Experiences of Organization for Economic Cooperation and Development countries with recruiting and retaining physicians in rural areas

Although there has been little evaluation of policy interventions, physician shortages in rural areas may be reduced by supply side policies that focus on the physician in combination with measures to sustain the economic and social viability of rural communities.

Abstract

Abstract Objective: This present study discusses the potential pitfalls in measuring physician shortages in rural areas and presents existing evidence of the effectiveness of policy interventions designed to influence the geographical distribution of physicians. Design: Information on the geographical distribution of physicians was derived from a survey of Organization for Economic Cooperation and Development (OECD) countries and a desk review of the academic literature and policy documents of OECD governments. Main outcome measure: Whether policies have been effective in recruiting and retaining physicians in rural areas. Results: Existing measures of physician shortages in rural areas may be misleading as they do not account for a number of supply side factors (e.g. physician productivity, mobility of physicians across areas) and demand‐side factors (e.g. patient needs for physician services). Increases in the national number of physicians have narrowed, but not eliminated, shortages in rural areas. Some success in increasing physician supply to rural areas has been reported with educational, regulatory and financial policies; whereas countries’ experiences with education‐related funding policies are mixed. There is some evidence suggesting that the effectiveness of these policies can be enhanced by supporting occupational opportunities for the spouse/partner, education of children and accommodation. Conclusions: Although there has been little evaluation of policy interventions, physician shortages in rural areas may be reduced by supply side policies that focus on the physician in combination with measures to sustain the economic and social viability of rural communities. What is already known on this subject?: Numerous studies have reported inequalities in the geographical distribution of physicians, but this has not taken into account physician activity levels or patient needs for physician services. Little is known about the effectiveness of policies designed to influence the geographical distribution of physicians. What does this study add?: The present study suggests that increasing physician numbers does not change their geographical distribution, but educational, regulatory and financial policies may be effective. The findings on loan repayment schemes are mixed. To attract more physicians to rural areas, these supply side policies may need to be accompanied by policies that sustain the economic and social viability of rural communities.