title: Retention of physician assistants in rural health clinics.
abstract: BACKGROUND
  Improvement of rural health care access has been a guiding principle of federal and state policy regarding physician assistants (PAs).
  
  
  OBJECTIVE
  To determine the factors that influence autonomous rural PAs (who work less than 8 hours per week with their supervising physician) to remain in remote locations.
  
  
  METHODS
  A qualitative exploratory study was undertaken in 8 rural Texas towns, including direct observation of clinics, semi-structured interviews with PAs, and focus groups with community residents.
  
  
  RESULTS
  The major factors contributing to retention among autonomous rural PAs include: confidence in the ability to provide adequate health care, desire for small-town life, residing in the community, and being involved with the community. Both PAs and residents thought the level of their town's health care was moderately good but could be improved. The clinic allowed easy access for primary care and minor injuries. Town residents and PAs also expressed a desire for major improvements including a pharmacy, visiting specialists, and additional medical equipment. Not all residents sought medical care at the clinic, with some electing to travel to physicians in larger towns.
  
  
  CONCLUSIONS
  Rural community residents have more confidence in and satisfaction with PAs who have remained in a clinic for several years. In order to increase retention rates, PAs committed to autonomous, rural primary care would benefit from additional training, particularly in emergency medicine, the benefits of community involvement, and adaptation to the local culture.
authors.affiliation: Department of Anthropology, University of North Texas, Denton, TX 76203, USA. LHenry@unt.edu
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Henry
authors.forename: Roderick S
authors.initials: RS
authors.lastname: Hooker
mesh_terms: D000328:Adult; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D010823:Physician Assistants / Q000523:psychology / Q000600:supply & distribution*; D010865:Pilot Projects; D011365:Professional Practice Location; D036301:Qualitative Research; D019035:Rural Health Services; D013781:Texas; D000078329:Workforce