Underserved Areas and Pediatric Resident Characteristics: Is There Reason for Optimism?

Area of Science:

• Medical Education
• Public Health
• Health Workforce Research

Background:

• Physician maldistribution in underserved areas is a persistent public health challenge.
• Understanding factors influencing practice location decisions is crucial for addressing this issue.
• Pediatric residents' career choices significantly impact future healthcare access for vulnerable populations.

Purpose of the Study:

• To investigate the relationship between pediatric residents' characteristics and their practice in underserved areas.
• To identify predictors of both the intention to practice and the actual placement in underserved settings.

Main Methods:

• A cross-sectional survey was administered to a national sample of pediatric residents (N=1000) and an additional sample of minority residents (N=223) graduating in 2009.
• Weighted logistic regression analysis was employed to examine associations between resident background, values, experiences, and practice goals with practice location.
• Outcomes assessed included residents' expectation to practice in underserved areas and their secured postresidency positions in such locations.

Main Results:

• The response rate was 57%, with 41% of residents expecting to practice in underserved areas and 38% securing positions in these locations.
• Service obligations (e.g., for loans/scholarships) and primary care/academic pediatrics practice goals were the strongest predictors for both expecting and securing practice in underserved areas.
• Other significant predictors included hospitalist practice goals, diversity of patient population importance, early career intentions, maternal education, and universalism values.

Conclusions:

• Physician characteristics, including service obligations and a commitment to serving underserved populations, are key factors in practice location decisions.
• Policies and funding can be targeted to support physicians with these traits to mitigate the uneven distribution of pediatric care providers.
• These findings offer a hopeful outlook for addressing physician shortages in underserved communities through strategic support of motivated trainees.