| Summary: | The primary purpose of this study was to examine the relationship between educational and curricular factors and physician location decisions. As a background to the study, a literature search traced the history of medical education in the U.S., focusing on various influences on physician distribution. In the research on physician location decision, this study is unique in its use of the constant comparative method. This method is an inductive approach developed and refined by Glaser and Strauss, used in this study to generate theory regarding the role of educational factors in physician location decisions. In this research, two groups of physicians who completed training after 1965 were selected for study, based on their locations in distinctly different practice settings in Arizona: urban and rural. An open-ended interview format was developed, and each physician was interviewed, with data analysis beginning during the first interview and continuing through the entire period of data collection. Using the constant comparative method, similar groups (rural physicians) were compared to bring out basic properties of categories, and different groups (urban physicians) were then compared to establish boundaries of applicability of the theory. As the interviews proceeded a basic theoretical framework emerged, enabling development of a grounded theory of physician location decisions. The study presents strong empirical evidence in support of the proposition that educational factors are influential in the decision of a physician to enter practice in a rural area. Four primary influences were identified: faculty role modeling, participation in rural clerkships, preceptorships, or required family practice rotations, service activities related to health care for medically underserved populations, and education in a non-traditional setting, or residency training in a rural area. Curriculum content and requirements take on major significance when these influences are subsumed under the major influence of socialization. The extent to which these educational factors play a role in the practice locations of physicians varies according to educational opportunities available during the training period.
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