Tillman, Matt

EXSUM US Healthcare System Literature Review

Question: Why is there a geographic maldistribution of physicians in the US?
Domain: Military Medical
Method of research: Literature Review
Models: Modified Bennett and Phillips (2010) model for physician choices in specialization and
location (personal, environmental, occupational, education). I consolidated those areas into
three: 1. Personal, 2. Occupational, 3. Educational.
Kissicks iron triangle - access
Assumptions: N/A
Overview: The purpose of this literature review was to describe the rural health access to care
dilemma facing the U.S in light of physician maldistribution and to consolidate information
concerning effective practices that have proven beneficial in the recruitment of physicians to
rural areas. My literature review was done in three phases. First, I reviewed the literature
describing the complexities and problems associated with rural health care. Second, I reviewed
the literature about physician maldistribution in the U.S.; and finally, I reviewed available
literature about effective recruitment programs for primary care physicians in rural America.
After review of the current literature, three distinct causes of physician maldistribution
were apparent including:
1. time spent in a rural community prior to medical school
2. desire to serve in a specialty versus general practice
3. time spent in a rural environment during medical education.
Finally, I considered two successful educational programs that are graduating increased numbers
of general practitioners and more rural providers than the U.S. average.

Tillman, Matt
1. The University of Cincinnati Family Medicine Residency Program. This program
changed its curriculum to force students into underserved and rural areas as has
seen its students increase in their practices in those areas by 10%.
2. The Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program.
Through selection and training in rural areas, this program has increased the
number of physicians practicing in these areas by 57% since inception. It also has
a higher number of primary care physicians graduating from its program (30.2%
vs 41.9%).

Proposed COA: This was a very qualitative review. Due to the emphasis of equitable care in
Healthy People 2010, there was a large body of literature from the previous decade about this
topic. However, with the more ambiguous goals of Healthy People 2020, that body of literature
was much less substantial. If I were to conduct this review again, I would attempt to use a more
quantitative approach.
Lessons Learned: Money really isnt the great motivator. Rural and urban physicians make
about the same money. Rural physicians are perceived to work harder but they have a lower cost
of living. However, only 11% of US physicians serve the 20% of the population in rural areas of
the country. Selection processes aimed at recruiting medical students with experience in rural
areas couple with education programs that require time in rural areas are successful at increasing
the number of physicians who want to practice in rural areas. In the light of the ACA, where
increased primary care physicians will be required, deliberate measures will be required to make
ends meet.