Download Physicians in Rural and Underserved Areas

Physicians Practicing in Rural and
Underserved Areas of Mississippi
Jeralynn Cossman
Debra Street
Rural/Non-Rural Counties
in Mississippi
HPSA/Non-HPSA Counties
in Mississippi
Both Rural and Underserved
Counties in Mississippi
Analytic Sample Descriptive Statistics by
Rural/Urban Practice Location
Analytic Sample Descriptive Statistics by
HPSA/non-HPSA Practice Location
Race Composition of MS MDs
Gender Composition of MS MDs
Age Composition of MS MDs
Mississippi Physicians:
Characteristics and Experiences of
Physicians in an Underserved State
Most Important Source of
Professional Satisfaction by Race
60%
50%
40%
30%
White
African American
20%
Other
10%
0%
High Income
Substantial
Intellectual
Challenge
Good Patient
Relationships
Congenial
Practice
Environment
Most Important Source of
Professional Satisfaction by Gender
45%
40%
35%
30%
25%
Men
20%
Women
15%
10%
5%
0%
High Income
Substantial Intellectual
Challenge
Good Patient
Relationships
Congenial Practice
Environment
Most Important Source of
Professional Satisfaction by Age Group
60%
50%
40%
30%
Under 40
40-59 years
20%
60 and older
10%
0%
High Income
Substantial
Intellectual
Challenge
Good Patient
Relationships
Congenial Practice
Environment
Physician Perspectives on
Challenging Patients by Race
Physician Perspectives on
Challenging Patients by Gender
Physician Perspectives on
Challenging Patients by Age Group
Age, Race, and Gender
with Patient Relationships
• Good patient relationships are important
• Most physicians report “complex” patients
• These things don’t vary substantially by age,
race or gender
Patient Payment Method
by Physician Race
35%
30%
25%
20%
15%
10%
5%
0%
Self-pay/Cash
Charity or
Uncompensated
Care
Other
4%
9%
6%
4%
3%
10%
7%
3%
4%
9%
9%
7%
Private Health
Insurance
Medicare
Medicaid
SCHIPs
White
28%
29%
21%
African American
18%
27%
32%
Other
20%
23%
27%
Patient Payment Method
by Physician Gender
35%
30%
25%
20%
15%
10%
5%
0%
Self-pay/Cash
Charity or
Uncompensated
Care
Other
3%
8%
7%
3%
4%
11%
6%
5%
Private Health
Insurance
Medicare
Medicaid
SCHIPs
Men
27%
31%
20%
Women
25%
19%
29%
Patient Payment Method
by Physician Age Group
35%
30%
25%
20%
15%
10%
5%
0%
Private Health
Insurance
Medicare
Medicaid
SCHIPs
Self-pay/Cash
Charity or
Uncompensated
Care
Other
Under 40
27%
25%
26%
6%
8%
7%
1%
40-59 years
28%
29%
22%
4%
8%
6%
3%
60 and older
24%
30%
19%
3%
9%
7%
7%
Patient Payment
by Race, Gender and Age
• White physicians are most likely to have
private pay patients, while black physicians
are more likely to have Medicaid patients
• Men physicians are more likely to have
Medicare patients and women physicians are
more likely to have Medicaid patients
• No real differences in payment by age
Changes in Patient Access
by Physician Race
How far patients travel for primary care*
How far patients travel for specialty care*
How far patients travel for surgical procedures*
Waiting times for patient appointments
Waiting times in the emergency room
Waiting times for specialist referrals
Interruptions in continuity of primary care*
Loss of health insurance coverage*
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
Large
Increase
5%
12%
6%
12%
22%
20%
8%
16%
21%
13%
19%
13%
23%
36%
19%
18%
32%
27%
10%
29%
2%
19%
35%
27%
Small
Increase
25%
27%
40%
26%
31%
31%
23%
27%
27%
33%
33%
43%
30%
26%
44%
41%
27%
42%
34%
32%
61%
45%
41%
53%
No Change
68%
59%
48%
59%
44%
41%
67%
54%
42%
47%
42%
36%
35%
32%
30%
38%
35%
27%
55%
38%
33%
33%
24%
16%
Small
Decrease
2%
3%
6%
4%
0%
6%
2%
3%
10%
6%
6%
6%
10%
7%
7%
4%
6%
4%
1%
0%
4%
2%
0%
4%
*Significant at the .10 level.
Rows may not equal 100% due to rounding.
Non-white physicians are more likely to report changes in
patient access issues than white physicians.
Large
Decrease
0%
0%
0%
0%
3%
2%
0%
0%
0%
0%
0%
2%
2%
0%
0%
0%
0%
0%
0%
0%
0%
1%
0%
0%
Sig.
0.03
0.01
0.00
0.34
0.46
0.35
0.00
0.10
Changes in Patient Access
by Physician Gender
How far patients travel for primary care*
How far patients travel for specialty care
How far patients travel for surgical procedures
Waiting times for patient appointments
Waiting times in the emergency room
Waiting times for specialist referrals
Interruptions in continuity of primary care
Loss of health insurance coverage*
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Large
Increase
6%
7%
12%
14%
9%
10%
13%
16%
22%
30%
18%
23%
11%
12%
20%
21%
Small
Increase
25%
28%
25%
33%
21%
31%
33%
38%
30%
33%
39%
43%
35%
41%
42%
59%
No Change
68%
60%
59%
49%
66%
55%
48%
38%
36%
30%
39%
29%
53%
47%
34%
18%
Small
Decrease
1%
6%
4%
4%
3%
4%
6%
8%
11%
6%
3%
5%
1%
0%
2%
2%
Large
Decrease
0%
0%
0%
1%
0%
0%
0%
0%
2%
1%
0%
0%
0%
0%
1%
0%
*Significant at the .10 level.
