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Factors and Perceptions in Practice Selection: A survey of Texas Primary Care Resident Physicians

Factors and Perceptions in Practice Selection: A survey of Texas Primary Care Resident Physicians. Pam Danner, MBA Former Program Director, West Texas AHEC Steve Shelton, PA, MBA Program Director, East Texas AHEC. The landscape….

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Factors and Perceptions in Practice Selection: A survey of Texas Primary Care Resident Physicians

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  1. Factors and Perceptions in Practice Selection: A survey of Texas Primary Care Resident Physicians Pam Danner, MBA Former Program Director, West Texas AHEC Steve Shelton, PA, MBA Program Director, East Texas AHEC

  2. The landscape… • In 2007, Texas ranked 43rd with 157 physicians per 100,000 population-the same as it had in 2000, while leading the nation in population growth (Texas Medical Association) • In 2007, Texas had fewer residency slots than New York, California and Pennsylvania and the numbers funded by Medicare are capped (TMA) • The number of graduates seeking family medicine has dropped 27% from 2002-2007 (Association of American Medical Colleges) • The AAMC predicts a shortage of 124,00 – 159,000 physicians by 2025. This prediction is “pre-reform” which is anticipated to increase the shortage by as much as 25% (AAMC)

  3. The Process • Garnered “political” support • State partners • Residency Programs • Developed the Instrument • Literature review, previous state agency surveys • IRB • University of Texas Medical Branch at Galveston • Texas Tech University Health Sciences Center • Developed the survey

  4. Political Support • Interested parties • The legislature • Trade organizations • Policy planners

  5. The IRB • Formal IRB review • Exempt status

  6. Major Goals of the Survey • To assess the background and educational experiences of primary care resident physicians (family medicine and internal medicine) at State of Texas residency programs • Assess resident physicians expectations and desired work environment • Evaluate opportunities for AHEC to better meet residents’ need for information about available practice support resources, particularly related to medically underserved opportunities.

  7. Objectives of the Survey • Determine what residents previous experience in rural and medically underserved communities has been • Determine what residents are seeking in practice location • Determine what physician residents are seeking in practice relationships with other providers and organizations • Determine what residents familiarity is with federal programs available to support or enhance rural or underserved practice • Compare and contrast different desires and expectations based on demographic characteristics • Determine types of resources that residents would find most beneficial in finding practice opportunity and in establishing practice

  8. Survey Methodology • 2 Methodologies, one survey document • Paper survey, administered at voluntary resident meetings • On-line

  9. The Survey • General demographic information • Place of residency history and spouse residence • Clinical training experience • Practice preferences • Call, size, ancillaries, etc. • Knowledge of clinic designations • Preference in employment or private practice

  10. Cont. • Knowledge of loan repayment programs • Current sponsorship level • Current job seeking methods • Rate community attributes • Interest in working with underserved

  11. Survey Response • 364 resident physicians responded, 49% male, 51% female

  12. Response cont. • 34% indicated they had lived in a community of less than 20,000 • 20% graduated from high school in a rural area • 50% had no training in a rural setting as part of medical education • Less than 20% did in residency training • 51% familiar with rural health clinics, 41% knew about FQHCs or CHC • 14% would consider practice in an RHC or FQHC

  13. Practice Location Preference • 68% interested in practicing in community over 50,000 • Only 10% indicated a preference for a community less than 20,000 • 35% preferred practicing within 50 miles of urban community • 27% had no preference for proximity to urban

  14. Practice Arrangement Preference • 64% prefer a group practice arrangement • 74% preferred call no more than once per week • 71% considered hospital privileges essential • 85% preferred hospital professional staffs of more than 10 • 85% will consider interdisciplinary practice with a physician assistant or nurse practitioner • 17% will consider providing OB services

  15. Employment vs. Private Practice • 75% indicated a preference for an employment arrangement • Defined salary • Defined Benefits

  16. Loan Repayment • 12% are involved in loan repayment commitment situations • 39% would be interested in loan repayment programs • 77% would accept multi-year contracts for practice entry • 75% need financial assistance to enter practice

  17. Employment Search • 45% will seek employment on their own • 18% will use a search firm • 21% will use on-line employment methods • 44% waited until their second or third year of residency to see employment options • 54% would consider practice in underserved community

  18. Important Community Attributes Responses ranked on a 5 point scale with 5 being most important • Low crime/safety/security – 4.45 • Friendliness of community – 4.39 • Quality of schools – 4.3 • Travel time to work – 4.12 • Cost of living – 4.08 • Availability of basic shopping – 4.06

  19. Community attributes of moderate importance • Amenities • Recreation • Availability of other physicians for peer support • Employment opportunities for spouse

  20. Lesser important community attributes • Being near where spouse grew up • Small community • Community engagement opportunities • Large community size

  21. Findings • Most residents did not have learning opportunities in rural settings • Most are unfamiliar with practice models common in rural areas or used with underserved populations even though more than half were interested in serving the underserved • Most do not desire practice opportunity consistent with traditional private practice situation • Limited call, etc.

  22. Findings Continued • Loan repayment is very appealing • Safety, security, friendliness, school quality, travel time, etc are important

  23. Formal Recommendations • Educate, encourage and incentivize communities of advantages to sponsorship of future health professionals • Use rural and small community experiences for learning to familiarize career decision makers of practice opportunities • Develop emphasis or special focus programs to address unmet healthcare workforce needs in rural and other underserved areas • Expand loan repayment programs • Incorporate more practice development information into primary care residency programs • Allow for employment of phsicians

  24. Opportunities for Texas AHEC Programs • Increase program areas which promote training with underserved populations (CHCs, RHCs, Rural sites) • On-line employment match sites should “work” • Increase partnership work with rural communities • HealthMATCH, HealthFind

  25. Real outcomes for Texas • Physician Employment Bill • Push to increase residency training sites • AHEC asked to be involved and have a voice!

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