Michael E. Whitcomb

The National Health Service Corps: rural physician service and retention.

Background: The National Health Service Corps (NHSC) scholarship program is the most ambitious program in the United States designed to supply physicians to medically underserved areas. In addition to providing medical service to underserved populations, the NHSC promotes long-term retention of physicians in the areas to which they were initially assigned. This study uses existing secondary data to explore some of the issues involved in retention in rural areas. Methods: The December 1991 American Medical Association (AMA) Masterfile was used to determine the practice location and specialty of the 2903 NHSC scholarship recipients who graduated from US medical schools from 1975 through 1983 and were initially assigned to nonmetropolitan counties. We used the AMA Masterfile to determine what percentage of the original cohort was still practicing in their initial county of assignment and the relation of original practice specialty and assignment period to long-term retention. Results: Twenty percent of the physicians assigned to rural areas were still located in the county of their initial assignment, and an additional 20 percent were in some other rural location in 1991. Retention was highest for family physicians and lowest for scholarship recipients who had not completed residency training when they were first assigned. Retention rates were also higher for those with longer periods of obligated service. Substantial medical care service was provided to rural underserved communities through obligated and postobligation service. Nearly 20 percent of all students graduating from medical schools between 1975 and 1983 who are currently practicing in rural counties with small urbanized populations were initially NHSC assignees. Conclusions: Although most NHSC physicians did not remain in their initial rural practice locations, a substantial minority are still rural practitioners; those remaining account for a considerable proportion of all physicians in the most rural US counties. This study suggests that rural retention can be enhanced by selecting more assignees who were committed to and then completed family medicine residencies before assignment.

Methotrexate pneumonitis: case report and review of the literature

Methotrexate has been recommended for long-term therapy of an increasing number of diseases including acute lymphoblastic leukaemia, psoriasis and other chronic dermatoses, Wegeners granulomatosis, and multiple solid tumours. Acute pneumonitis is a known complication of methotrexate therapy. An additional case is reported and the clinical features of the 13 previous cases are summarized. Clinical and radiographic evidence of acute pneumonitis associated with eosinophilia and a rapid clearing with steroid treatment is the characteristic syndrome.

Quality of the Family Physician Component of the AMA Masterfile

Background: This investigation was undertaken to gain insight into the validity of the American Medical Association (AMA) Masterfile data. Methods: Allopathic family physicians were chosen as the study population. Omissions were picked up from by comparing the AMA list with the 1990 Ohio Academy of Family Physicians Foundation–Ohio Department of Health (OAFPF–ODH) census. Verification of the 1990 specialty and geographic location of allopathic family physicians not common to both files was achieved by sequentially (1) reviewing the AMA names against 1990 deletions from the 1985 OAFPF-ODH census, (2) contacting physicians directly by telephone, (3) verifying 1990 physician status with county medical personnel, and (4) mailing a brief questionnaire to each physician whose 1990 status remained unverified. Results: The status of specialty and geographic location in 1990 was verified in 91 percent of names not common to both lists. Incorrect omissions (undercounts) and incorrect inclusions (overcounts) offset each other for both lists. Two groups of family physicians contribute to counting biases: family physicians who fulfill short-term goals by part-time practice in several locations, and family physicians who restrict their practice to a limited medical content area. Conclusions: Because of nearly equal offsetting of overcounting (incorrect inclusions) and undercounting (incorrect omissions), the 1990 Ohio family physician AMA Masterfile data is adequate for workforce projections and policy studies when the county data are aggregated at the state level. The overcounting and undercounting for smaller areas or categories must still be studied, however. Application of the AMA Masterfile data of other geographic areas requires a knowledge of the components of undercounts and overcounts of the population being studied.