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Practice Locations of Graduates of a Social Pediatrics Residency
To the Editor: There has been an ongoing decline in the number of primary care physicians working in underserved areas.1-2 To help address this problem, the Albert Einstein College of Medicine and Montefiore Medical Center initiated the Residency Program in Social Pediatrics (RPSP) in 1970. The goal was to train pediatricians who would possess the skills and willingness to practice in underserved communities and would remain in those settings for extended periods.3-4 We assessed the practice locations of all RPSP graduates who participated in the program between July 1970 and June 2002.
Methods
We conducted a mail survey of all 183 RPSP graduates. Respondents were asked to characterize their practice locations using standard federal government designations for underserved locations (ie, Health Professions Shortage Area, Neighborhood or Community Health Center, Medically Underserved Area, Federally-Funded Health Center, and Indian Reservation).
Results
A total of 147 (80%) graduates responded. Of the respondents, 65% were men, 45% were white, 20% were Hispanic, 16% were black, and 9% were Asian. Overall, 28% of respondents graduated in the 1970s, 15% in the 1980s, 44% in the 1990s, and 13% in the 2000s. On average, graduates' patient panels comprised 70% Medicaid or uninsured patients and 28% self-pay or privately insured patients.
At the time of the survey, 91% of graduates were practicing in urban or rural settings, 70% in a medically underserved area, 54% in a health professions shortage area, 51% at a community health center, 49% in a federally funded health center, and 3% in an Indian reservation. When asked about previous locations of medical practice since graduation, 93% had practiced in a medically underserved area, 81% at a community health center, 72% in a health professions shortage area, 72% in a federally-funded health center, and 9% had practiced in an Indian reservation.
Eighty-three percent of graduates reported that the RPSP had an "extremely high" impact on their choice of medical practice settings, 14% reported a "moderate" impact, whereas only 3% reported "little" impact on their choice of practice setting.
Comment
A majority of RPSP graduates were engaged in medical practice in underserved areas in keeping with the stated mission of the program. It is possible that many graduates were already committed to work in underserved areas, and chose our program because it was concordant with their career plans. On the other hand, it is also possible that the experience in our program supported and strengthened their commitment to working in a health-shortage area. Although the relative contribution of these factors is unclear, we would anticipate that other such programs could have similar success rates in encouraging medical careers in underserved areas.
Philip O. Ozuah, MD, PhD
Albert Einstein College of Medicine
Children's Hospital at Montefiore
Bronx, NY
Sheldon L. Stick, PhD
Department of Educational Administration
The Center for the Study of Higher and Postsecondary Education
University of Nebraska–Lincoln
1. Rivo ML, Kindig DA. A report card on the physician work force in the United States. N Engl J Med. 1996;334:892-896.
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2. Newshouse JP. Where have all the doctors gone? JAMA. 1982;247:2392-2396.
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3. Boufford J. Primary care residency training: the first five years. Ann Intern Med. 1977;87:359-368.
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4. Strelnick AH, Bateman WB, Jones C, et al. Graduate primary care training: a collaborative alternative for family practice, internal medicine, and pediatrics. Ann Intern Med. 1988;109:324-334.
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Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
JAMA. 2003;290:1154.
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