Emergence of commitment to practice in a rural medically underserved community.

摘要

Retention of the rural physician workforce remains one of the nation's more complex and persistent problems. Quantitative studies were the principal research designs employed to examine retention. Findings from these investigations consistently highlighted the role of medical education in developing solutions to improve the number of physicians practicing in rural medically underserved communities. However, developing rural health curricula and clinical training sites in rural areas has promoted little change in retaining the rural physician workforce over the decades.; The nation remains challenged with meeting the health care needs of over 45 million people living in medically underserved areas with a limited physician workforce unable to answer the health care needs of these needy populations. Rural areas are confronted with additional factors of restrictive economic environments, aging populations, impoverished communities, inadequate schools, and deficient public transportation systems. The problem of an insufficient rural physician workforce persists.; This study suggests a new perspective on retaining a rural physician workforce. The foundation of this study is process---one of discovery and explanation. The principal research question asks, how do NHSC physicians explain their commitment to practice in a rural medically underserved community ? The approach to this investigation is qualitative and employs a bounded case study design, using grounded theory methodology for data analysis with the intent to develop substantive theory. The study included in depth interviews with seven physicians and two dentists practicing in rural medically underserved communities within the Midwest region of the United States. All interviews were conducted in person with each participant within their practice or community environments. Not all study participants were affiliated with the National Health Service Corps (NHSC) loan repayment program. However, all participants did participate in the NHSC' mentoring program as a means to influence retention in rural underserved areas.; Through constant comparative analysis of the interview transcripts, a theoretical model emerges identifying a criterion category (commitment to practice), and explanatory categories (world view, self directed, professional development, mentoring, and organizational culture) with associative and explanatory processes. Further analysis, shaped three approaches to medical practice: the mutual dependency profile, the convenience profile, and the achievement profile. Associated with each profile is length of commitment to practice. The mutual dependency profile is linked with more of a life long commitment, and the convenience and achievement profiles are associated with more temporal commitments. The findings of this study offer a new lens to view the challenge of retaining a rural physician workforce. Further investigation is warranted to affirm the findings.