Stenger Joseph, Cashman Suzanne B, Savageau Judith A
Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
J Rural Health. 2008 Fall;24(4):375-83. doi: 10.1111/j.1748-0361.2008.00184.x.
Small towns across the United States struggle to maintain an adequate primary care workforce.
To examine factors contributing to physician satisfaction and retention in largely rural areas in Massachusetts, a state with rural pockets and small towns.
A survey mailed in 2004-2005 to primary care physicians, practicing in areas designated by the state as rural, queried respondents about personal and practice characteristics as well as workforce concerns. Predictors of satisfaction and likelihood of remaining in current or rural practice somewhere were assessed.
Of 227 eligible physicians, 160 returned their surveys (response rate, 70.5%). Approximately one third (34.0%) reported they had grown up in communities of 100,000 or larger. Factors associated with higher overall practice satisfaction included not feeling overworked (P = .043) or professionally isolated (P = .004), and being involved in their practice (P = .045) and home communities (P = .036) as well as ease of seeking additional physicians for practice and obtaining CME credits (P = .014 and P = .017, respectively). Female physicians were more likely to report an intention to remain in rural practice somewhere for the next decade (P = .034). In rating their satisfaction with various aspects of the rural practice environment, physicians reported greatest satisfaction with their practice overall (67%) and their call group size (66%). They were least satisfied with their current (30%) and likely future income (40%). In multivariate analyses, larger practice community size was positively related to the dependent variable of overall satisfaction and negatively related to likelihood of staying in current practice or in rural practice somewhere.
Our findings reaffirm the importance of rural medical education opportunities in physician recruitment, retention, and practice satisfaction. They also indicate that in a small New England state, a major source of physicians for rural and small town communities is physicians who have been raised in urban/suburban communities and who were trained outside of the region but who were prepared to live and to practice in rural and small town communities.
美国各地的小镇都在努力维持充足的基层医疗劳动力。
研究影响马萨诸塞州广大农村地区医生满意度和留任意愿的因素，该州有农村地区和小镇。
2004 - 2005年向该州指定为农村地区执业的基层医疗医生邮寄了一份调查问卷，询问受访者的个人和执业特征以及劳动力相关问题。评估了满意度的预测因素以及留在当前或农村地区执业的可能性。
在227名符合条件的医生中，160人回复了调查问卷（回复率为70.5%）。约三分之一（34.0%）的医生报告称他们在人口10万或以上的社区长大。与更高的总体执业满意度相关的因素包括不觉得工作过度劳累（P = 0.043）或职业上孤立无援（P = 0.004），参与其执业（P = 0.045）和家乡社区事务（P = 0.036），以及便于寻求额外的执业医生和获得继续医学教育学分（分别为P = 0.014和P = 0.017）。女医生更有可能报告打算在未来十年留在某个农村地区执业（P = 0.034）。在对农村执业环境的各个方面进行满意度评分时，医生对其总体执业情况（67%）和值班小组规模（66%）满意度最高。他们对当前收入（30%）和未来可能的收入（40%）满意度最低。在多变量分析中，更大的执业社区规模与总体满意度这一因变量呈正相关，与留在当前执业或农村地区执业的可能性呈负相关。
我们的研究结果重申了农村医学教育机会在医生招聘、留用和执业满意度方面的重要性。它们还表明，在新英格兰的一个小州，农村和小镇社区医生的一个主要来源是那些在城市/郊区社区长大、在该地区以外接受培训但准备在农村和小镇社区生活和执业的医生。
