An Examination of Practices and Barriers of Procedures Performed by Physicians in Rural Hawai'i

Abstract

There is an estimated shortage of 46 000 to 90 000 physicians in the US, especially in rural areas. Physicians working in rural areas often maintain a larger scope of practice compared to their urban counterparts. This scope may include performing procedures which may require additional training, and lack of that training may limit rural physicians' capability to perform procedures. Physicians practicing in rural areas of Hawai'i were surveyed about their scope of practice regarding procedures and the perceived hindrances in performing procedures. Physicians identified as rural practitioners and rural physicians attending local conferences were asked to participate. Forty-seven (out of 301) rural Hawai'i physicians participated in the survey, of which 89% reported performing procedures. The most common procedures performed included suture removal, incision and drainage, wound care, and suturing. Of the 47 respondents, a total of 28 physicians or 60% reported wishing to perform procedures but not doing so. The procedures physicians would like to perform included gynecological (36%), casting (21%) and wound care (14%). Barriers to performing procedures included lack of time (51%), inadequate training (37%), out of practice (22%), and poor reimbursement (17%). While most rural physicians in this study perform procedures, many would like to perform more. Lack of training and support are significant barriers to increasing scope of procedures performed. Medical schools, residencies, and continuing education programs should consider expanding training in these areas, especially for those planning to practice or currently practicing in rural areas.

Keywords: procedures in primary care; rural health services; rural medicine; scope of practice.