SCIENTIFIC
Factors Influencing the Decision to Practice Medicine in West Virginia : Findings from a Statewide Survey of Physicians
AUTHORS : A . Brianna Sheppard , PhD 1 , 2 , 3
Courtney A . Hereford , MSPH , MSW 3 , 4 Cynthia A . Persily , PhD 5 April L . Vestal , MPH 1 Emily R . Thomas , DO 6 Janet Hinton , MS 4
1
West Virginia University Institute for Community and Rural Health
2
West Virginia University School of Public Health , Dept . of Social and Behavioral Sciences
3
West Virginia Clinical and Translational Science Institute
4
West Virginia School of Osteopathic Medicine Center for Rural and Community Health
5
West Virginia Higher Education Policy Commission Division of Health Sciences
6
West Virginia School of Osteopathic Medicine Department of Clinical Science
ABSTRACT
INTRODUCTION The purpose of the study was to identify factors that influence the decision to practice medicine in West Virginia ( WV ) and to identify state-specific targets to address workforce issues .
METHODS A cross-sectional study was conducted between November 2019 and March 2020 using an online link to an anonymous survey sent to all physicians with an e-mail address on file with the state allopathic medical licensing board and the WV Osteopathic Medical Association . Descriptive statistics and inductive analyses were employed .
RESULTS Forty-five percent of respondents were from WV , and 17 % were from rural WV in the sample size of 428 . Quality of life and loan forgiveness / repayment were more important to primary care than specialty care providers . Community attributes were important to native West Virginians . Recruitment and retention themes that emerged were as follows : home and family , the capacity to dually serve as faculty and clinician , to serve where most needed , debt payback , and quality of life .
DISCUSSION Quality of life and community attributes were the most influential factors in deciding to practice medicine in WV . Financial incentives were effective recruitment tools . Retention was strongly influenced by social and reimbursement policy in the state , clinical leadership at the local level , and lifestyle factors in the geographic region .
CONCLUSION Enhancing relationships and coordinating programs across sectors to provide targeted recruitment , addressing socioeconomic and public health issues , and periodically evaluating physician satisfaction may be leverage points for physician recruitment and retention in WV .
INTRODUCTION
Recruitment and retention of healthcare providers in rural areas of the country have been ongoing challenges . 1 , 2 Maldistribution of primary care physicians in rural compared to urban areas potentiates the lack of adequate healthcare . 3 The Association of American Medical Colleges estimates that aging , population growth , and physician demand will result in a total physician shortage of 54,100 to 139,000 by 2033 , with shortages of primary care physicians estimated at 21,400 to 55,200 . 4 West Virginia ( WV ) resident health outcomes have trended downward , including mental health and quality of life due to a combination of social and economic factors , physical environment , clinical care , and behaviors . 5 An aging medical workforce , increased shortages of primary care providers , and the recruitment and retention of providers to care for rural populations present an ever-growing concern , amplified by the COVID-19 pandemic . 1 , 6
Several benefits of rural practice and rural lifestyle have been identified by medical students and residents and are promoted by institutions and communities to increase recruitment and retention of primary care physicians and improve health outcomes for its residents . 7 , 8 Higher education efforts such as required or elective training in rural and underserved areas and rural track programs during medical school increase orientation of students toward primary care practice . 7-10 Considerations , including person versus technique-oriented perceptions of medical specialties ; 9 traits such as trust , altruism , and cooperation in the work environment ; 8 and higher earning potential for specialty versus primary care , 11-13 are also predictive in terms of career choice and specialty .
WV has numerous pipeline and financial incentive programs aimed at increasing student interest in primary care and practice in rural and underserved areas . 14
Studies indicate that financial incentives can be successful in recruitment and retention efforts of health professionals with careful consideration of cost-effectiveness and intent . 15 Program awareness and providing competitive award amounts are cited as integral to successful implementation of financial incentives as part of recruitment and retention strategies for healthcare providers . 15 , 16 The purpose of the study was to identify and better understand factors and experiences that influence the decision to practice medicine in WV and to identify state-specific targets to address workforce issues .
METHODS STUDY DESIGN AND POPULATION
A cross-sectional study using an online link to an anonymous survey was conducted between November 19 , 2019 , and March 20 , 2020 . Study population included all physicians with an email address on file with the WV Board of Medicine or
32 • www . wvsma . org