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 More than half of U.S. doctors are now married to other highly
educated people, and those marriages are tied to a 38 percent
reduced odds of the doctors working in rural underserved areas,
researchers report in JAMA.
“It’s making it increasingly difficult for rural areas to attract
physicians,” said lead author Douglas O. Staiger of Dartmouth
College in Hanover, New Hampshire.
The researchers used Census and survey records to study one percent
of all employed physicians age 25 to 70 working in the U.S. every
decade from 1960 to 2000 - totaling almost 20,000 doctors, and every
year from 2005 to 2011 - totaling more than 55,000 doctors.
From the data, the researchers determined if a doctor’s spouse had
six or more years of college before 1990 or a master’s degree or
higher from 1990 to 2011.
They sorted rural Census blocks into primary care Health
Professional Shortage Areas.
Doctors with highly educated spouses increased from 9 percent in
1960 to 54 percent in 2010, and one third of highly educated spouses
were also doctors consistently over time.
In 1960, 4 percent of married physicians were women, but that number
rose to 31 percent in 2010. They were more likely than men to be
married to a spouse with a graduate degree.
Between 2005 and 2011, about 11 percent of the U.S. population lived
in Health Professional Shortage Areas, while only about 5 percent of
doctors worked in these areas.
About 4 percent of married doctors with a highly educated spouse
worked in underserved areas, compared to about 7 percent of married
doctors without highly educated spouses.
Single, young, female, black and Hispanic doctors were also less
likely to work in underserved areas, compared to married doctors
without highly educated spouses.
“People have focused on lots of the other reasons for the physician
shortage, and we were just trying to emphasize that an increasingly
important barrier is this joint location issue for married couples
who both have careers,” Staiger said.
Cities offer more general amenities, higher average incomes and more
opportunities for professional development, he said.
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“People who haven’t grown up in rural areas are unlikely to locate
there, and fewer and fewer people have grown up in rural areas,” he
said.
But rural areas still need doctors, particularly primary care and
urgent care doctors, he said. These areas try to attract doctors by
offering more money.
Other ways to address the problem may include training nurse
practitioners or other health professionals to act as primary care
providers, or to use telemedicine to connect urban doctors to rural
patients, Staiger said.
“A lot of research for decades has shown that the two most powerful
factors are having grown up in a rural area and being committed to
particular specialties that fit in a rural area, like family
practice,” said Dr. Howard Rabinowitz of Thomas Jefferson University
Hospital in Philadelphia.
“The first way people approach it is to try and preferentially admit
to medical school students who are likely to go rural,” said
Rabinowitz, who was not part of the new study.
Some rural practices will pay off a doctor’s student loans to
attract them to the job, he told Reuters Health.
Identifying people who actually want to go rural and support them
has been the most effective way to address the shortage so far, he
said.
SOURCE: http://bit.ly/1OM72Ov JAMA, March 1, 2016.
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