Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles, USA.
Am J Public Health. 2010 Nov;100(11):2168-75. doi: 10.2105/AJPH.2009.181669.
We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas.
We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods.
Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area.
Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work-life balance.
我们研究了可能增加服务不足地区初级保健供应的影响医生实践决策的因素。
我们对来自加利福尼亚州洛杉矶县的 42 名初级保健医生进行了深入访谈，这些医生按种族/民族（非裔美国人、拉丁裔和非拉丁裔白人）和执业地点（服务不足地区与非服务不足地区）进行了分层。我们使用标准的定性方法对转录本进行了审查，并将其编码为主题。
与选择基于地理和人口的实践决策有关的三个主要主题出现了：（1）个人动机，（2）职业动机，和（3）诊所支持。我们发现，在选择执业地点的个人动机（例如个人使命和自我认同）的子主题在服务不足地区工作的医生的回答中更为常见，而在不服务不足地区工作的医生的回答中则不那么常见。相比之下，非服务不足地区的医生更有可能将工作时间和生活方式作为选择当前执业地点或离开服务不足地区的原因。
医学院和短缺地区临床实践可以通过确定关键的个人动机来增强向服务不足地区招聘初级保健医生的策略，并通过工作与生活的平衡来促进长期保留。