Rows may not equal 100% due to rounding.
Men physicians are no more likely to report changes in patient
access issues than women physicians.
Sig.
0.01
0.29
0.13
0.31
0.17
0.21
0.52
0.00
Changes in Patient Access
by Physician Age Group
How far patients travel for primary care
How far patients travel for specialty care
How far patients travel for surgical procedures
Waiting times for patient appointments
Waiting times in the emergency room
Waiting times for specialist referrals
Interruptions in continuity of primary care*
Loss of health insurance coverage
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Large
Increase
12%
12%
16%
12%
12%
16%
12%
9%
10%
16%
14%
12%
23%
23%
24%
18%
19%
20%
10%
11%
9%
15%
20%
23%
Small
Increase
25%
28%
22%
25%
29%
22%
17%
24%
25%
28%
35%
34%
23%
33%
31%
42%
39%
41%
25%
40%
30%
44%
48%
40%
No Change
57%
56%
60%
57%
56%
60%
64%
64%
65%
47%
45%
48%
42%
33%
35%
36%
37%
35%
64%
48%
58%
40%
29%
35%
Small
Decrease
6%
4%
3%
6%
4%
3%
6%
3%
1%
9%
5%
7%
11%
11%
9%
2%
4%
3%
1%
1%
2%
0%
3%
1%
*Significant at the .10 level.
Rows may not equal 100% due to rounding.
Older physicians are not generally more likely to report
changes in patient access issues than younger physicians.
Large
Decrease
1%
1%
0%
1%
1%
0%
1%
0%
0%
0%
1%
0%
1%
1%
2%
1%
0%
0%
0%
0%
1%
1%
0%
2%
Sig.
0.87
0.54
0.36
0.83
0.85
0.89
0.04
0.11
Average Hours Spent on Professional
Activities in a Typical Week (excluding
call) by Race, Gender and Age Group
Percent of Physicians Taking Call by
Race, Gender and Age Group
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
79%
72%
81%
79%
73%
73%
75%
62%
Perceived Control over
Practice Conditions by Race
The physicians to whom you refer patients
When to admit patients to the hospital
Length of patient hospital stays
The specific medications patients receive
Details of your primary practice or clinic
schedule
Which diagnostic tests you order
The volume of paperwork that you have to do
The hours you work
Volume of your patient load
Pre-authorization for patient services
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
None
10%
12%
23%
8%
9%
16%
29%
24%
12%
4%
12%
12%
8%
21%
17%
2%
3%
7%
42%
50%
31%
11%
19%
12%
22%
27%
28%
53%
55%
49%
Some
25%
49%
27%
16%
36%
26%
22%
36%
42%
36%
39%
36%
25%
30%
26%
12%
16%
16%
44%
28%
38%
48%
44%
49%
42%
39%
37%
35%
24%
42%
Much
33%
21%
30%
38%
33%
28%
34%
30%
32%
50%
36%
41%
40%
21%
36%
52%
59%
49%
12%
19%
19%
30%
22%
28%
25%
21%
23%
10%
12%
7%
Complete
33%
18%
21%
38%
21%
30%
16%
9%
15%
10%
12%
12%
28%
27%
21%
34%
22%
28%
3%
3%
12%
12%
16%
12%
10%
12%
12%
2%
9%
2%
Sig.
0.01
0.02
0.05
0.11
0.07
0.37
0.02
0.83
0.94
0.20
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
Non-white physicians perceive less control over practice
conditions than white physicians (5 of 10 items).
Perceived Control over
Practice Conditions by Gender
The physicians to whom you refer patients
When to admit patients to the hospital
Length of patient hospital stays
The specific medications patients receive*
Details of your primary practice or clinic
schedule*
Which diagnostic tests you order
The volume of paperwork that you have to do
The hours you work*
Volume of your patient load*
Pre-authorization for patient services
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
None
11%
11%
8%
12%
26%
33%
5%
4%
9%
13%
3%
1%
41%
42%
10%
17%
22%
26%
52%
58%
Some
25%
32%
17%
23%
24%
28%
34%
46%
23%
37%
11%
17%
43%
39%
48%
47%
42%
42%
36%
33%
Much
32%
30%
37%
37%
35%
26%
51%
39%
39%
32%
52%
54%
13%
12%
31%
20%
27%
17%
10%
9%
Complete
32%
28%
38%
29%
15%
13%
10%
11%
30%
19%
34%
29%
3%
7%
11%
17%
10%
15%
3%
1%
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
Women physicians perceive less control over practice
conditions than men physicians (4 of 10 items).
Sig.
0.49
0.11
0.19
0.06
0.00
0.13
0.22
0.01
0.05
0.47
Perceived Control over
Practice Conditions by Age Group
The physicians to whom you refer patients
When to admit patients to the hospital
Length of patient hospital stays*
The specific medications patients receive
Details of your primary practice or clinic
schedule
Which diagnostic tests you order*
The volume of paperwork that you have to
do*
The hours you work*
Volume of your patient load*
Pre-authorization for patient services
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
None
5%
10%
14%
4%
9%
11%
25%
28%
27%
3%
5%
8%
7%
10%
8%
3%
2%
5%
37%
44%
37%
16%
11%
9%
35%
23%
13%
49%
56%
54%
Some
25%
25%
29%
15%
18%
21%
13%
23%
35%
32%
37%
39%
29%
24%
25%
8%
12%
16%
43%
41%
44%
38%
51%
44%
34%
45%
40%
37%
34%
34%
Much
36%
34%
25%
35%
38%
33%
37%
34%
26%
50%
50%
46%
32%
39%
38%
40%
58%
45%
12%
13%
12%
34%
29%
29%
23%
23%
30%
12%
8%
10%
Complete
33%
30%
32%
46%
35%
35%
25%
15%
12%
16%
9%
8%
32%
27%
29%
50%
29%
35%
8%
2%
7%
12%
10%
18%
8%
9%
16%
3%
2%
3%
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
Older physicians perceive less control over practice
conditions than younger physicians (5 of 10 items).
