Table 1.
Studies Examining the Association Between Different Factors/Predictors and Primary Care Physician Practice in an Underserved Urban and Rural Areas, Among 72 Studies Published Through November 2015
| Factors/predictorsa by theme | Practice in underserved or physician shortage areab | |
|---|---|---|
| Studies with negative, mixed, or no association | Studies with positive association | |
| Personal characteristics, attributes, or background c | ||
| Racial-ethnic minority (URM)12–14,16,17,31,36,37,43,55,57,59 | 0 | 12 |
| Second language fluency13,14 | 0 | 2d |
| Growing up in inner-city15,36,51 | 0 | 3 |
| Growing up in rural area39,41,44,45,63,64,71 | 0 | 7 |
| Prior interest in underserved practice36,51,55 | 0 | 3 |
| Prior interest in rural practice44 | 0 | 1 |
| Prior interest in family medicine44,68 | 0 | 2 |
| IMG12,13,32–35,37,38,40,42,51,67 | 4 | 8 |
| Financial factors e | ||
| Educational debt19,20,55 | 2 | 1f |
| NHSC scholarship15,36,46,47,49–51,54 | 0 | 8 |
| Title VII funding exposure18,48,53,54 | 0 | 4 |
| Loan repayment, scholarships and other programs20,52 | 0 | 2 |
| Medical school curricula and programs g | ||
| Primary care specialty12–14,43,51,57,63,71 | 3h | 4 |
| Family medicine specialty12,25,43,51,54,63,65,67 | 1 | 7 |
| Pre-doctoral rural medicine program (2007–2015)25,27,44,62–71,87 | 0 | 14 |
| Medical school of graduation54,55,57 | 0 | 3 |
| Pre-doctoral educational program for underserved56,58,59,61 | 0 | 4 |
| Post-baccalaureate program17,60 | 0 | 2 |
| Graduate medical education programs i | ||
| Family medicine rural track26,72–87,89,90 | 0 | 19 |
| Community health center exposure54,80,83,88 | 0 | 4 |
Abbreviations: IMG indicates international medical graduate; NHSC, National Health Service Corp; refs, references.
Studies that included multiple predictors are included in more than one predictor theme/category. See Method for details regarding categorization according to primary and secondary themes.
In this review, the authors defined “Underserved or physician shortage area” as a Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), high limited English proficiency (LEP) area, high poverty/low income area, rural area, safety net (rural health center, community health center, Indian Health Service), and/or area with high percentage of minority populations.
Nineteen studies had a primary focus on personal characteristics, attributes, or background (refs 12–14, 16, 31–45). An additional 11 studies had a secondary focus on factors related to this theme; their primary focus was on financial factors (refs. 15, 51) or medical school curricula and programs (refs 17, 55, 57, 59, 63, 64, 67, 68, 71).
Spanish or Asian languages; outcome defined as high LEP area.
Thirteen studies had a primary focus on financial factors (refs 15, 18–20, 46–54). Two additional studies had a secondary focus on financial factors; their primary focus was on personal characteristics (ref 36) or medical school curricula and programs (ref 55).
One study evaluated the association between debt and participation in the NHSC. Inverse associations were observed.
Of the 20 studies with a primary focus on medical school curricula and programs, 8 focused on underserved practice (refs 17, 55–61) and 12 on rural practice (refs 25, 27, 62–71). An additional eight studies had a secondary focus on factors related to this theme; their primary focus was on personal characteristics (refs 12–14, 43, 44, 51), financial factors (ref 54), or GME programs (ref 87).
One study consisted of osteopathic physicians (ref 57).