Date of Award

Spring 5-2019

Degree Type

Dissertation/Thesis

Degree Name

Doctor of Philosophy (PhD)

Advisor(s)

STEPHEN H. LINDER, PHD

Second Advisor

LINDA HIGHFIELD, PHD

Third Advisor

PAMELA DIAMOND, PHD

Abstract

This study aims to gain a better understanding of primary care (PC) physician movements in Texas between 2010 and 2014. The first and second objectives were to identify the person- and place-specific factors associated with those physicians moving to PC shortage counties. The third objective was to clarify the policy landscape related to PC shortage and identify any associations these policies had with changes to PC physicians’ movements. The methods combined quantitative and qualitative approaches. The study used data on licensed physicians from the Texas Medical Board, and data on Health Professionals Shortage Areas from the Texas Health Professions Resource Center. Descriptive, bivariate, and multivariate analyses were conducted to answer the research questions on person- and place-specific factors. The policy component involved a systematic desk review, and comparative analyses to identify whether the introduction of policies was associated with changes in the physician moves. From 29,343 unique PC physicians, 73% never moved counties. Physicians’ gender, age, medical school (public/private), degree (DO/MD), and Medicaid enrollment status, all had significant associations with their movements. At the Texas level, physician outflow was greater than their influx. As for shortage counties, they had lower rates of crime and infant deaths compared to non-shortage counties. Moreover, a population of 50,000 or more, and the presence of Federally Qualified Health Centers increased the odds of PC physicians moving to shortage counties. The desk review showed that federal policies and programs on PC shortage were stable throughout the study timeframe. While the state policy scene was more dynamic, with over 50 relevant bills enacted between 2007 and 2015. The comparative policy analysis revealed a statistically significant difference in the movement origins for only one bill requiring international physicians to work in underserved areas. Person- and place-specific factors have a significant association with physician movements in Texas. However, it is challenging to determine the effect of a single policy on the movement patterns of physicians. Additional research is needed, involving primary data collection, covering a longer period, and accounting for other confounding person- and place specific factors to improve our understanding of physicians’ motives to move to shortage areas.

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