Physicians with highly educated spouse less likely to work in rural underserved areas

In a study appearing in the March 1, 2016 issue of JAMA Douglas O. Staiger, Ph.D., of Dartmouth College, Hanover, N.H., and colleagues examined the prevalence of physicians with highly educated spouses and whether having such a spouse was associated with working in rural underserved areas.

An undersupply of physicians in rural areas remains a problem. Rural origin, age, and sex have been linked to physician choice of rural settings. An additional factor may be that many physicians have highly educated spouses with independent careers, which may constrain their ability to locate in rural areas. For this analysis, the researchers studied a 1 percent sample of all employed physicians age 25 to 70 years working in the United States every 10 years from 1960 to 2000 (n = 19,668) and every year from 2005 to 2011 (n = 55,381). The authors identified spouses reporting 6 or more years of college (before 1990) or a master's degree or higher (1990 and later).

Overall, 5.3 percent of physicians worked in a rural Health Professional Shortage Area (HPSA) between 2005 and 2011, whereas 10.9 percent of the U.S. population lived in these areas. Compared with other married physicians, physicians with a highly educated spouse were significantly less likely to work in a rural HPSA (4.2 percent for married physicians with highly educated spouses vs 7.2 percent for married physicians without highly educated spouses). Single physicians were also less likely to work in a rural HPSA, as were physicians who were young, women, black, or Hispanic.

The authors note that the absolute difference between those with and without highly educated spouses was only 2.9 percent, and the proportion of both groups locating in rural underserved areas was small relative to the population. "Other approaches, such as allowing provision of health care without requiring physicians to locate in rural areas (i.e., through telemedicine), should be investigated."