ral primary care and sustain engagement in WV practice through a variety of innovative experiences and opportunities across all levels of education . 2 , 5 , 7 , 9 Results from the current study indicate that more respondents with varying levels and types of pipeline and training experiences who identify as a WV native currently practicing in-state provide primary care than specialty care . More native WV physicians provide primary care than non-native respondents . Additionally , a higher number of respondents who attended medical school in WV chose primary care as a specialty , while respondents who attended medical school out of state were more likely to practice specialty care than primary care . Choice of primary care practice did not differ between graduates of WV ’ s three in-state medical schools in this sample .
Respondents identifying as a native of WV were also more likely to have completed residency in-state compared to out of state . Data from the 2020 WV Health Sciences and Rural Health Report Card found that for the 2015 graduates of WV medical schools who completed primary care residencies in state , 83 % were retained in WV to practice , while only 10 % of graduates who completed out-of-state primary care residencies returned to WV to practice . 5 This trend has been consistent since 2011 , with retention rates of WV medical student graduates who complete primary care residency in state at 68 % to 83 % and out of state at 4 % to 10 %. The authors concluded , “ the location of a medical school graduate ’ s residency program frequently predicts whether that graduate will practice in WV .” 5 AAMC points to a national trend , with over half ( 55.5 %) of physicians who completed their resident training from 2012 to 2019 continuing to practice in the state where they completed their residency . 24 Together , these data suggest that the outflow of physicians following medical school and residency 14 are related to choice of practice specialty . Exploration of ways to retain more medical students in WV residencies should continue , including increasing and targeting residency placement slots in needed specialty areas and innovative financing of residency programs . 3 , 24
Sixty-seven percent of respondents also reported completing a fellowship of some sort . Most of these fellowships were completed out of state , and many of these fellowships were completed in the last 10 years . Only 7 % of respondents reported completing an additional degree or certificate in addition to their doctorate of medicine ( MD ) or osteopathic medicine ( DO ), most of which were master ’ s degrees and none in public health . National data on additional degrees are limited . AAMC reports that 3.3 % of active residents who graduated from US MD-granting schools were dual MD-PhD graduates ; 24 data on other degrees were not able to be located .
The increased choice of primary care practice by WV medical school graduates may be explained in part by pipeline programming at each WV medical school that provides enhanced activities designed to increase practice interest in both primary care and in rural and underserved areas of the state . These programs were initially supported through the WV RHEP prior to 2011 and through the RHI since that time . 13 Three months of rural rotations were required by all health profession programs from 1994-2011 through the WV Higher Education Policy Commission ( WV HEPC ), which provided oversight to all in-state medical schools as part the WV RHEP . WV RHEP program funding was eliminated by the legislature in 2011 , and the rural rotation mandate was lifted and replaced with pipeline , recruitment , and retention program funding provided to the three medical schools by WV HEPC . 18
Findings on the importance of pipeline programs were mixed in this study . Seventy percent of all respondents reported participation in some type of pipeline programming . Many respondents who indicated participating in specific programs addressed in this survey reported participation across multiple programs . However , the influence of program participation on respondents ’ decisions to become a physician and practice site location were inconclusive . Potential explanations for the mixed results on pipeline program impact and choice of career and practice location are program awareness , branding , and intersection . For example , the statewide RHEP , AHEC , and RHI programs include interprofessional teams and AHEC , RHI , and HSTA programs include health careers clubs and shadowing opportunities ,
while HSTA specializes in offering students STEM-specific opportunities . Respondents may recall pipeline participation but not the specific program .
Another potential explanation for the mixed effect of pipeline programming on medical career and practice site decisions is the complexity of multi-layered influences . Literature provides empirical evidence about the factors influencing career decision making , some of which are family influence , passion , capacity , self-efficacy , apparent difficulty , values , sense of belonging , gender , and race . 25-27 Pipeline programs should focus on helping students evaluate across the spectrum of important influences as they make decisions about a future career . The choice of medicine as a career itself has also been widely studied . A report of the National Physician Survey ( 2007 ) noted that an overwhelming majority of medical students chose a career in medicine based on intellectual stimulation and challenge ( 93 %) and doctor-patient relationships ( 83 %). 28 Pipeline programs can help students realize the intellectual stimulation , challenge , and opportunities for relationship building during a career in medicine .
Choice of location of practice is also a multifactorial issue . Reasons documented in previous studies by this team include family ties to a geographic area , a need to give back to a community , opportunities for spousal employment , and the ability to be a part of an academic environment even in rural practice . 2 , 14 While WV programs such as RHI expose participants to rural practice and life , pipeline programs are not designed to influence these factors specifically . However , such programs could emphasize and build from the importance of these factors in later career satisfaction .
Several limitations to the current study exist . Among study respondents , there is a low representation of physicians practicing in rural and underserved areas . Most of the respondents were from urban centers of the state where the three medical schools are located . Moreover , the response rate of 4.7 % of all licensed MDs and DOs does not allow for generalization to the population of physicians currently licensed in WV . Due to the anonymity of the survey , it is unclear how many individuals from the population of
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