non-respondents completed medical school and supplemental training opportunities at an in-state versus out-of-state institution compared to the number of physicians who chose to complete the survey . As noted in the companion paper for this study , 15 the single publicly available data identified on WV physician demographics ( including gender , age , specialty , and medical school attended ) suggests that the study sample is representative of the target population . However , these data are from the year 2000 ; thus , it is unknown if the participant group is a representative sample of WV physicians licensed in WV at the time of the survey . 29 Conclusions presented reflect only the experiences of respondents to the survey .
CONCLUSION
Rural WV confronts a physician and primary care shortage that continues to grow , underscoring recruitment and retention as a priority . 2 As evidenced in prior studies in WV and similar US contexts , 1-4 this study supports continued targeting of WV natives for enrollment in pipeline activities to encourage entry into WV medical schools and enhanced efforts to recruit WV medical school graduates for in-state residencies and fellowships . Comprehensive programs that support pipeline activities across training levels , such as incorporation of community-based shadowing opportunities and rotations into curricula , may increase the number of rural providers . Such programs should target both traditional and person-centered practice decision factors like sense of belonging , intellectual stimulation , and relationshipbuilding as well as the state ’ s quality of life and community attributes identified as most
3 , 15 , 26 influential in choosing WV practice .
Moreover , current programming emphasizing primary care to tackle the PCP shortage could be adapted and expanded to address the overall physician shortage and dual need for specialty care in rural and underserved areas . Creating and securing more fellowships for specialties needed in WV as part of the training pipeline , such as addiction and obesity medicine , and providing opportunities for those fellows to work with rural and underserved populations during training may also improve state workforce deficits . Expanding and promoting financial incentives with competitive award amounts and loan forgiveness and service options may fortify recruitment and retention efforts . 7 As WV currently has the nation ’ s largest medical student cohort per 100,000 population 14 , continuing to increase , diversify , and enhance the high-quality learning opportunities available for WV medical students and residents may be a more effective approach to physician retention than increasing the number of medical school seats .
Future research will include a qualitative study with survey respondents who indicated a willingness to participate in a follow-up interview or focus group to provide more in-depth understanding of the factors and training experiences assessed within the survey . Another area for exploration includes qualitative studies examining why WV graduates choose not to return to WV to practice after residency or fellowship . Together , this information can provide additional insight on appealing and unappealing aspects of practicing medicine in the state . Potential topics for continued study include more specific aspects of practice and community that encourage physicians to stay or return to WV such as the role of health systems in encouraging physicians in both primary care and specialty fields to serve rural areas , either by living and practicing in the area or provision of care via telehealth . Continued in-depth evaluations of recruitment and retention programs , such as those conducted by HSTA , can help to elucidate the influence of pipeline and training experiences on eventual choice of practice . Additionally , prospective studies that follow cohorts of trainees in newly created pipeline and training initiatives can test specific hypotheses about the contribution of personal characteristics and training experiences on choice of practice specialty and / or location .
REFERENCES
1 . Parlier AB , Galvin SL , Thach S , Kruidenier D , Fagan EB . The Road to Rural Primary Care : A Narrative Review of Factors That Help Develop , Recruit , and Retain Rural Primary Care Physicians . Acad Med . 2018 ; 93 ( 1 ): 130-140 . Doi : 10.1097 / ACM . 0000000000001839
2 . Vestal AL , Boone L , Walker R , Sheppard AB , Morris D , Noland AJ . Perceptions of Specialties and Primary Care Careers : Findings from West Virginia Medical Student and Resident Focus Groups . Marshall J Med . 2018 ; 4 ( 4 ). Article 10 Doi : 10.18590 / mjm . 2018 . vol4 . iss4.10
3 . Boydstun J , Cossman JS . Career expectancy of physicians active in patient care : evidence from Mississippi . Rural and Remote Health . 2016 May ; 16:3813 .
4 . Eidson-Ton WS , Rainwater J , Hilty D , Henderson S , Hancock C , Nation CL , Nesbitt T . Training medical students for rural , underserved areas : A rural medical education program in California . J Health Care Poor Underserved . 2016 ; 27 ( 4 ): 1674- 1688 . Doi : 10.1353 / hpu . 2016.0155
5 . West Virginia Higher Education Policy Commission . 2020 West Virginia Health Sciences and Rural Health Report . West Virginia Higher Education Policy Commission Web Site . https :// www . wvhepc . edu / wp-content / uploads / 2020 / 12 / HealthSciencesReport _ 2020 _ 17Dec 2020 . pdf . Accessed January 8 , 2021 .
6 . Dunn MC , Saks NS . Inspiring rural high school students to consider careers in medicine and the health professions . Rural Educ . 2020 ; 41 ( 2 ): 64-69 . doi : 10.35608 / ruraled . v41i2.867
7 . Smith SG , Nsiah-Kumi PA , Jones PR , Pamies RJ . Pipeline programs in the health professions , part 1 : preserving diversity and reducing health disparities . J Natl Med Assoc . 2009 Sep ; 101 ( 9 ): 836- 40 , 845-51 . doi : 10.1016 / s0027- 9684 ( 15 ) 31030-0 . PMID : 19806840 .
8 . Gwathmey TM , Tallant EA , Howlett AC , Diz DI . Programs to Recruit and Retain a More Diverse Workforce in Biomedical Sciences Research . J best Pract Heal Prof Divers Res Educ policy . 2016 ; 9 ( 1 ): 1188-
West Virginia Medical Journal • March 2022 • 51