Gillette Chris, Ostermann Jan, Garvick Sarah, Everett Chris, Caviness Dawn, Aguilar Aylin A
Department of PA Studies, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America.
Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America.
PLoS One. 2025 Jan 13;20(1):e0316521. doi: 10.1371/journal.pone.0316521. eCollection 2025.
Globally, those who live in rural areas experience significant barriers to accessing health care due to a maldistribution of health care providers. Those who live in rural areas in the Appalachian region of the United States face one of the worst shortages of health care providers despite experiencing more complex health needs compared to Americans in more affluent, urban areas. Prior research has failed to identify effective solutions to narrow the provider maldistribution, despite it being a policy focus for decades. More work is needed to better understand the complex, multidimensional process in which health care providers select jobs and how job, community, and providers' intrapersonal characteristics influence job selection. This paper is a protocol for a study aimed at identifying effective policies and incentives to improve recruitment of healthcare providers for their first job in rural Appalachia. We will use rigorous, theoretically grounded discrete choice experiment methodology (DCE) to accomplish the study's objective. The main outcome will be the relative importance of alternative community and job characteristics for trainees' choices of jobs in rural Appalachia. secondary outcomes of interest will be trade-offs that these trainees make when selecting a job, described in the form of marginal rates of substitution (mRS). Participants include medical residents and fellows, PA students and NP students in their final year of training. The choice context will be the recruitment of these trainees for their first job. Data will be analyzed using mixed logit analysis. Results from this DCE will improve our understanding of the job selection process for health care providers. The identification and prioritization of predictors of trainees' rural job choices will allow for the development of policies and incentives that will enable policymakers and health care systems to recruit more providers to rural and underserved areas.
在全球范围内，由于医疗服务提供者分布不均，农村地区居民在获得医疗保健方面面临重大障碍。美国阿巴拉契亚地区农村的居民面临着最严重的医疗服务提供者短缺问题之一，尽管与更富裕的城市地区的美国人相比，他们面临着更复杂的健康需求。尽管数十年来这一直是政策重点，但先前的研究未能找到缩小医疗服务提供者分布不均的有效解决方案。需要开展更多工作，以更好地理解医疗服务提供者选择工作的复杂多维度过程，以及工作、社区和提供者的个人特征如何影响工作选择。本文是一项研究的方案，旨在确定有效的政策和激励措施，以改善农村阿巴拉契亚地区医疗服务提供者的首次就业招聘情况。我们将使用严格的、基于理论的离散选择实验方法（DCE）来实现该研究目标。主要结果将是替代社区和工作特征对农村阿巴拉契亚地区实习生工作选择的相对重要性。感兴趣的次要结果将是这些实习生在选择工作时所做的权衡，以边际替代率（mRS）的形式描述。参与者包括医学住院医师和研究员、医师助理（PA）学生和护理执业医师（NP）学生最后一年的培训学员。选择背景将是这些学员的首次就业招聘。数据将使用混合逻辑回归分析进行分析。该DCE的结果将增进我们对医疗服务提供者工作选择过程的理解。确定实习生农村工作选择的预测因素并对其进行优先级排序，将有助于制定政策和激励措施，使政策制定者和医疗保健系统能够招募更多提供者到农村和服务不足地区工作。
