Comparative Assessment of the J1 Visa and State Loan Repayment Programs in the Recruitment and Retention of Physicians in Rural Nebraska

Document Type

Presentation

Presentation Date

6-1-2014

Abstract or Description

Research Objective: Nebraska, like most states in the United States, has a significant maldistribution of physicians. Majority of the physicians are located in urban areas even though rural populations make up 40% of the state population. Programs such as the J1 visa waiver and loan repayment programs have been introduced in attempts to encourage practice in rural and underserved areas. The J1 Visa program targets medical graduates from other countries that allow them to become permanent residents if they practice in rural and underserved areas for 3 or more years. The loan repayment program, on the other hand, provides loan repayments for US medical graduates to encourage them to practice in health professional shortage areas for at least 2 years. The objective of the study was to compare the length of stay and migratory factors for physician beneficiaries of the J1 visa and state loan repayment programs in rural Nebraska.

Study Design: A longitudinal study design was used Data on physician individual level characteristics was provided by the Health Professionals Tracking Service (HPTS) which can be constructed longitudinally for physicians and their practice locations in Nebraska. Physicians were retrospectively followed between 1997-2012 to identify when they first moved to rural Nebraska and when they subsequently moved to an urban area or out of Nebraska. Movement from one rural area to another was considered a continuation of time spent in rural region. The Nebraska State Joint Data Center provided information on physician family information which was used to create three categories of physicians; single, married without children, married with children. The Area Resource File (ARF) provided county-level socioeconomic information. This information was lagged by a year to assess their effect on physician migration. Analysis was conducted at the county level based on the survival model, using SAS 9.3.

Population Studied: The study was restricted to J1 visa waiver and State Loan Repayment program physician beneficiaries in Rural Nebraska from 1997 to 2012.

Principal Findings: The two programs together recruited 240 physicians to rural Nebraska (State loan repayment 112; J1 visa 128). Majority of the physicians were male (72.08%), had families (51.25%) and were primary physicians (54.17%). The mean length of stay for J1 visa waiver and state loan repayment beneficiaries was 4 and 6 years respectively. Findings suggest that J1 visa recipient are more likely to leave rural Nebraska compared to state loan repayment program recipients. In addition, older physicians and primary care physicians are more likely to stay. Even though there was a negative association between leaving a rural practice location and having a family (being married without children or being married with children), this association was only marginally significant.

Conclusions: The findings from this study may inform policies on the recruitment and retention of physicians to rural Nebraska.

Implications for Policy, Delivery, or Practice: For policy makers and public health practitioners, the results of study suggests that reliance on International Medical Graduates to serve the needs of rural areas is at best a short term measure. Longer lasting solutions need to sought.

Sponsorship/Conference/Institution

Academy Health Annual Research Meeting (ARM)

Location

San Diego, CA

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