Pathman D E, Konrad T R, Ricketts T C
Department of Family Medicine, University of North Carolina at Chapel Hill.
Health Serv Res. 1994 Apr;29(1):39-58.
This study inquires whether retention in rural practice settings is longer for graduates of public medical schools and community hospital-based residencies, and for those who participated in rural rotations as medical students and residents. These questions are addressed separately for "mainstream" rural physicians and physicians serving in the National Health Service Corps (NHSC).
Design is a prospective cohort study.
Study subjects were 202 primary care physicians who graduated from U.S. allopathic medical schools from 1970-1980, and who in 1981 were working in a nationally representative sample of externally subsidized rural practices. Nearly half were serving in the NHSC. Physicians were first identified in 1981 as part of an earlier study.
In 1990, study subjects were re-located and sent a follow-up mail survey inquiring about their medical training backgrounds and their careers from the time of graduation until 1990. We examined associations between four features of physicians' medical training and their subsequent retention in rural practice settings.
Among those not in the NHSC, rural retention duration did not differ for those from public versus private medical schools, those who trained in community hospitals versus university hospital-based residencies, or for those who completed versus did not complete rural rotations as students or residents. Among NHSC physicians, no retention duration differences were noted for those with rural experiences as students or residents, or for those trained in community hospital residencies. Contrary to common wisdom, public school graduates in the NHSC remained in rural areas for shorter periods than private school graduates.
These findings call into question whether current rural-focused medical education initiatives prepare rural physicians in ways able to influence their retention in rural settings. For purposes of enhancing the rural practice retention of its alumni, the NHSC should not selectively award scholarships to students from public medical schools.
本研究探讨公立医学院校毕业生和社区医院住院医师培训项目毕业生，以及那些在医学院学生和住院医师阶段参加过农村轮转的人员，在农村执业环境中的留存时间是否更长。这些问题分别针对“主流”农村医生和在美国国家卫生服务团（NHSC）工作的医生进行探讨。
前瞻性队列研究。
研究对象为202名初级保健医生，他们于1970年至1980年毕业于美国opathic医学院，并于1981年在全国具有代表性的外部补贴农村医疗机构样本中工作。近一半的人在NHSC工作。这些医生在1981年首次被确定为一项早期研究的一部分。
1990年，对研究对象重新定位，并邮寄随访调查问卷，询问他们从毕业到1990年的医学培训背景和职业生涯。我们研究了医生医学培训的四个特征与其随后在农村执业环境中的留存情况之间的关联。
在非NHSC的人员中，公立医学院校与私立医学院校的毕业生、在社区医院接受培训与在大学附属医院接受住院医师培训的人员，以及作为学生或住院医师完成或未完成农村轮转的人员，在农村的留存时间没有差异。在NHSC医生中，作为学生或住院医师有农村经历的人员，以及在社区医院住院医师培训项目中接受培训的人员，在留存时间上没有差异。与普遍看法相反，NHSC中的公立学校毕业生在农村地区的停留时间比私立学校毕业生短。
这些发现质疑了当前以农村为重点的医学教育举措是否以能够影响农村医生在农村地区留存的方式培养农村医生。为了提高其校友在农村执业的留存率，NHSC不应选择性地向公立医学院校的学生授予奖学金。