Sig.
0.30
0.36
0.00
0.29
0.79
0.00
0.03
0.07
0.00
0.69
Levels of Stress and Burnout
Enjoy my
work, not
stressed
Race
White
African American
Other
Gender
Men
Women
Age group
Under 40
40-59 years
60 and older
Occasionally One or more
stressed, not symptoms
burned out
of burnout
Burnout
symptoms
won't go
away
So burned
out I need
help
Sig.
20%
33%
19%
55%
49%
55%
20%
15%
19%
4%
3%
6%
1%
0%
0%
0.80
22%
17%
54%
59%
20%
16%
4%
5%
0%
4%
0.00
33%
13%
34%
55%
57%
50%
10%
23%
13%
2%
6%
2%
0%
1%
1%
0.00
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
Women report more stress than men and physicians 40-59
report more stress than those who are younger or older.
Percent of Physicians Named
in a Lawsuit by Race
20
18
16
14
12
2004
10
2005
8
2006
6
4
2
0
White
African American
Other
Percent of Physicians Named
in a Lawsuit by Gender
25
20
15
2004
2005
10
2006
5
0
Men
Women
Percent Physicians Named
in a Lawsuit by Age Group
20
18
16
14
12
2004
10
2005
8
2006
6
4
2
0
Under 40
40-59
60 and older
Malpractice and Liability Climate
by Race, Gender and Age Group
Rate each of the following items relating to
your practice climate in Mississippi
Medical malpractice conditions*
Availability of liability insurance*
Medical malpractice conditions
Availability of liability insurance
Medical malpractice conditions*
Availability of liability insurance
White
African American
Other
White
African American
Other
Men
Women
Men
Women
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Poor
Fair
Average
Good
Excellent
Sig.
23%
55%
46%
16%
40%
36%
25%
27%
19%
16%
29%
28%
21%
10%
21%
15%
39%
32%
27%
34%
37%
36%
37%
40%
33%
40%
41%
38%
33%
41%
34%
29%
29%
13%
20%
32%
13%
17%
27%
28%
30%
30%
27%
26%
32%
34%
28%
33%
9%
0%
5%
17%
10%
10%
9%
4%
17%
13%
3%
8%
14%
15%
15%
20%
1%
0%
2%
2%
0%
2%
1%
0%
2%
1%
0%
1%
1%
0%
2%
2%
0.00
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
Non-white physicians perceive the liability climate to be
worse than white physicians, but there are no
differences by age or gender.
0.00
0.38
0.50
0.09
0.17
Defensive Medicine by Race
How often do concerns about medical
malpractice liability cause you to…
Order more tests than you would based on
your professional judgement of what is
medically needed?
Prescribe more medications, such as
antibiotics, than you would based only on
your professional judgement of what is
Refer patients to specialists more often than
you would based only on your professional
judgement
Suggest invasive procedures, such as biopsies,
to confirm diagnoses more often than you
would based only on your professional
Avoid personally conducting certain
procedures or interventions?
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
Never,
Sometimes,
almost
Sometimes,
less than
never, less
about once
once in 6
than once a
a month
months
year
8%
17%
23%
22%
22%
19%
7%
26%
26%
14%
27%
23%
26%
26%
13%
14%
26%
31%
10%
23%
25%
13%
26%
19%
17%
21%
21%
22%
30%
22%
38%
25%
6%
22%
29%
24%
19%
20%
23%
31%
10%
35%
20%
28%
23%
Often, at
least once
per week
Regularly,
daily or
almost daily
27%
16%
17%
22%
26%
14%
25%
19%
26%
15%
16%
12%
21%
10%
13%
25%
22%
24%
15%
10%
14%
17%
23%
14%
11%
16%
12%
17%
14%
18%
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
There are no racial differences in the reporting of defensive
medicine practices.
Sig.
0.15
0.53
0.90
0.44
0.33
Defensive Medicine by Gender
Never, almost
Sometimes, less Sometimes,
never, less
than once in 6 about once a
than once a
months
month
year
How often do concerns about medical malpractice liability
cause you to…
Order more tests than you would based on your professional
judgement of what is medically needed?
Prescribe more medications, such as antibiotics, than you
would based only on your professional judgement of what is
medically needed?
Refer patients to specialists more often than you would
based only on your professional judgement
Suggest invasive procedures, such as biopsies, to confirm
diagnoses more often than you would based only on your
professional judgement?
Avoid personally conducting certain procedures or
interventions?
Often, at
least once
per week
Regularly, daily
or almost daily
Sig.
0.00
Men
9%
16%
21%
26%
28%
Women
9%
25%
33%
22%
11%
Men
14%
25%
23%
21%
17%
Women
17%
36%
23%
21%
3%
Men
11%
23%
22%
25%
19%
Women
10%
24%
35%
25%
7%
Men
22%
27%
22%
16%
12%
Women
27%
38%
18%
11%
6%
Men
19%
19%
21%
21%
19%
Women
22%
23%
35%
15%
6%
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
Men physicians are more likely to report defensive medicine
practices than women physicians.
