Is Training Physician Associates in a Rural Area Associated With Them Choosing a Rural Position? A Repeated Cross-Sectional Quasi-Experiment.

Abstract

Introduction: There has long been a shortage of health care providers in rural areas. Interventions that have been shown to increase rural recruitment have yet to be explored in physician associates (PAs). This study seeks to identify the association between PA training site and first job location.

Methods: We conducted a repeated cross-sectional analysis of recent PA graduates' data at one institution. The institution consists of 2 campuses, an urban and rural campus. We analyzed the data using multivariable logistic regression.

Results: We analyzed 7 cohorts (n = 601) of students, of whom 26.29% (n = 158) trained at the rural campus. There were no significant differences between campus locations on any sociodemographic characteristics, except race (White, rural = 78.48% vs. urban = 68.85%, P = .02). Students were more likely to choose a job in a rural area when they completed more rural rotations (odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.22-1.70), controlling for primary care specialty, gender identity, attending a rural campus, and being raised in an economically disadvantaged area. In a sensitivity analysis of more recent cohorts, we found similar results. Training at a rural campus or completing rural rotations were not associated with obtaining jobs in primary care health professional shortage areas or medically underserved areas.

Discussion: Similar to research in medical students, PAs who complete clinical training in rural areas may be more likely to choose their first job in a rural area, independent of where they were raised. This has policy and institutional implications to address access to care disparities for rural populations.