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Research ArticleOriginal Research

Mobility of US Rural Primary Care Physicians During 2000–2014

Matthew R. McGrail, Peter M. Wingrove, Stephen M. Petterson and Andrew W. Bazemore
The Annals of Family Medicine July 2017, 15 (4) 322-328; DOI: https://doi.org/10.1370/afm.2096
Matthew R. McGrail
1Monash University, School of Rural Health, Churchill, Victoria, Australia
2Centre of Research Excellence in Rural and Remote Primary Health Care, Bendigo, Victoria, Australia
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  • For correspondence: matthew.mcgrail@monash.edu
Peter M. Wingrove
3Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC
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Stephen M. Petterson
3Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC
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Andrew W. Bazemore
3Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC
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    Figure 1

    Biennial mobility rate of primary care physicians, by age.

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    Table 1

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

    Original Location: RUCC CategoryaAged ≤45 yAged 46–65 y
    Of Those MovingOf Those Moving
    Physicians, No.Movers, %Moving to Rural, %Moving to Metropolitan, %Physicians, No.Movers, %Moving to Rural, %Moving to Metropolitan, %
    1 (M)354,82317694428,3579793
    2 (M)127,524161585161,66181783
    3 (M)55,28417208070,98692575
    4 (R)21,93717227830,442103070
    5 (R)10,32918326814,52884555
    6 (R)20,05320297128,736123862
    7 (R)13,51218425819,682115347
    8 (R)2,2622336643,045174852
    9 (R)2,9172653474,441166733
    Total608,64116.912.2b87.8b761,8788.916.3c83.7c
    • 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.

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    Table 2

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

    Factorβ 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 county5.74 (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 American0.014 (−0.032 to 0.060)
     Hispanic0.029 (−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.

    • View popup
    Table 3

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

    FactorOdds Ratio (95% CI)
    Aged ≤45 y (n=70,568)Aged 46–65 y (n=100,374)
    Female1.24 (1.18 to 1.30)a1.46 (1.37 to 1.54)a
    Family physician0.86 (0.82 to 0.90)a0.99 (0.94 to 1.04)
    Osteopathic1.02 (0.94 to 1.10)1.25 (1.15 to 1.35)a
    International medical graduate1.65 (1.53 to 1.77)a1.41 (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 area0.57 (0.53 to 0.62)a0.64 (0.59 to 0.70)a
    Primary care physician supply (PPR per 1,000 residents)0.77 (0.71 to 0.84)a0.74 (0.66 to 0.82)a
    No hospital in county1.09 (0.97 to 1.23)1.02 (0.89 to 1.17)
    RUCC category (reference: 8 or 9)
     4 or 50.92 (0.83 to 1.03)0.90 (0.80 to 1.01)
     6 or 70.93 (0.84 to 1.03)0.98 (0.87 to 1.09)
    Adjacent to metropolitan1.10 (1.05 to 1.16)a1.28 (1.21 to 1.36)a
    Median household income (per $10,000)1.08 (1.03 to 1.14)a1.07 (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)b1.012 (0.995 to 1.029)
    Population aged ≥65 years (%)0.984 (0.977 to 0.991)a1.004 (0.996 to 1.013)
    Population race/ethnicity (%)
     Non-Hispanic African American1.000 (0.997 to 1.002)1.005 (1.002 to 1.008)a
     Hispanic1.004 (1.001 to 1.007)b1.003 (1.000 to 1.006)
    • PPR = primary care physician–to-population ratio; RUCC = Rural-Urban Continuum Code.

    • ↵a P <.01.

    • ↵b P <.05.

Additional Files

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  • The Article in Brief

    Mobility of US Rural Primary Care Physicians During 2000-2014

    Matthew R. McGrail , and colleagues

    Background Mobility and nonretention of rural physicians has an impact on training, workforce policy, and physician supply in both the location from which the physician moved and the physician's destination area. This study aims to describe the geographic mobility patterns of rural primary care physicians.

    What This Study Found Between 2000 and 2014, the mobility rate of younger primary care physicians was approximately double that of older physicians. Biennial turnover of younger physicians was around 17 percent, compared to 9 percent for older physicians, with little difference between rural and metropolitan physicians. Nonretention of physicians was significantly worse in rural counties without a hospital, counties with a smaller population, and those with decreased physician supply. The study, based on AMA Masterfile data, found no association with county-level economic or demographic measures. Female physicians from urban areas were more likely to leave rural practice.

    Implications

    • The study authors call on rural health workforce planners and policy makers to be cognizant of these key factors in guiding retention policies and support for vulnerable rural communities.
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The Annals of Family Medicine: 15 (4)
The Annals of Family Medicine: 15 (4)
Vol. 15, Issue 4
July/August 2017
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Mobility of US Rural Primary Care Physicians During 2000–2014
Matthew R. McGrail, Peter M. Wingrove, Stephen M. Petterson, Andrew W. Bazemore
The Annals of Family Medicine Jul 2017, 15 (4) 322-328; DOI: 10.1370/afm.2096

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Mobility of US Rural Primary Care Physicians During 2000–2014
Matthew R. McGrail, Peter M. Wingrove, Stephen M. Petterson, Andrew W. Bazemore
The Annals of Family Medicine Jul 2017, 15 (4) 322-328; DOI: 10.1370/afm.2096
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Subjects

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