Exploring differences in caseloads of rural and urban healthcare providers in Alaska and New Mexico.
OBJECTIVE
Although it is commonly accepted that rural healthcare providers face demands that are both qualitatively and quantitatively different from those faced by urban providers, this conclusion is based largely on data from healthcare consumers and relies on qualitative work with small sample sizes, surveys with small sample sizes, theoretical reviews and anecdotal reports. To enhance our knowledge of the demands faced by rural healthcare providers and to gain the perspectives of healthcare providers themselves, this study explored the caseloads of rural providers compared with those of urban providers.


METHODS
An extensive survey of over 1500 licensed clinicians across eight physical and behavioural healthcare provider groups in Alaska and New Mexico was undertaken to explore differences in caseloads based on community size (small rural, rural, small urban, urban), state (Alaska, New Mexico) and discipline (health, behavioural).


RESULTS
Findings indicated numerous caseload differences between community sizes that were consistent across both states, with complex case presentations being described most commonly by small rural and rural providers. Substance abuse, alcohol use, cultural diversity, economic disadvantage and age diversity were issues faced more often by providers in rural and small rural communities than by providers in small urban and urban communities. Rural, but not small rural, providers faced challenges around work with prisoners and individuals needing involuntary hospitalization. Although some state and discipline differences were noted, the most important findings were based on community size.


CONCLUSIONS
The findings of this study have important implications for provider preparation and training, future research, tailored resource allocation, public health policy, and efforts to prevent 'burnout' of rural providers.
Brems
Christiane
C
University of Alaska Anchorage, Anchorage, Alaska 99508, USA. cbrems@uaa.alaska.edu
Johnson
Mark E
ME
Warner
Teddy D
TD
Roberts
Laura Weiss
LW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000413:Alaska / Q000453:epidemiology; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D018864:Cultural Diversity; D005260:Female; D019538:Health Care Surveys; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009516:New Mexico / Q000453:epidemiology; D011365:Professional Practice Location / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000145:classification / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D016526:Workload / Q000706:statistics & numerical data*