Factors Associated With Health Care Professionals' Choice to Practice in Rural Minnesota

• Published in: JAMA network open 2023-05, Vol.6 (5), p.e2310332-e2310332
• Main Authors: Fritsma, Teri, Henning-Smith, Carrie, Gauer, Jacqueline L, Khan, Faizel, Rosenberg, Mark E, Clark, Kirby, Sopdie, Elizabeth, Sechler, Angela, Sundberg, Michael A, Olson, Andrew P J
• Format: Article
• Language: English
• Subjects: Adult; Advanced practice nurses; Cross-Sectional Studies; Debt cancellation; Female; Health Policy; Humans; Male; Medical personnel; Middle Aged; Minnesota; Online Only; Original Investigation; Physicians; Professionals; Prospective Studies; Rural areas; Scope of practice; Surveys and Questionnaires
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2023.10332

Rural health inequities are due in part to a shortage of health care professionals in these areas. To determine the factors associated with health care professionals' decisions about where to practice. This prospective, cross-sectional survey study of health care professionals in Minnesota was administered by the Minnesota Department of Health from October 18, 2021, to July 25, 2022. Advanced practice registered nurses (APRNs), physicians, physician assistants (PAs), and registered nurses (RNs) renewing their professional licenses were eligible. Individuals' ratings on survey items related to their choice of practice location. Rural or urban practice location as defined by the US Department of Agriculture's Rural-Urban Commuting Area typology. A total of 32 086 respondents were included in the analysis (mean [SD] age, 44.4 [12.2] years; 22 728 identified as female [70.8%]). Response rates were 60.2% for APRNs (n = 2174), 97.7% for PAs (n = 2210), 95.1% for physicians (n = 11 019), and 61.6% for RNs (n = 16 663). The mean (SD) age of APRNs was 45.0 (10.3) years (1833 [84.3%] female); PAs, 39.0 (9.4) years (1648 [74.6%] female); physicians, 48.0 (11.9) years (4455 [40.4%] female); and RNs, 42.6 (12.3) years (14 792 [88.8%] female). Most respondents worked in urban (29 456 [91.8%]) vs rural (2630 [8.2%]) areas. Bivariate analysis suggested that family considerations are the most important determinant of practice location. Multivariate analysis revealed that having grown up in a rural area was the strongest factor associated with rural practice (odds ratio [OR] for APRNs, 3.44 [95% CI, 2.68-4.42]; OR for PAs, 3.75 [95% CI, 2.81-5.00]; OR for physicians, 2.44 [95% CI, 2.18-2.73]; OR for RNs, 3.77 [95% CI, 3.44-4.15]). When controlling for rural background, other associated factors included the availability of loan forgiveness (OR for APRNs, 1.42 [95% CI, 1.19-1.69]; OR for PAs, 1.60 [95% CI, 1.31-1.94]; OR for physicians, 1.54 [95% CI, 1.38-1.71]; OR for RNs, 1.20 [95% CI, 1.12-1.28]) and an educational program that prepared for rural practice (OR for APRNs, 1.44 [95% CI, 1.18-1.76]; OR for PAs. 1.70 [95% CI, 1.34-2.15]; OR for physicians, 1.31 [95% CI, 1.17-1.47]; OR for RNs, 1.23 [95% CI, 1.15-1.31]). Autonomy in one's work (OR for APRNs, 1.42 [95% CI, 1.08-1.86]; OR for PAs, 1.18 [95% CI, 0.89-1.58]; OR for physicians, 1.53 [95% CI, 1.31-1.78]; OR for RNs, 1.16 [95% CI, 1.07-1.25]) and a broad scope of practice (OR for APRNs, 1.46 [95% CI, 1.15-1.86]; OR for