0.00
0.01
0.04
0.00
Defensive Medicine by Age Group
How often do concerns about medical malpractice liability
cause you to…
Order more tests than you would based on your professional
judgement of what is medically needed?
Prescribe more medications, such as antibiotics, than you
would based only on your professional judgement of what is
medically needed?
Refer patients to specialists more often than you would
based only on your professional judgement
Suggest invasive procedures, such as biopsies, to confirm
diagnoses more often than you would based only on your
professional judgement?
Avoid personally conducting certain procedures or
interventions?
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Never,
Sometimes,
almost
Sometimes, Often, at least Regularly,
less than
never, less
about once a
once per
daily or
once in 6
than once a
month
week
almost daily
months
year
8%
15%
30%
29%
18%
8%
18%
22%
23%
29%
12%
21%
22%
28%
17%
13%
25%
23%
29%
9%
12%
27%
23%
22%
16%
24%
29%
21%
15%
12%
8%
21%
29%
29%
12%
9%
23%
23%
26%
20%
17%
27%
23%
21%
12%
21%
32%
24%
16%
7%
21%
29%
21%
17%
13%
30%
30%
20%
12%
9%
23%
19%
32%
24%
3%
18%
18%
25%
20%
20%
22%
27%
14%
19%
19%
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
Physicians who are 40-59 are more likely to report defensive
medicine practices than physicians who are younger or older.
Sig.
0.08
0.02
0.05
0.31
0.00
Recruitment and Retention
by Race
Rate each of the following items relating to your
practice climate in Mississippi
Recruiting new physicians*
Retaining experienced physicians*
Recruiting minority physicians*
Retaining experienced minority physicians*
Recruiting women physicians*
Retaining experienced women physicians*
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
Poor
Fair
Average
Good
Excellent
Sig.
43%
38%
62%
19%
38%
33%
19%
58%
29%
16%
49%
24%
16%
46%
21%
14%
46%
24%
36%
41%
21%
39%
41%
29%
33%
21%
29%
32%
33%
32%
34%
30%
48%
31%
33%
39%
18%
19%
14%
28%
13%
33%
31%
15%
29%
38%
15%
27%
37%
18%
19%
40%
15%
27%
3%
0%
0%
13%
6%
2%
15%
3%
7%
13%
3%
12%
12%
3%
7%
13%
3%
5%
0%
3%
2%
1%
3%
2%
2%
3%
5%
2%
0%
5%
2%
3%
5%
2%
3%
5%
0.08
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
Minority physicians are more likely to report concerns with
recruitment and retention than white physicians.
0.02
0.00
0.00
0.00
0.00
Recruitment and Retention
by Gender
Rate each of the following items relating to your
practice climate in Mississippi
Recruiting new physicians
Retaining experienced physicians
Recruiting minority physicians
Retaining experienced minority physicians
Recruiting women physicians*
Retaining experienced women physicians*
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Poor
Fair
Average
Good
Excellent
Sig.
44%
46%
21%
19%
22%
25%
19%
18%
17%
20%
17%
16%
35%
33%
37%
44%
32%
35%
29%
42%
33%
42%
29%
44%
18%
19%
28%
27%
31%
25%
37%
29%
36%
30%
39%
31%
3%
2%
13%
10%
13%
14%
13%
10%
12%
8%
13%
9%
1%
0%
2%
0%
2%
2%
2%
2%
3%
0%
2%
1%
0.75
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
Women physicians are more likely to report concerns with
recruitment and retention of women physicians than men
physicians are.
0.37
0.67
0.13
0.07
0.03
Recruitment and Retention
by Age Group
Rate each of the following items relating to your
practice climate in Mississippi
Recruiting new physicians*
Retaining experienced physicians
Recruiting minority physicians
Retaining experienced minority physicians
Recruiting women physicians*
Retaining experienced women physicians*
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Poor
Fair
Average
Good
Excellent
Sig.
30%
48%
38%
15%
22%
20%
19%
23%
22%
14%
19%
19%
7%
21%
13%
7%
19%
15%
41%
33%
38%
39%
40%
33%
32%
33%
33%
38%
33%
27%
38%
36%
32%
37%
33%
27%
22%
17%
18%
28%
27%
30%
32%
28%
30%
37%
34%
36%
43%
31%
39%
45%
33%
42%
7%
2%
4%
14%
11%
16%
12%
14%
14%
10%
13%
15%
8%
11%
15%
7%
13%
14%
1%
0%
2%
4%
1%
2%
4%
2%
2%
3%
1%
3%
4%
2%
2%
4%
2%
2%
0.04
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
Older physicians are more likely to report concerns with
recruitment and retention of women physicians than younger
physicians are.
0.27
0.95
0.52
0.04
0.07
Physician Supply is a
Problem for Own Practice
66%
70%
60%
58%
55%
58% 59%
59%
63%
48%
50%
40%
30%
20%
10%
0%
Race
Gender
Age Group
Reimbursement Climate
by Race
Rate each of the following...
Medicaid reimbursement rates
Medicare reimbursement rates*
Private insurance reimbursement rates*
Manageable amount of uncompensated care
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
Poor
69%
61%
66%
54%
57%
58%
16%
33%
24%
46%
60%
57%
Fair
20%
36%
27%
29%
33%
33%
41%
50%
41%
31%
30%
24%
Average
10%
3%
7%
16%
10%
8%
35%
13%
36%
19%
10%
17%
Good
2%
0%
0%
1%
0%
0%
8%
3%
0%
4%
0%
2%
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
Minority physicians are more likely to report concerns with
Medicare and private reimbursement rates than white
physicians. There are no racial differences in perception of
Medicaid reimbursement rates or uncompensated care.
