Recruiting and retaining primary care physicians in urban underserved communities: the importance of having a mission to serve

Abstract

Objectives: We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas.

Methods: We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods.

Results: Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area.

Conclusions: Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work-life balance.

FIGURE 1

Pathways to increasing physician supply in underserved areas: Los Angeles County, California, 2008. Note. The diagram shows the pathways of physicians into and out of underserved practice locations using physicians’ descriptions of residency training location (underserved vs nonunderserved setting); childhood background (description of being from an underserved area or nonunderserved area); and positions held since residency (underserved vs nonunderserved).