Migration of obstetrician-gynecologists into and out of rural areas, 1985-1990.
This study sought to determine if county-level demographic, health care resource, policy, and competitive factors are associated with the movement of obstetrician-gynecologists (ob-gyns) into and out of rural areas. County-level descriptive data from the Area Resource File, the American Medical Association Physician Masterfile, and the American Hospital Association Guide were used for hospital descriptions. This was a correlational study that measured the association of ecologic indicators of nonmetropolitan counties with indicators of gain or loss of ob-gyns. Descriptive statistics characterize the supply and movement of ob-gyns by size and location of the counties. Multinomial logistic regression models describe the net effect of the ecologic indicators on physician movement. During the period 1985 to 1990, a total of 962 patient care ob-gyns moved out of 531 nonmetropolitan counties, and 979 ob-gyns moved into 528 counties. Counties in the southern Atlantic states experienced the greatest net inflow, whereas Illinois, Missouri, and Texas had the greatest net outflow. Counties that retained ob-gyns during this period were in the mid-range of population. Positive correlates of outward migration were adjacency to a metropolitan county and loss of hospital bed supply; negative correlates with outward migration were the supply of hospital beds and total population. Inward migration was positively correlated with retention or gain of county family physicians and with adjacency; negative correlates were overall population and total family physician supply. The movement of ob-gyns in nonmetropolitan counties is influenced by state policies, local resources, and relative location. No clear evidence shows that there are competitive relations between family physician supply and ob-gyn supply.
Ricketts
T C
TC
Department of Health Policy and Administration, University of North Carolina School of Public Health, Chapel Hill 27599-7590, USA.
Tropman
S E
SE
Slifkin
R T
RT
Konrad
T R
TR
D000328:Adult; D000368:Aged; D005260:Female; D006176:Gynecology / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000706:statistics & numerical data / Q000639:trends; D010821:Physicians, Family / Q000706:statistics & numerical data / Q000600:supply & distribution / Q000639:trends; D011157:Population Dynamics; D011365:Professional Practice Location / Q000706:statistics & numerical data / Q000639:trends*; D019035:Rural Health Services / Q000706:statistics & numerical data; D014481:United States; D000078329:Workforce