians, by age.

Table 1

Summary of Biennial Movers by Rurality and Age Cohorts—Primary Care Physicians, 2000–2014

Original Location: RUCC Category^a	Aged ≤45 y				Aged 46–65 y

			Of Those Moving				Of Those Moving

	Physicians, No.	Movers, %	Moving to Rural, %	Moving to Metropolitan, %	Physicians, No.	Movers, %	Moving to Rural, %	Moving to Metropolitan, %
1 (M)	354,823	17	6	94	428,357	9	7	93
2 (M)	127,524	16	15	85	161,661	8	17	83
3 (M)	55,284	17	20	80	70,986	9	25	75
4 (R)	21,937	17	22	78	30,442	10	30	70
5 (R)	10,329	18	32	68	14,528	8	45	55
6 (R)	20,053	20	29	71	28,736	12	38	62
7 (R)	13,512	18	42	58	19,682	11	53	47
8 (R)	2,262	23	36	64	3,045	17	48	52
9 (R)	2,917	26	53	47	4,441	16	67	33
Total	608,641	16.9	12.2^b	87.8^b	761,878	8.9	16.3^c	83.7^c

RUCC=Rural-Urban Continuum Codes.
↵a Original location postresidency; higher category indicates increasing rurality. M indicates metropolitan; R indicates rural.
↵b Number moving metropolitan to rural: 8,354; number moving rural to metropolitan: 9,137.
↵c Number moving metropolitan to rural: 6,504; number moving; rural to metropolitan: 6,391.
Note: Not shown here, analysis was repeated for family physicians only, but there were no differences of note.

Table 2

Factors Associated With Increased County-Level Mobility (Nonretention) of Rural Primary Care Physicians

Factor	β Estimate (95% CI)^a
Primary care physician supply (PPR per 1,000 residents)	−6.70 (−8.66 to −4.75)^b
RUCC category
4 or 5	−4.50 (−6.21 to −2.78)^b
6 or 7	−3.09 (−4.64 to −1.54)^b
No hospital in county	5.74 (3.78 to 7.67)^b
Long work commute (%)	−0.001 (−0.055 to 0.053)
Population uninsured (%)	0.084 (−0.089 to 0.256)
Median house price (per $100,000)	−0.163 (−0.953 to 0.627)
Unemployment rate (%)	0.160 (−0.083 to 0.403)
Population aged ≥65 years (%)	−0.082 (−0.216 to 0.052)
Population race/ethnicity (%)
Non-Hispanic African American	0.014 (−0.032 to 0.060)
Hispanic	0.029 (−0.022 to 0.081)
Adjacent to metropolitan	−0.080 (−0.927 to 0.767)

PPR = primary care physician–to-population ratio; RUCC = Rural-Urban Continuum Code.
↵a Outcome measure is a score between 0 and 100 (eg, 20 = 20% nonretention).
↵b P <.01.
Notes: The number of observations was 1,797. The R² value was 0.25.

Table 3

Factors Associated With Observed Odds of Rural Primary Care Physicians Moving to Metropolitan Counties

Factor	Odds Ratio (95% CI)

	Aged ≤45 y (n=70,568)	Aged 46–65 y (n=100,374)
Female	1.24 (1.18 to 1.30)^a	1.46 (1.37 to 1.54)^a
Family physician	0.86 (0.82 to 0.90)^a	0.99 (0.94 to 1.04)
Osteopathic	1.02 (0.94 to 1.10)	1.25 (1.15 to 1.35)^a
International medical graduate	1.65 (1.53 to 1.77)^a	1.41 (1.31 to 1.53)^a
Health Professional Shortage Area (HPSA)	1.05 (0.99 to 1.11)	1.06 (1.00 to 1.13)
Born in rural area	0.57 (0.53 to 0.62)^a	0.64 (0.59 to 0.70)^a
Primary care physician supply (PPR per 1,000 residents)	0.77 (0.71 to 0.84)^a	0.74 (0.66 to 0.82)^a
No hospital in county	1.09 (0.97 to 1.23)	1.02 (0.89 to 1.17)
RUCC category (reference: 8 or 9)
4 or 5	0.92 (0.83 to 1.03)	0.90 (0.80 to 1.01)
6 or 7	0.93 (0.84 to 1.03)	0.98 (0.87 to 1.09)
Adjacent to metropolitan	1.10 (1.05 to 1.16)^a	1.28 (1.21 to 1.36)^a
Median household income (per $10,000)	1.08 (1.03 to 1.14)^a	1.07 (1.02 to 1.13)^a
Median house price (per $100,000)	0.94 (0.89 to 1.00)	1.07 (1.01 to 1.13)^b
Unemployment rate (%)	1.012 (1.002 to 1.032)^b	1.012 (0.995 to 1.029)
Population aged ≥65 years (%)	0.984 (0.977 to 0.991)^a	1.004 (0.996 to 1.013)
Population race/ethnicity (%)
Non-Hispanic African American	1.000 (0.997 to 1.002)	1.005 (1.002 to 1.008)^a
Hispanic	1.004 (1.001 to 1.007)^b	1.003 (1.000 to 1.006)

PPR = primary care physician–to-population ratio; RUCC = Rural-Urban Continuum Code.
↵a P <.01.
↵b P <.05.