Self-Identity Key to Doctorsâ€™ Work Choice

LOS ANGELES — Medical schools and clinics could boost the number of primary care physicians in medically underserved areas by selecting and encouraging students from these communities, who often exhibit a strong sense of responsibility for and identification with the people there, according to a new study by UCLA researchers and colleagues published in the current issue of the American Journal of Public Health.

Training these students in underserved settings during medical school and their residencies could also increase the likelihood they would continue serving those populations, the researchers found. Physicians-in-training who are not from underserved populations or who do not train in such areas are unlikely to work for any length in these communities.

The findings highlight the importance of identifying doctors who are motivated by mission-based values such as a sense of responsibility to a particular community or patient population early in medical training, said Dr. Kara Odom Walker, who led the study while in the Robert Wood Johnson Foundation Clinical Scholars program at the David Geffen School of Medicine at UCLA.

"In the current health care reform debate, if health insurance coverage increases, residents in areas with an inadequate physician supply will have greater difficulty receiving timely and appropriate clinical care, and this could create poorer population health indicators," said Walker, now an assistant clinical professor of family and community medicine at the University of California, San Francisco.

In their findings, which were based on in-depth interviews with 42 Los Angeles County African American, Hispanic and non-Hispanic white primary care physicians in both underserved and non-underserved areas, the researchers noted three themes that emerged to explain physicians' choice of practice location: personal motivators, career motivators and clinic support.

Physicians who worked in underserved areas were more likely to cite motivators such as personal mission and self-identity as reasons for their choice, compared with physicians who didn't work in those areas. Physicians who had never worked in or had left underserved areas, by contrast, cited factors such as work hours and lifestyle in their choice of practice location.

The authors noted that incentives such as loan-repayment reform for primary care medical students and more medical education opportunities for minorities and immigrants could help draw more physicians to critically underserved areas, which have been particularly hard hit, given the overall national shortage of primary care physicians.

"By using enlightened and informed recruitment strategies that seek out and develop a corps of motivated, mission-driven and committed primary care physicians and retaining them by employing strategies to improve work-life balance, we can meet the challenge of disparities in care among the underserved," the authors conclude. "The current health care reform debate provides unique opportunities to develop and implement such strategies."

The study has some limitations, the researchers noted. Despite using some strategies to reduce potential bias, the themes that emerged during the interviews were still subject to the researchers' interpretation. Also, the researchers found their interview subjects through referrals from a seven-member community advisory board, so the opinions expressed by the the surveyed physicians may not be representative of those from other areas.

The Robert Wood Johnson Clinical Scholars Program funded the study.

Study co-authors included Arleen F. Brown and Robin Ramey of UCLA; Gery Ryan of the RAND Corp.; Felix L. Nunez of the Family Health Care Center of Greater Los Angeles; Robert Beltran of the Latino Med Policy Institute, and Robert G. Splawn of the Los Angeles County Department of Health Services.

The Robert Wood Johnson Foundation Clinical Scholars program fosters the development of physician-leaders who will transform health and health care in the U.S. Scholars will be equipped to work with communities, organizations, practitioners and policymakers to conduct innovative research important to enhance the health and well-being of these communities. The program's major focus emphasizes community-based research and leadership training.

The David Geffen School of Medicine at UCLA ranks among the nation's elite medical schools, producing doctors and researchers whose contributions have led to major breakthroughs in health care. With more than 2,000 full-time faculty members, nearly 1,300 residents, more than 750 medical students and almost 400 Ph.D. candidates, the medical school is ranked seventh in the country in research funding from the National Institutes of Health and third in the United States in research dollars from all sources.