Excellent
0%
0%
0%
0%
0%
3%
0%
0%
0%
0%
0%
0%
Sig.
0.35
0.03
0.03
0.50
Reimbursement Climate
by Gender
Rate each of the following...
Medicaid reimbursement rates
Medicare reimbursement rates
Private insurance reimbursement rates*
Manageable amount of uncompensated care*
Men
Women
Men
Women
Men
Women
Men
Women
Poor
70%
63%
54%
55%
20%
10%
45%
58%
Fair
21%
24%
30%
28%
40%
50%
32%
25%
Average
8%
12%
15%
16%
33%
35%
19%
15%
Good
2%
1%
1%
1%
7%
4%
4%
3%
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
Men physicians are more likely to report concerns with
private reimbursement rates than women physicians. There
are no gender differences in perception of Medicaid or
Medicare reimbursement rates or uncompensated care.
Excellent
0%
0%
0%
0%
0%
0%
0%
0%
Sig.
0.38
0.97
0.04
0.09
Reimbursement Climate
by Age Group
Rate each of the following...
Medicaid reimbursement rates
Medicare reimbursement rates*
Private insurance reimbursement rates
Manageable amount of uncompensated care
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Poor
62%
70%
70%
44%
57%
55%
11%
19%
19%
45%
50%
43%
Fair
25%
21%
19%
41%
28%
30%
39%
41%
45%
34%
31%
28%
Average
11%
9%
8%
14%
15%
13%
46%
33%
29%
16%
16%
23%
Good
1%
1%
3%
0%
0%
2%
4%
7%
7%
4%
3%
6%
*Significant at the .10 level.
Rows may not add to 100% due to rounding.
Older physicians are more likely to report concerns with
Medicare reimbursement rates than younger physicians.
There are no age differences in perception of Medicaid or
Medicare reimbursement rates or uncompensated care.
Excellent
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
Sig.
0.32
0.04
0.28
0.32
The Quality of Patient
Relationships by Race
White
African American
Other
White
Many patients demand potentially unnecessary
African American
treatments.†
Other
White
I am isolated from my patients because of ethnic,
African American
cultural or gender differences.*†
Other
White
I often feel like what I do for my practice is just a
African American
drop in the bucket.†
Other
White
Time pressures keep me from developing good
African American
relationships with my patients.†
Other
White
I am overwhelmed by the needs of my patients.† African American
Other
White
My relationships with patients is more
African American
adversarial than it used to be.†
Other
White
I am having a positive impact on a socioAfrican American
economically disadvantaged population.*
Other
I feel a strong personal connection to my
patients.
Strongly
Agree
Agree
39%
52%
30%
13%
12%
19%
1%
0%
2%
6%
15%
4%
2%
10%
7%
4%
3%
2%
3%
0%
5%
16%
56%
18%
46%
39%
50%
40%
27%
33%
2%
9%
10%
30%
30%
18%
20%
17%
24%
17%
25%
27%
20%
16%
18%
51%
34%
59%
Neither
Agree nor Disagree
Disagree
9%
6%
18%
24%
33%
29%
18%
13%
24%
21%
21%
29%
27%
17%
29%
31%
28%
32%
21%
22%
15%
24%
9%
21%
5%
3%
2%
20%
18%
19%
43%
31%
37%
33%
24%
38%
41%
40%
33%
40%
25%
27%
40%
31%
35%
8%
0%
0%
Strongly
Disagree
1%
0%
0%
3%
9%
0%
37%
47%
27%
10%
9%
11%
10%
17%
7%
9%
19%
11%
15%
31%
28%
1%
0%
2%
*Significant at the .10 level.
† Question is reverse coded.
Rows may not add to 100% due to rounding.
Minority physicians are more likely to feel they are having a
positive impact on disadvantaged populations but also are
more likely to report feeling isolated from their patients.
Sig.
0.44
0.27
0.02
0.37
0.15
0.24
0.22
0.00
The Quality of Patient
Relationships by Gender
I feel a strong personal connection to my
patients.*
Many patients demand potentially unnecessary
treatments.*†
I am isolated from my patients because of ethnic,
cultural or gender differences.†
I often feel like what I do for my practice is just a
drop in the bucket.*†
Time pressures keep me from developing good
relationships with my patients.†
I am overwhelmed by the needs of my patients.†
My relationships with patients is more
adversarial than it used to be.*†
I am having a positive impact on a socioeconomically disadvantaged population.
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Strongly
Agree
Agree
37%
50%
14%
9%
0%
2%
5%
12%
3%
2%
3%
4%
4%
2%
17%
22%
47%
41%
40%
33%
3%
3%
30%
26%
21%
17%
20%
16%
22%
11%
51%
50%
Neither
Agree nor Disagree
Disagree
11%
5%
25%
25%
19%
13%
22%
22%
28%
21%
30%
34%
20%
24%
24%
20%
5%
4%
18%
31%
41%
45%
32%
36%
38%
48%
39%
35%
39%
42%
7%
9%
Strongly
Disagree
1%
0%
3%
3%
37%
37%
11%
5%
10%
12%
9%
11%
16%
21%
1%
0%
*Significant at the .10 level.
† Question is reverse coded.
Rows may not add to 100% due to rounding.
Men physicians are more likely to report that their patients are more
adversarial and demanding; women physicians are more likely to report a
strong personal connection and they what they do is a “drop in the bucket”.
Sig.
