Where to Live and Work? Examining the Influence Of job and Community Characteristics On Post-graduation Plans among Physician Assistant Students

Abstract

Physician assistants are one way to address the healthcare provider shortage in rural areas. However, recruitment and retention of physician assistants to live and work in rural communities remain a challenge. One's relationship to his or her hometown, be it rural or not, has important implications for who might be willing to live and work in a rural community. The purpose of this research was to examine factors influencing physician assistant students’ desire to return to their hometowns to live and work after graduation. Data were collected in 2016 and 2017 through a survey administered to physician assistant students (n=149) in a PA program at a Midwestern University. Survey questions examined hometown connections, community features, and job expectations, as well as desire to return to one's hometown. Students who grew up in rural communities reported lower levels of community satisfaction and were less likely to perceive that jobs were available in their hometowns. A series of regression models were run to examine the impact of hometown connections, community characteristics and evaluation, and job characteristics in predicting interest in returning to hometown while controlling for the effects of age and gender. Coming from a rural, suburban, or urban hometown did not significantly predict desire to return when controlling for respondents' evaluation of their hometowns. The strongest predictor of willingness to return to one's hometown was community attachment. Understanding the factors that impact physician assistant students’ post-graduation plans may inform efforts to recruit and retain rural health care providers. Keywords: Physician assistants, rural health care, community attachment, rural youth, rural outmigration, health care shortages, medical provider recruitment