1. Physicians Practicing in Rural and Underserved Areas of Mississippi Jeralynn Cossman Debra Street

2. Rural/Non-Rural Counties in Mississippi

3. HPSA/Non-HPSA Counties in Mississippi

4. Both Rural and Underserved Counties in Mississippi

5. Analytic Sample Descriptive Statistics by Rural/Urban Practice Location

6. Analytic Sample Descriptive Statistics by HPSA/non-HPSA Practice Location

7. Race Composition of MS MDs

8. Gender Composition of MS MDs

9. Age Composition of MS MDs

10. Mississippi Physicians: Characteristics and Experiences of Physicians in an Underserved State

11. Most Important Source of Professional Satisfaction by Race

12. Most Important Source of Professional Satisfaction by Gender

13. Most Important Source of Professional Satisfaction by Age Group

14. Physician Perspectives on Challenging Patients by Race

15. Physician Perspectives on Challenging Patients by Gender

16. Physician Perspectives on Challenging Patients by Age Group

17. 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

18. Patient Payment Method by Physician Race

19. Patient Payment Method by Physician Gender

20. Patient Payment Method by Physician Age Group

21. 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

22. Changes in Patient Access by Physician Race Non-white physicians are more likely to report changes in patient access issues than white physicians.

23. Changes in Patient Access by Physician Gender Men physicians are no more likely to report changes in patient access issues than women physicians.

24. Changes in Patient Access by Physician Age Group Older physicians are not generally more likely to report changes in patient access issues than younger physicians.

25. Average Hours Spent on Professional Activities in a Typical Week (excluding call) by Race, Gender and Age Group

26. Percent of Physicians Taking Call by Race, Gender and Age Group

27. Perceived Control over Practice Conditions by Race Non-white physicians perceive less control over practice conditions than white physicians (5 of 10 items).

28. Perceived Control over Practice Conditions by Gender Women physicians perceive less control over practice conditions than men physicians (4 of 10 items).

29. Perceived Control over Practice Conditions by Age Group Older physicians perceive less control over practice conditions than younger physicians (5 of 10 items).

30. Levels of Stress and Burnout Women report more stress than men and physicians 40-59 report more stress than those who are younger or older.

31. Percent of Physicians Named in a Lawsuit by Race

32. Percent of Physicians Named in a Lawsuit by Gender

33. Percent Physicians Named in a Lawsuit by Age Group

34. Malpractice and Liability Climate by Race, Gender and Age Group Non-white physicians perceive the liability climate to be worse than white physicians, but there are no differences by age or gender.

35. Defensive Medicine by Race There are no racial differences in the reporting of defensive medicine practices.

36. Defensive Medicine by Gender Men physicians are more likely to report defensive medicine practices than women physicians.

37. Defensive Medicine by Age Group Physicians who are 40-59 are more likely to report defensive medicine practices than physicians who are younger or older.

38. Recruitment and Retention by Race Minority physicians are more likely to report concerns with recruitment and retention than white physicians.

39. Recruitment and Retention by Gender Women physicians are more likely to report concerns with recruitment and retention of women physicians than men physicians are.

40. Recruitment and Retention by Age Group Older physicians are more likely to report concerns with recruitment and retention of women physicians than younger physicians are.

41. Physician Supply is a Problem for Own Practice

42. Reimbursement Climate by Race 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.

43. Reimbursement Climate by Gender 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.

44. Reimbursement Climate by Age Group 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.

45. The Quality of Patient Relationships by Race 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.

46. The Quality of Patient Relationships by Gender 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”.

47. The Quality of Patient Relationships by Age Group 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.

48. MD Family Experiences by Race 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.

49. MD Family Experiences by Gender 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.

50. MD Family Experiences by Age Group Several age differences in family experiences are noted, likely related to child-rearing and its timing in their professional career.

51. Community Perspectives by Race Nearly every community perception varies substantially by race, with the exception of being proud to practice medicine in Mississippi.

52. Community Perspectives by Gender There are no gender differences in community perceptions.

53. Community Perspectives by Age Group 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.

55. Double Jeopardy? Rural and HPSA MDs in Mississippi

56. Descriptive Statistics by Practice Location HPSA+Rural (N=114) Other (N=614) Place of birth Born in the U.S.80%93% Born elsewhere20%7% Gender Men84%78% Women16%22% Race White81%87% Non-White19%13% Marital Status Married87%86% Widowed, divorced, single13%14% Average age54 years52 years Rural/non-rural location Rural practice100%65% Non-rural practice0%35% Percentages may not add to 100 due to rounding.

57. Most Important Source of Professional Satisfaction by Practice Location

58. Physician Perspectives on Challenging Patients by Practice Location 0%10%20%30%40%50%60%70%80% HPSA+Rural Other are generally frustrating to deal with? have substance abuse problems? have complex or numerous psycho-social problems? have complex or numerous medical problems?

59. Typical Patient Payment Method by Practice Location

60. Percent of Physicians Named in a Lawsuit by Practice Location

61. Defensive Medicine by Practice Location

62. Recruitment and Retention by Practice Location

63. Reimbursement Climate by Practice Location

64. Professional Relationships by Practice Location

65. Practice Resources and Conditions by Practice Location

66. MD Family Experiences by Practice Location

67. MD Community Perspectives by Practice Location

68. Evidence for Double Jeopardy?

69. 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

70. Physicians Practicing in Rural and Underserved Areas of Mississippi Jeralynn Cossman, PhD Lynne.Cossman@msstate.edu Debra Street, PhD dastreet@buffalo.edu Questions?