0.03
0.01
0.33
0.01
0.17
0.76
0.03
0.48
The Quality of Patient
Relationships by Age Group
I feel a strong personal connection to my
patients.*
Many patients demand potentially unnecessary
treatments.†
I am isolated from my patients because of ethnic,
cultural or gender differences.†
I often feel like what I do for my practice is just a
drop in the bucket.†
Time pressures keep me from developing good
relationships with my patients.*†
I am overwhelmed by the needs of my patients.†
My relationships with patients is more
adversarial than it used to be.*†
I am having a positive impact on a socioeconomically disadvantaged population.
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Strongly
Agree
Agree
37%
37%
48%
20%
15%
6%
0%
1%
1%
9%
7%
5%
7%
2%
3%
7%
3%
3%
3%
4%
3%
19%
18%
19%
40%
48%
40%
38%
38%
40%
5%
4%
1%
34%
29%
25%
30%
22%
10%
16%
20%
13%
20%
22%
13%
46%
52%
51%
Neither
Agree nor Disagree
Disagree
19%
8%
10%
25%
25%
27%
20%
18%
17%
15%
22%
25%
20%
27%
29%
32%
30%
32%
24%
20%
19%
20%
23%
24%
5%
6%
1%
16%
21%
23%
40%
42%
42%
39%
32%
32%
35%
41%
43%
35%
38%
41%
32%
40%
42%
15%
6%
6%
Strongly
Disagree
0%
1%
0%
1%
3%
5%
35%
36%
40%
4%
10%
14%
9%
9%
16%
10%
8%
12%
22%
14%
23%
0%
1%
0%
Sig.
0.01
0.11
0.70
0.14
0.00
0.25
0.10
0.19
*Significant at the .10 level.
† Question is reverse coded.
Rows may not add to 100% due to rounding.
Younger doctors feel time pressures prevent close patient
relationships and the oldest group of physicians are more
likely to report strong connections to their patients.
MD Family Experiences
by Race
My family and I are strongly connected to the
community where I work.*
My work schedule leaves me enough time for my
family.
The interruption of my personal life by work is a
problem.†
Living in close proximity to parents and/or
extended family is important to me.
My spouse (or partner) supports my career.
Work rarely encroaches on my personal time.
High quality schools are important in deciding
where I want to work and live.*
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
Strongly
Agree
Agree
24%
28%
7%
6%
10%
9%
5%
3%
2%
14%
28%
14%
44%
52%
49%
2%
9%
5%
27%
50%
43%
47%
30%
46%
37%
23%
41%
33%
33%
40%
47%
44%
44%
48%
41%
49%
19%
15%
21%
49%
33%
40%
Neither
Agree nor
Disagree
16%
36%
27%
17%
23%
18%
27%
27%
23%
20%
13%
23%
5%
7%
0%
17%
12%
25%
16%
3%
15%
Disagree
Strongly
Disagree
11%
6%
21%
33%
39%
25%
31%
27%
23%
15%
13%
7%
2%
0%
2%
45%
33%
36%
6%
10%
3%
2%
0%
0%
7%
7%
7%
3%
9%
12%
4%
3%
12%
1%
0%
0%
18%
30%
14%
2%
3%
0%
*Significant at the .10 level.
† Question is reverse coded.
Rows may not add to 100% due to rounding.
Other minority physicians feel less connected to the
community and minority physicians are more likely to report
the importance of high quality schools than white physicians.
Sig.
0.00
0.75
0.20
0.13
0.79
0.12
0.06
MD Family Experiences
by Gender
My family and I are strongly connected to the
community where I work.
My work schedule leaves me enough time for my
family.
The interruption of my personal life by work is a
problem.†
Living in close proximity to parents and/or
extended family is important to me.*
My spouse (or partner) supports my career.
Work rarely encroaches on my personal time.
High quality schools are important in deciding
where I want to work and live.
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Strongly
Agree
Agree
23%
23%
6%
6%
5%
4%
13%
21%
45%
42%
3%
2%
30%
29%
46%
48%
36%
38%
34%
35%
46%
49%
47%
50%
18%
20%
47%
50%
Neither
Agree nor
Disagree
18%
18%
17%
17%
27%
22%
21%
14%
5%
5%
18%
16%
16%
13%
Disagree
Strongly
Disagree
12%
10%
32%
36%
30%
34%
16%
8%
2%
2%
44%
43%
6%
6%
2%
0%
8%
4%
4%
4%
4%
7%
1%
1%
17%
20%
2%
2%
*Significant at the .10 level.
† Question is reverse coded.
Rows may not add to 100% due to rounding.
Women physicians are more likely to say they want to live
close to their family, but there are no other gender differences
in family experiences.
Sig.
0.57
0.56
0.73
0.01
0.97
0.94
0.95
MD Family Experiences
by Age Group
My family and I are strongly connected to the
community where I work.
My work schedule leaves me enough time for my
family.*
The interruption of my personal life by work is a
problem.*†
Living in close proximity to parents and/or
extended family is important to me*.
My spouse (or partner) supports my career.
Work rarely encroaches on my personal time.*
High quality schools are important in deciding
where I want to work and live.*
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Strongly
Agree
Agree
17%
23%
28%
10%
3%
12%
1%
7%
1%
21%
13%
14%
55%
41%
48%
4%
1%
7%
36%
30%
25%
49%
46%
45%
37%
35%
44%
44%
37%
19%
58%
46%
43%
42%
49%
46%
19%
15%
27%
49%
49%
41%
Neither
Agree nor
Disagree
18%
18%
17%
17%
18%
15%
27%
24%
33%
13%
20%
24%
3%
5%
5%
15%
15%
25%
11%
14%
22%
Disagree
Strongly
Disagree
13%
12%
9%
30%
35%
27%
26%
29%
38%
5%
16%
12%
0%
3%
1%
47%
46%
34%
4%
5%
9%
4%
2%
1%
6%
9%
3%
3%
3%
9%
4%
4%
7%
0%
1%
1%
15%
22%
7%
0%
2%
3%
*Significant at the .10 level.
