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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]