Up to the middle of the 1970's most government policies dealing with physician manpower dealt with the problems of increasing the supply of physicians, rather than changing the geographic disparity of physicians between urban and rural areas. In 1983 the British Columbia government introduced legislation (passed in a modified form in 1985) that would restrict certain groups of physicians from obtaining Medical Service Plan billing numbers in certain areas of the province, in an attempt to change the geographic distribution of physicians in this province. Regulation is only one of a number of approaches to altering the distribution of physicians. The purpose of this study is to attempt to recommend other approaches that could be used to alter the geographic distribution of physicians, based on the factors which the residents and interns of British Columbia would consider necessary before they will establish practices in the rural areas of the province. The literature was examined to determine the present supply and distribution of physicians in the province of British Columbia. It was shown that the metropolitan areas had much higher concentrations of physicians than did the non-metropolitan regions. The literature was then searched to determine what types of policies had been used in an effort to change this geographic disparity and also to determine what factors influence physicians to locate their practices where they do. From this research a questionnaire was developed and mailed to all residents and interns registered in the University of British Columbia medical program in the academic year 1984-85. A response rate of 31.8% was obtained in this survey. It was found that many physicians were raised in large communities and planned to locate their practices in similar geographic areas to where they were raised. It was also found that the factors which the residents and interns considered to be the most important fell into the "Fixed Determinant" category, that is factors that are personal preferences of the physician. This makes it very difficult to formulate any type of non-regulatory policy to affect the geographic distribution of physicians in British Columbia / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The primary purpose of this study was to examine the relationship between educational and curricular factors and physician location decisions. As a background to the study, a literature search traced the history of medical education in the U.S., focusing on various influences on physician distribution. In the research on physician location decision, this study is unique in its use of the constant comparative method. This method is an inductive approach developed and refined by Glaser and Strauss, used in this study to generate theory regarding the role of educational factors in physician location decisions. In this research, two groups of physicians who completed training after 1965 were selected for study, based on their locations in distinctly different practice settings in Arizona: urban and rural. An open-ended interview format was developed, and each physician was interviewed, with data analysis beginning during the first interview and continuing through the entire period of data collection. Using the constant comparative method, similar groups (rural physicians) were compared to bring out basic properties of categories, and different groups (urban physicians) were then compared to establish boundaries of applicability of the theory. As the interviews proceeded a basic theoretical framework emerged, enabling development of a grounded theory of physician location decisions. The study presents strong empirical evidence in support of the proposition that educational factors are influential in the decision of a physician to enter practice in a rural area. Four primary influences were identified: faculty role modeling, participation in rural clerkships, preceptorships, or required family practice rotations, service activities related to health care for medically underserved populations, and education in a non-traditional setting, or residency training in a rural area. Curriculum content and requirements take on major significance when these influences are subsumed under the major influence of socialization. The extent to which these educational factors play a role in the practice locations of physicians varies according to educational opportunities available during the training period.

Background: In 2007, occupational specific dispensation (OSD) was introduced for public sector employees in South Africa which is unique to each identified occupation in the public service. The OSD for doctors was later introduced in 2009. The purpose of the OSD was to improve government's ability to attract and retain skilled employees, through increased remuneration. Previously, employees in the public service were remunerated by a single salary structure which did not adequately address the diverse needs of occupational categories in the public service (DPSA, 2009). Although the South African government has been investing a significant amount of resources to attract and retain medical doctors in public service, no formal study has been done to evaluate its impact in reducing the vacancy rate and retention of medical doctors in public hospitals in South Africa. This study aimed to assess the vacancy rate and the profile of doctors working at the Dr George Mukhari Hospital (DGMH) a public sector tertiary academic hospital for last three years (2007-2010) to determine the impact of OSD. Aim: To determine the impact of OSD on the vacancy rate and the profile of doctors working at the DGMH during a three year period (2007 to 2010) Methodology: A cross sectional study design was used to extract retrospective data routinely collected from the Personnel Salaries (PERSAL) system. Variables for the study included: Number of posts per category (Medical officer/ Registrar/ Specialist) funded/ filled and vacant, Profile (age, gender, ethnicity, nationality). The data was exported to MS EXCEL for storage and analysis. No primary data collection was done. The study commenced after obtaining approval from the University of the Witwatersrand ’Human research Ethics Committee (Medical) and Gauteng Department of Health and Social development. Results: The vacancy rate for doctors at the DGMH did not show any significant change after the introduction of ODS. The Hospital employed around 40% female doctors. The majority of doctors were Black and Coloured doctors, although certain department were still staffed by White doctors. There were no significant changes in the mean age of the doctors working in the Hospital. As expected the specialists were generally older than the registrars and medical officers. More South African doctors were appointed in 2010 in comparison to 2008. Conclusion: OSD did not have the intended effect of decreasing the vacancy rate of doctors at the DGMH. This might be because unfunded posts did not get additional funding to free them and therefore the status quo would have remained the same with or without OSD. It suggests that the additional funding should be considered for vacant unfunded posts. Hopefully, the funding model for NHI will dramatically increase the funding in the public sector allowing for OSD and an increase in funded vacant posts simultaneously.