† Question is reverse coded.
Rows may not add to 100% due to rounding.
Several age differences in family experiences are noted,
likely related to child-rearing and its timing in their
professional career.
Sig.
0.49
0.00
0.00
0.04
0.22
0.00
0.05
Community Perspectives by Race
Cost of living in a community is an important
consideration for where I want to work.*
Mississippi taxes are a burden.*†
People from elsewhere don't realize Mississippi is
a great place to live.*
I feel a sense of belonging to the community
where I practice.
Local amenities, like parks, shopping, and cultural
events, are important in deciding where I want to
work and live.*
I do not feel at home in the community where I
practice.*†
Practicing medicine in Mississippi is not much
different from practicing in other states.*
I feel respected by the community where I
practice.*
I am proud to practice medicine in Mississippi.
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
White
African American
Other
Strongly
Agree
Agree
10%
24%
27%
7%
16%
19%
28%
27%
23%
25%
27%
16%
13%
24%
18%
3%
0%
0%
4%
15%
8%
20%
33%
30%
30%
31%
34%
54%
49%
61%
28%
39%
19%
58%
49%
42%
54%
46%
58%
56%
33%
55%
8%
27%
14%
37%
27%
15%
65%
42%
57%
50%
47%
48%
Neither
Agree nor
Disagree
20%
12%
11%
34%
32%
37%
12%
21%
26%
13%
18%
18%
18%
27%
18%
13%
6%
16%
25%
12%
28%
12%
15%
9%
18%
13%
18%
Disagree
Strongly
Disagree
14%
12%
0%
26%
13%
19%
2%
3%
2%
8%
9%
7%
11%
15%
2%
50%
39%
46%
27%
27%
43%
3%
6%
2%
2%
6%
0%
2%
3%
0%
5%
0%
7%
0%
0%
7%
1%
0%
2%
2%
0%
7%
26%
27%
25%
7%
19%
8%
0%
3%
2%
1%
3%
0%
*Significant at the .10 level.
† Question is reverse coded.
Rows may not add to 100% due to rounding.
Nearly every community perception varies substantially by
race, with the exception of being proud to practice medicine
in Mississippi.
Sig.
0.00
0.05
0.00
0.81
0.03
0.03
0.00
0.08
0.54
Community Perspectives by Gender
Cost of living in a community is an important
consideration for where I want to work.
Mississippi taxes are a burden.†
People from elsewhere don't realize Mississippi is
a great place to live.
I feel a sense of belonging to the community
where I practice.
Local amenities, like parks, shopping, and cultural
events, are important in deciding where I want to
I do not feel at home in the community where I
practice.†
Practicing medicine in Mississippi is not much
different from practicing in other states.
I feel respected by the community where I practice
I am proud to practice medicine in Mississippi.
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
Strongly
Agree
Agree
12%
12%
8%
10%
27%
27%
24%
24%
14%
15%
3%
1%
5%
5%
23%
15%
30%
32%
53%
59%
30%
22%
56%
58%
52%
60%
56%
49%
11%
6%
36%
27%
62%
70%
50%
46%
Neither
Agree nor
Disagree
20%
14%
33%
37%
14%
14%
14%
12%
19%
21%
14%
11%
25%
25%
12%
11%
17%
18%
Disagree
Strongly
Disagree
13%
11%
24%
30%
2%
1%
9%
4%
10%
12%
47%
57%
26%
37%
3%
4%
2%
3%
2%
4%
5%
2%
1%
1%
2%
0%
2%
3%
26%
26%
8%
6%
1%
1%
1%
0%
*Significant at the .10 level.
† Question is reverse coded.
Rows may not add to 100% due to rounding.
There are no gender differences in community perceptions.
Sig.
0.21
0.13
0.87
0.17
0.56
0.19
0.20
0.34
0.50
Community Perspectives by Age Group
Cost of living in a community is an important
consideration for where I want to work.*
Mississippi taxes are a burden.†
People from elsewhere don't realize Mississippi is
a great place to live.
I feel a sense of belonging to the community
where I practice.
I feel a sense of belonging to the community
where I practice.
Local amenities, like parks, shopping, and cultural
events, are important in deciding where I want to
work and live.
I do not feel at home in the community where I
practice.†
Practicing medicine in Mississippi is not much
different from practicing in other states.*
I feel respected by the community where I
practice.*
I am proud to practice medicine in Mississippi.*
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Under 40
40-59 years
60 and older
Strongly
Agree
Agree
17%
12%
8%
5%
10%
8%
33%
28%
24%
19%
24%
29%
19%
24%
29%
13%
14%
13%
3%
2%
2%
5%
4%
7%
20%
18%
32%
28%
28%
38%
58%
55%
52%
34%
30%
19%
47%
56%
62%
56%
54%
52%
56%
54%
52%
65%
54%
53%
9%
10%
9%
34%
33%
40%
67%
64%
57%
56%
48%
49%
Neither
Agree nor
Disagree
8%
18%
27%
33%
31%
44%
17%
14%
12%
11%
13%
15%
11%
13%
15%
13%
20%
20%
15%
14%
10%
21%
23%
31%
11%
13%
9%
14%
21%
11%
Disagree
Strongly
Disagree
17%
13%
10%
26%
25%
23%
3%
2%
1%
14%
8%
5%
14%
8%
5%
8%
10%
11%
51%
49%
48%
31%
31%
18%
1%
4%
2%
3%
2%
1%
1%
2%
3%
3%
5%
6%
0%
1%
1%
0%
2%
1%
0%
2%
1%
1%
2%
3%
22%
25%
32%
8%
9%
5%
0%
1%
1%
0%
1%
1%
*Significant at the .10 level.
