Renner Daniel M, Westfall John M, Wilroy Lou Ann, Ginde Adit A
University of North Carolina Hospitals, Chapel Hill, NC, USA.
Rural Remote Health. 2010 Oct-Dec;10(4):1605. Epub 2010 Nov 9.
There is an ongoing shortage of rural healthcare providers relative to urban healthcare providers worldwide. Many strategies have been implemented to increase the distribution of rural healthcare providers, and financial incentives such as loan repayment programs have become popular means to both recruit and retain healthcare providers in rural communities. Studies detailing the effects of such programs on rural provider recruitment and retention are limited. The objective of this study was to assess the influence of loan repayment and other factors on the recruitment and retention of healthcare providers in rural Colorado, USA, and to compare the motivations and attitudes of these rural providers with their urban counterparts.
A survey was sent to 122 healthcare providers who had participated in one of three loan repayment programs in Colorado between the years of 1992 and 2007: the Colorado Health Professional Loan Repayment Program; the Colorado Rural Outreach Program; and the Dental Loan Repayment Program of Colorado. Differentiation between rural and urban communities was accomplished by using the Rural Urban Commuting Area Codes developed by the University of Washington's Rural Health Research Center and Economic Research Service. Statistical analysis was performed using STATA from StataCorp.
Of the 93 respondents included in the study, 57 worked in rural communities and 36 worked in urban communities during their programs. Of the rural participants, 74% were already working in or intending to work in an eligible community when they were made aware of the loan repayment program. Of those planning to work in a rural community regardless of any loan repayment option, 42% reported that the loan repayment program had an important influence on the specific community in which they chose to practice. Of the rural participants already working in a rural community, 38% reported loan repayment as being an important factor in their retention. The most important factors the rural providers cited for their recruitment were the location of the community, scope of practice, and family fit with the community. The most important factors for the urban providers were the location of the community, salary, and scope of practice. Of the rural providers, 36% attended rural high schools, while 9% of urban providers attended rural high schools. Of the rural providers who were planning on practicing in a rural area regardless of any loan repayment option, 37% had attended rural high schools. Rural participants most often left their communities because their families wanted to move, personal or professional isolation, and dissatisfaction with the medical community. Of rural participants 22% cited the desire for a higher income as an important reason to leave their communities, while the desire for a higher income was the most commonly cited reason for the urban providers. Rural retention rates were not influenced by past attendance at rural high schools or by intention to practice in a rural community regardless of loan repayment.
Loan repayment programs targeting rural Colorado usually enroll providers who would have worked in a rural area regardless of loan repayment opportunities, but are likely to play a role in providers' choice of specific rural community for practice. They also appear to have a limited but important influence on rural provider retention, though financial concerns are generally less influential for non-retained rural providers than are family preferences and professional dissatisfaction.
相对于全球城市医疗服务提供者而言，农村地区医疗服务提供者持续短缺。人们已实施了许多策略来增加农村医疗服务提供者的分布，诸如贷款偿还计划等经济激励措施已成为在农村社区招募和留住医疗服务提供者的常用手段。详细说明此类计划对农村医疗服务提供者招募和留存影响的研究有限。本研究的目的是评估贷款偿还及其他因素对美国科罗拉多州农村地区医疗服务提供者招募和留存的影响，并将这些农村医疗服务提供者的动机和态度与其城市同行进行比较。
向122名医疗服务提供者发送了调查问卷，这些提供者在1992年至2007年期间参加了科罗拉多州的三个贷款偿还计划之一：科罗拉多州卫生专业人员贷款偿还计划；科罗拉多州农村外展计划；以及科罗拉多州牙科贷款偿还计划。通过使用华盛顿大学农村卫生研究中心和经济研究局制定的城乡通勤区号来区分农村和城市社区。使用StataCorp公司的STATA进行统计分析。
本研究纳入的93名受访者中，57人在参与计划期间在农村社区工作，36人在城市社区工作。在农村参与者中，74%在得知贷款偿还计划时已经在符合条件的社区工作或打算在该社区工作。在那些无论有无贷款偿还选项都计划在农村社区工作的人中，42%报告称贷款偿还计划对他们选择执业的特定社区有重要影响。在已经在农村社区工作的农村参与者中，38%报告称贷款偿还对他们的留存有重要影响。农村医疗服务提供者提到的招募最重要因素是社区位置、执业范围以及家庭与社区的契合度。城市医疗服务提供者最重要的因素是社区位置、薪资和执业范围。在农村医疗服务提供者中，36%曾就读于农村高中，而城市医疗服务提供者中有9%曾就读于农村高中。在那些无论有无贷款偿还选项都打算在农村地区执业的农村医疗服务提供者中，37%曾就读于农村高中。农村参与者最常离开社区的原因是家人想搬家、个人或职业上的孤立以及对医疗社区的不满。在农村参与者中，22%提到渴望更高收入是离开社区的重要原因，而渴望更高收入是城市医疗服务提供者最常提到的离开原因。农村留存率不受过去是否就读于农村高中或无论贷款偿还情况如何都打算在农村社区执业的意图影响。
针对科罗拉多州农村地区的贷款偿还计划通常招募那些无论有无贷款偿还机会都会在农村地区工作的医疗服务提供者，但可能在医疗服务提供者选择特定农村社区执业方面发挥作用。它们似乎对农村医疗服务提供者的留存也有有限但重要的影响，尽管对于未留住的农村医疗服务提供者而言，经济担忧通常不如家庭偏好和职业不满那样有影响力。
