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Date of Award

Spring 4-1-2012

Author's School

College of Arts & Sciences

Author's Department/Program

Anthropology

Abstract

In 2011, more than 50 million Americans lacked access to adequate health care. Rural Americans constitute one of the most underserved groups in the United States, and face many unique barriers to accessing appropriate health care, including primary care. The state of Kansas contains one of the largest rural populations in the United States. Increasing the number of primary care physicians in rural areas is a most basic method to decrease the rural health care disparity. In effort to increase this workforce, many government and private organizations offer substantial financial incentives, including loan forgiveness programs, to physicians in exchange for a service commitment in underserved rural areas. However, physician recruitment and retention remains a formidable and enduring challenge in rural America. The low retention rates of primary care physicians are especially alarming. Factors influencing retention remain poorly understood and are of intense interest for lessening rural health care access disparities. The overwhelming majority of the literature on retention-related factors is focused on negative dynamics that cause physicians to leave rural and underserved communities.

The purpose of this project is to explore the factors that reinforce and increase the retention of established rural physicians by using an anthropological lens. This project accomplishes this goal using a dual approach: 1) Through a literature-based analysis this project examines the themes of the larger culture of American medicine and the values held by its physician members, as well as the values and themes unique to rural American medical culture from a largely etic perspective; 2) The project presents and discusses a series of original qualitative interviews with longtime rural Kansas physicians who serve as key informants and describe their emic perceptions of rural medicine.

Project results indicate that several factors based in anthropology encourage physician retention in rural areas. These factors are intrinsically linked to the cultures of both rural medicine and rural communities, and strongly resonate with many of the cultural ideals of American physicians. This project also dispels several common negative myths and associations of rural medicine. The results of this project included two highlights: 1) a new understanding of the relationship between rural medical realities and the ideals of professional medical culture, 2) the value of developing an emic understanding of rural medical culture. Together, these two ideas – and their previously unforeseen or under-stressed components – can be valuable in the future development of policies and interventions aimed decreasing rural health disparities by increasing rural physician retention.

Language

English (en)

Advisor/Committee Chair

Bradley Stoner, MD, PhD

Advisor/Committee Chair's Department

Department of Anthropology