† Question is reverse coded.
Rows may not add to 100% due to rounding.
Younger doctors may choose to practice in MS because cost of
living is low, doctors 40-59 feel the least respected by their
communities and older doctors are the most likely to report that
they are proud to work in MS.
Sig.
0.03
0.11
0.63
0.22
0.22
0.78
0.83
0.06
0.06
0.06
Summary of Demographic Differences
Race
Gender
Reimbursement Climate
√
√
Quality of Patient Relationships
√
√
Family Experiences
√
Community Perceptions
√
Age
√
√
√
√
Double Jeopardy?
Rural and HPSA MDs in
Mississippi
Descriptive Statistics
by Practice Location
Place of birth
Born in the U.S.
Born elsewhere
Gender
Men
Women
Race
White
Non-White
Marital Status
Married
Widowed, divorced, single
Average age
Rural/non-rural location
Rural practice
Non-rural practice
HPSA+Rural
(N=114)
Other
(N=614)
80%
20%
93%
7%
84%
16%
78%
22%
81%
19%
87%
13%
87%
13%
54 years
86%
14%
52 years
100%
0%
65%
35%
Percentages may not add to 100 due to rounding.
Most Important Source of
Professional Satisfaction
by Practice Location
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
HPSA+Rural
Other
High Income
Substantial Intellectual
Challenge
Good Patient
Relationships
Congenial Practice
Environment
Physician Perspectives on
Challenging Patients
by Practice Location
Other
are generally frustrating to deal with?
have substance abuse problems?
have complex or numerous psycho-social
problems?
have complex or numerous medical
problems?
HPSA+Rural
0%
10%
20%
30%
40%
50%
60%
70%
80%
Typical Patient Payment Method
by Practice Location
35%
30%
25%
20%
15%
10%
5%
0%
Private Health
Insurance
Medicare
Medicaid
SCHIPs
Self-pay/Cash
Charity or
Uncompensated
Care
Other
HPSA+Rural
18%
33%
29%
4%
8%
5%
0%
Other
29%
28%
20%
4%
9%
7%
4%
Percent of Physicians
Named in a Lawsuit
by Practice Location
30
25
20
15
10
5
0
2004
2005
2006
HPSA+Rural
Other
Defensive Medicine
by Practice Location
Recruitment and Retention
by Practice Location
Reimbursement Climate
by Practice Location
Professional Relationships
by Practice Location
Non-physicians in my practice support my
professional judgment.
My non-physician colleagues are a major source of
support.*
Non-physicians in my practice reliably carry out
clinical instructions.
My physician colleagues value my unique
perspective in practice.*
My physician colleagues are a source of
professional stimulation.*
I get along well with my physician colleagues.*
My physician colleagues are an important source
of personal support.*
I wish there were more doctors like me in my
practice.†
It is easy to communicate with physicians with
whom I share patients.
Many of my colleagues do not share my life
experiences.†
My colleagues support my efforts to balance
family and career responsibilities.*
*Significant at the .10 level.
† Question is reverse coded.
Rows may not add to 100% due to rounding.
HPSA+Rural
Other
HPSA+Rural
Other
HPSA+Rural
Other
HPSA+Rural
Other
HPSA+Rural
Other
HPSA+Rural
Other
HPSA+Rural
Other
HPSA+Rural
Other
HPSA+Rural
Other
HPSA+Rural
Other
HPSA+Rural
Other
Strongly
Agree
Agree
41%
47%
15%
27%
21%
23%
9%
17%
7%
18%
26%
39%
2%
12%
22%
21%
13%
18%
10%
13%
3%
14%
49%
47%
61%
46%
62%
61%
45%
57%
44%
53%
67%
56%
37%
41%
43%
39%
63%
64%
44%
37%
58%
47%
Neither
Strongly
Agree nor Disagree
Disagree
Disagree
8%
3%
21%
23%
12%
12%
40%
22%
39%
21%
2%
4%
42%
30%
32%
37%
13%
11%
34%
30%
30%
32%
1%
2%
2%
3%
5%
3%
6%
4%
8%
6%
3%
1%
15%
13%
3%
3%
10%
7%
11%
17%
7%
6%
1%
1%
1%
1%
0%
1%
0%
1%
3%
2%
1%
0%
3%
4%
0%
1%
1%
1%
1%
3%
2%
1%
Sig.
0.33
0.07
0.81
0.00
0.00
0.01
0.03
0.85
0.61
0.33
0.06
Practice Resources and Conditions
by Practice Location
MD Family Experiences
by Practice Location
MD Community Perspectives
by Practice Location
Evidence for Double Jeopardy?
Are Physicians in HPSA+Rural Locations
Fundamentally Different from Physicians in Other
Locations?
Defensive Medicine
√
Recruitment and Retention
Reimbursement Climate
Professional Relationships
√
Practice Resources and Conditions
Family Experiences
Community Perceptions
Take home messages
• Rural doctors experience challenges
– Many of which are experienced differently by
race, age and gender
• No real evidence for double jeopardy
– Being in a rural HPSA no more difficult than being
in a non-rural, non-HPSA location
Questions?
Physicians Practicing in Rural and
Underserved Areas of Mississippi
Jeralynn Cossman, PhD
[email protected]
Debra Street, PhD
[email protected]