What factors influence health professions trainees' preferences for employment in rural Appalachia? a qualitative study to inform the design of a discrete choice experiment.

Optimizing the geographic allocation of health care providers has the potential to improve health care access and health outcomes for rural populations. To inform the design of a discrete choice experiment (DCE) survey to elicit health professions trainees' preferences for rural practice, this formative research aimed to: (1) elicit factors that influence job selection among health profession trainees, including medical residents physician assistant (PA) and nurse practitioner (NP) students, (2) identify how these trainees evaluate trade-offs for rural job placement and (3) inform attribute selection for inclusion into a future DCE to identify health professions trainees' preferences for rural practice. Third- and fourth-year medical residents, PA students, and NP students completed an in-depth semi-structured interview, an adaptive choice-based conjoint exercise, and a ranking exercise. Inductive and deductive coding and reflexive thematic analysis were used to analyze the data. We reached thematic saturation after 22 interviews (n = 14 PA, n = 6 residents, n = 2 NP). We identified multiple domains across two major themes: (1) job-related attributes and (2) community-related attributes. Job-related attribute domains included: (1) team dynamics, management/leadership, and clinical decision support, (2) onboarding and professional development, and (3) compensation package/remuneration. Community-related covered two attribute domains included: (1) amenities and social environment and (2) rurality and commute time. Participants were willing to trade non-pecuniary factors against salary and loan repayment. We identified 10 attributes for potential inclusion in the DCE. This study identified several viable factors for potential inclusion as attributes in a DCE. Several of these factors have yet to be explored in a policy environment and may aid the design of rural healthcare recruitment strategies.

Duke Scholars

Author Jan Ostermann Duke Global Health Institute

Author Christine M Everett Population Health Sciences