EXAMINING INTENTION AMONG FUTURE PHYSICIANS TO PRACTICE IN HIGH NEED HEALTH PROFESSIONAL SHORTAGE AREAS IN TENNESSEE

Abstract

Introduction: Primary care physician shortages in Health Professional Shortage Areas (HPSA) have plagued underserved and rural areas for decades. Previous research has found that these areas experience less access to health care, poorer health outcomes, poorer health factors, poorer social determinants, have lower health literacy and struggle with recruiting and retaining qualified Primary Care physicians who understand the health needs of rural/underserved populations (Brown et al., 2011; MacKinney et al., 2014; Douthit et al., 2015). Tennessee has over 139 HPSA designations in primary care. This study seeks to examine themes around primary care physician shortages and how upcoming physicians in the state of Tennessee are filling the primary care physician gaps. The research is written in a two article format. Following the introduction and literature review, the first article consists of a scoping literature review. The second article uses chi square associations in two parts. The first analysis is between practice and location intention and GIS mapping of year 4 medical students and year 1 residents. The second part of analysis is between shortage areas and hometown county intention, location, and early health career exposure and GIS mapping of earliest health career exposure, hometown county and HPSA average locations. Methods: A scoping literature review using PRISMA guidelines examined the themes and sub-themes of primary care physicians in rural/underserved areas. Studies were identified by searching online databases – Pubmed, Google Scholar, and JEWEL using key words: “health career outreach programs”, "health profession shortage areas", "physician pipeline programs", "primary care physicians recruitment America", and "Primary Care Physicians America" . The search was extended by checking similar articles and referenced articles in studies. Studies selected met the following criteria: a) must pertain to primary care specialties, b) published from 2008 - 2018, and c) must pertain to health care in the United States. A cross sectional study using a modified survey from Duffrin et al (2014) obtained data about specialty choice, demographics, employment intentions, employment locations, motivations, early health career exposure, and qualitative comments on primary care and shortage areas. Chi Square associations were performed for all variables. Additionally, article two uses GIS mapping to visualize student hometown locations, HPSA need and choice of a primary care specialty. Epi InfoTM 7.2.2.6 (CDC) software is used in these county level analyses for the state of Tennessee. Article two uses GIS mapping to visualize student hometown locations, HPSA need and early health career exposure.

Results/Discussion: In article one, the scoping review of 84 articles revealed key themes in addressing Primary Care Physician Shortages. Articles represented all geographic areas of the United States of America, including Hawai'i and Alaska. Four areas stood out as main themes associated with Primary Care Physician Shortages. One theme acknowledges the need to establish a cohort of young students developing interest in health care career choice as early as middle school. Another theme examines keys to rural/underserved practice. The third theme focuses on workforce concerns of primary care practices, and the fourth theme centers around the role of education in addressing primary care physician shortages. Each theme contains major sub-themes that more deeply explore specific concerns of primary care physician shortages. In article two, the survey received 42 responses. As a result of low response rate, this research was only able to perform chi square statistical analysis. No significant associations were found between hometown location, primary care specialty choice, practice location, and early health career exposure. A significant association was found between gender and primary care practice specialty. GIS mapping reflects respondents’ hometown locations, HPSA need, practice specialty choices, and time of health career exposure.