Physician perceptions of practice environment and professional satisfaction in California: from urban to rural.
BACKGROUND
Few studies have systematically examined the experience of rural practice from the physician's perspective or included physicians from an array of specialties, particularly non-primary care.


OBJECTIVE
To better understand differences between rural and urban physicians in perceptions of their practice environment.


METHODS
In 2001-2002, self-administered questionnaires were sent to a probability sample of primary care and specialist physicians identified from the American Medical Association's Physician masterfile in California. Logistic regression was performed to model the effect practice location had on key variables, controlling for physician demographics, specialty, and the insurance profile of the physician's patients.


RESULTS
Completed questionnaires were obtained from 1,365 of 2,240 eligible urban physicians (61%), and 398 of 632 rural physicians (63%). Among primary care physicians, those in rural areas defined as nonadjacent or small non-metropolitan counties were the least likely to report pressures to see more patients, limit referrals, and limit treatment options. In contrast, among specialists, those in rural areas within metropolitan areas (or in large adjacent non-metropolitan counties) were more likely than urban specialists to report practice pressures. Although rural physicians in both primary care and specialist fields were more likely than urban physicians to report difficulty attracting new physicians to their communities, they perceived their overall practice climate to be better. Physicians in the nonadjacent-or-small non-metropolitan category were the most satisfied, but specialists in the nonadjacent-or-small non-metropolitan category were the least satisfied.


CONCLUSIONS
Physicians in rural California appear to have maintained a greater sense of clinical autonomy and higher professional satisfaction compared with their urban counterparts.
Luman
Kyle
K
Department of Family and Community Medicine and the Center for California Health Workforce Studies, University of California, San Francisco, CA 93720 USA.
Zweifler
John
J
Grumbach
Kevin
K
D001291:Attitude of Health Personnel; D002140:California; D003710:Demography; D004777:Environment; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008511:Medicine; D010820:Physicians / Q000523:psychology* / Q000600:supply & distribution; D010821:Physicians, Family; D017009:Professional Autonomy; D011365:Professional Practice Location; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013038:Specialization; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000706:statistics & numerical data*