SCIENTIFIC
Factors Influencing the Decision to Practice Medicine in West Virginia : Training Experiences
AUTHORS : Courtney A . Hereford , MSPH , MSW 1 , 2
A . Brianna Sheppard , PhD 2 , 3 , 4 April L . Vestal , MPH 3 Cynthia A . Persily , PhD 5 Janet Hinton , MS 6 Emily R . Thomas , DO 7
1
West Virginia School of Osteopathic Medicine Center for Rural and Community Health
2
West Virginia Clinical and Translational Science Institute
3
West Virginia University Institute for Community and Rural Health
4
West Virginia University School of Public Health , Dept . of Social and Behavioral Sciences
5
West Virginia Higher Education Policy Commission Division of Health Sciences
6
West Virginia School of Osteopathic Medicine Dept . of Graduate Medical Education
7
West Virginia School of Osteopathic Medicine Dept . of Clinical Science
INTRODUCTION
An expanding , aging population intensifies the need for medical care across the United States ( US ), notably in rural areas of the US where the greatest outcome and access disparities persist . 1-3 Numerous programs promote rural medical practice to increase recruitment and retention of primary care physicians ( PCPs ) and improve community health outcomes . 1 , 4 , 5 Pipeline programs are designed to influence career choices in health professions , particularly in medicine . Many colleges and universities sponsor pipeline programs to increase awareness and exposure of middle school , high school , and undergraduate students to health science professions and programs . 6 Programs emphasizing math and science skill improvement increase the “ likelihood of successfully advancing into a health professions career ,” 7 and programs emphasiz-
ABSTRACT
INTRODUCTION The study describes pipeline , training , and contextual experiences and factors that influence the decision to practice medicine in West Virginia ( WV ).
METHODS The cross-sectional study using descriptive statistics was conducted between November 2019 and March 2020 using an online link to an anonymous survey sent to all physicians licensed to practice medicine in WV with an e-mail address on file with the WV Board of Medicine or WV Osteopathic Medical Association at the time of the study .
RESULTS More WV medical school graduates identifying as a WV native practiced primary care than non-native WV medical graduates in this sample . More native WV medical graduates practiced primary care than non-native peers ; however , both groups chose primary care at a greater rate than out-of-state medical school graduates . Returning to home communities and an established network of family and friends were influential factors for WV medical graduates . More WV natives completed residency in-state ( n = 127 ) compared to outof-state ( n = 55 ). More than half of the sample
ing science , technology , engineering , and math ( STEM ) have aided in diversifying the workforce and providing underrepresented students with opportunities to prepare for college . 8
West Virginia ( WV ) has several pipeline programs focused on increasing the enrollment of high school graduates at in-state medical schools , including those supported by the Rural Health Initiative ( RHI ), the WV Area Health Education Center Program ( AHEC ), the WV Chapter of the Health Occupation Student Association ( HOSA ), and the Health Sciences & Technology Academy ( HTSA ). 5 A recent evaluation of the HSTA program compared standardized test scores
( 69.4 %) participated in at least one pipeline program during medical school ( n = 153 ), residency ( n = 86 ), undergraduate ( n = 50 ), other graduate training ( n = 18 ), or K-12 ( n = 16 ). Approximately 24 % of all respondents ’ primary practice was in a rural area , and 60 % of respondents practiced in a primary care health profession shortage area .
DISCUSSION More native WV respondents are currently providing primary care and completed residency in-state compared to non-native respondents . The choice of primary care practice was similar across graduates of WV ’ s three medical schools . A majority of respondents participated in pipeline programming though the effect on career and practice location decisions are unclear .
CONCLUSIONS Continued recruitment of WV medical school graduates into in-state residency programs , concurrently with expanded primary care training placements and promotion , may increase the number and retention of WV primary care physicians in the coming years . Further study should examine factors that influence physician choice not to return to WV to practice after residency or fellowship training .
of HSTA and non-HSTA students to measure academic success in school . Results showed higher test scores linked to positive outcomes such as the inclination to study academically rigorous areas , including STEM fields , as well as the propensity to pursue college education . 9 Significant evidence demonstrates higher test scores among HSTA students compared to non-participants , both overall and by equivalent grade point average , race , and gender . These data from Smith and colleagues indicate that the academic foundation and intervention received through HSTA programs support heightened performance and promote both greater preparedness to attend college and greater pursuit of post-secondary study .
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