This dissertation analyzes one state's efforts to increase the number of its primary care physicians and encourage their retention and distribution to rural underserved areas. This analysis was accomplished through an examination of physicians as they completed training in Texas family medicine, internal medicine, pediatrics, and obstetric/gynecology residency programs. State licensure data provided insights into these primary care specialties by showing which residents remained in the state to practice, and by showing the numbers and specialties of physicians who practice in rural underserved areas. The primary purpose of this study was to increase understanding and document similarities and differences in the primary care residency programs' production of physicians who remained in Texas and who practiced in a whole county HPSA following training. The following analyses were used to evaluate the research questions and hypotheses: frequency distributions, geographic depictions, Chi-Square tests and binary logistic regression. These analyses provided supporting evidence that significant differences exist among resident programs in the four primary care medical specialties. Differences were also found in residents' likelihood to remain in Texas to practice and their likelihood to practice in whole county Health Professional Shortage Areas (HPSAs). This study showed that those residents who trained in Texas largely remained in Texas and actively practiced medicine years after their residency training had been completed. The training and location of primary care physicians in Texas is influenced by what medical specialty programs are available and where. This suggests that increasing the number and type of residency programs in more remote areas may have a positive influence on the physician workforce of those regions. This study confirms the finding of other institutional and single medical specialty studies that physicians tend to remain in the state in which they complete their residency training. However, this study found that there are variations by primary care specialty, gender, ethnicity, and program location. Residency training is an essential piece in supplying the Texas physician workforce and ensuring that its stability and long-term growth will position it to be prepared to care for the population.

Projection of the future supply of physician services has attracted considerable attention all over the world, especially in North America and Europe. Supply projections, however, have not taken into account physicians’ patterns of service provision. To date, no research on supply projections has examined the relative contribution to supply life-cycle activity patterns of physicians. This study examined the life-cycle activity patterns of two groups of non-postgraduate Directory Active fee-for-service physicians in British Columbia who had practised medicine for the period 1974-84 or 1980-84. Practice activity, the dependent variable, was measured by fee-adjusted payments made to individual physicians. Practice activity was conceptualized to be influenced by three groups of interrelated factors-- personal, professional, and environmental--each comprised of a number of distinct contributory variables. Data analyses included descriptive, logistical regression and time-series/ cross-section regression methods. The time-series/cross-section regression results showed that about 35% of the variance in practice activity could be explained by all variables except past practice activity. Including this variable in the regression equations increased the variances explained to about 90%. Specialty- and sex-specific analyses showed that variances explained by the three factors, and especially the variables comprising each of the factors, varied considerably. The personal factor accounted for most of the variances; the contributions of the professional factor were very small, while those of the environmental factor were negligible. A low previous year’s income emerged as the best predictor of self-declared retirement. Most GPs, medical, and surgical specialists retired long after the usual retirement age of 65 years. The practice activity of female GPs and medical specialists was significantly lower than those of their male counterparts; this observation did not apply to female surgical specialists. Sex-specific results showed that activity levels and patterns of childbearing-aged females did not differ significantly from their non-childbearing aged counterparts. The research provides comprehensive data on the major variables influencing physician activity in a setting with comprehensive, universal, first dollar health care insurance. It also offers many insights for those interested in policy respecting physician supply and requirements, physician retirement patterns, and sex- and specialty-specific differences in practice patterns.

