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

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.

Change in the pattern of illegal drug use in an inner city population over 50: an observational study.

Though alcohol and prescription drug abuse are well studied in older adults, there is little information regarding illicit drug use in older adults. We investigated illicit drug use in older adults presenting to an inner city emergency department in Los Angeles over a 10-month period. Of 3,417 adults over 50 presenting to the Emergency Department (ED), charts of 107, whose urine toxicology screens were positive for illicit drugs, were reviewed retrospectively. Cocaine was used most frequently (63%), followed by opiates (16%) and marijuana (14%). These rates of drug usage essentially mirror those seen in the general population of the Los Angeles area. Fifty-nine percent of patients using illicit drugs had cardiovascular disease compared with 10% of all older adults upon initial presentation to the ED. The use of illicit drugs by older persons may be an expanding phenomenon conferring serious but unrecognized health risks, and is in need of further study.