Which U.S. medical schools are providing the most physicians for the Appalachian region of the United States?

PURPOSE: To identify the U.S. medical schools with the most graduates practicing in rural, urban, and economically distressed areas of Appalachia. METHOD: Using June 2009 American Medical Association Physician Masterfile data, the authors identified physicians who graduated from medical school during 1991-2005 and were practicing in the 420 counties of the United States' Appalachian region. They then determined the U.S. medical schools with the most 2001-2005 graduates practicing in primary care (PC) or non-PC specialties in urban or rural areas and the most 1991-2005 graduates practicing in economically distressed/at-risk counties. RESULTS: Ten U.S. medical schools, led by the West Virginia School of Osteopathic Medicine, produced 50.5% (197/390) of 2001-2005 graduates practicing PC in rural areas of Appalachia; 10 schools, led by the University of Alabama School of Medicine, produced 44.1% (366/829) of graduates practicing PC in urban areas. During 2001-2005, 10 schools, led by the West Virginia University School of Medicine, graduated 42.1% (128/304) of non-PC physicians practicing in rural counties; 11 schools, led by the University of Alabama School of Medicine, graduated 38.5% (323/840) of non-PC physicians practicing in urban areas. All schools on the top 10 lists are located within states with Appalachian counties. University of Kentucky College of Medicine had the most 1991-2005 graduates practicing in economically distressed or at-risk counties. CONCLUSIONS: Physicians practicing in Appalachia are largely graduates of medical schools in or near the region. New schools being developed in the region may help reduce its continuing physician shortages.

A comparative assessment of West Virginia's financial incentive programs for rural physicians.

CONTEXT: Financial incentive programs are increasingly being used as a strategy to recruit physicians to underserved rural areas. Critical evaluation of state-supported programs is often lacking but is necessary to determine their efficacy and to improve outcomes. PURPOSE: The purpose of this study was to assess 4 service-contingent programs in West Virginia, a state with critical physician shortages. METHODS: Survey instruments were developed to evaluate the effectiveness of these programs and to document the practice environments and career paths of obligated allopathic and osteopathic physicians compared with a control group of nonobligated rural practitioners. Data were also collected from physicians who were recipients of multiple incentive programs and from obligated physicians who had defaulted. FINDINGS: Responses from more than 60% of surveyed physicians indicated that the typical respondent was a married white male who was a midcareer family practice physician. Obligated physicians were more likely than nonobligated physicians to have graduated from a West Virginia medical school and residency program, to be influenced by financial factors in their career decisions, to provide care to uninsured patients, and to work in offices that offered sliding fee scales. Both groups of physicians demonstrated similar retention patterns, reported a high degree of job satisfaction, and expressed a need for more practice management training. CONCLUSIONS: Although these financial incentive programs were found to be effective in recruiting primary care physicians to medically underserved areas of the state, the financial support of these programs was found to be too modest, and improved marketing of the programs was indicated.