Projection of the future supply of physician services has attracted considerable attention all over the world, especially in North America and Europe. Supply projections, however, have not taken into account physicians’ patterns of service provision. To date, no research on supply projections has examined the relative contribution to supply life-cycle activity patterns of physicians. This study examined the life-cycle activity patterns of two groups of non-postgraduate Directory Active fee-for-service physicians in British Columbia who had practised medicine for the period 1974-84 or 1980-84. Practice activity, the dependent variable, was measured by fee-adjusted payments made to individual physicians. Practice activity was conceptualized to be influenced by three groups of interrelated factors-- personal, professional, and environmental--each comprised of a number of distinct contributory variables. Data analyses included descriptive, logistical regression and time-series/ cross-section regression methods. The time-series/cross-section regression results showed that about 35% of the variance in practice activity could be explained by all variables except past practice activity. Including this variable in the regression equations increased the variances explained to about 90%. Specialty- and sex-specific analyses showed that variances explained by the three factors, and especially the variables comprising each of the factors, varied considerably. The personal factor accounted for most of the variances; the contributions of the professional factor were very small, while those of the environmental factor were negligible. A low previous year’s income emerged as the best predictor of self-declared retirement. Most GPs, medical, and surgical specialists retired long after the usual retirement age of 65 years. The practice activity of female GPs and medical specialists was significantly lower than those of their male counterparts; this observation did not apply to female surgical specialists. Sex-specific results showed that activity levels and patterns of childbearing-aged females did not differ significantly from their non-childbearing aged counterparts. The research provides comprehensive data on the major variables influencing physician activity in a setting with comprehensive, universal, first dollar health care insurance. It also offers many insights for those interested in policy respecting physician supply and requirements, physician retirement patterns, and sex- and specialty-specific differences in practice patterns. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

In this study, county level data for three time periods (1970, 1985, and 1989) are examined to determine the factors affecting the distribution of primary care physicians in rural counties of Virginia. Consistent predictors of proportions of physicians to the population were identified: golf holes per capita and the ratio of hospital beds to population were the most consistent predictors. Per capita income and the elderly population were only significant for some of the years. Variables deemed to be controllable by the community (in the short run) were generally more consistent in predicting the proportions of physicians to population. Policy implications are discussed, and several strategies for improving access to health care in rural areas, thus altering the massive imbalance in physician to population ratio in urban and rural areas are suggested. / Master of Science

No abstract available. / Thesis (M.B.A)-University of KwaZulu-Natal, Pietemaritzburg, 2005.

Abstract not available. / Thesis (M.B.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.

The work content and style of practice of family physicians in British Columbia has been evolving since the second world war. Since the late sixties, a reassessment of the role of family physicians has been underway, both in Canada and the United States. Primary health care has recently been given greater recognition in North America. The development of family practitioners’ tasks in the last twenty years is reviewed from the point of view of a practitioner. In Canada, the health care system has been changing since the forties, as a result of a series of federal-provincial agreements. It had become apparent that, despite constitutional deeding of health care to the provinces, federal incentives and funding were required to develop an appropriate nationwide system of health care. What was a joint private enterprise and local community sponsored health care system in the thirties, has now become a complex government-funded operation. Government involvement in third party payment schemes, for doctors particularly (the last of a series of national health insurance programs), has changed the relationship of doctors to their patients, because both became subject to the new rules of the Medical Care Act of 1967. Government involvement in payment for services has led to questions about accountability for spending. Subsequently, this led to the need for better planning, especially health manpower planning, which began to be considered very important in the early sixties. At that time, the Royal Commission on Health Services examined the prospects of bringing physicians’ services and allied health manpower services to all Canadians. The attempts to plan physician manpower in Canada and British Columbia in the sixties and seventies are considered and criticized. Conclusions are drawn regarding the prospects for future manpower planning for primary care to be given by family practitioners in British Columbia. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate