Abstract

The Northeast Pennsylvania Area Health Education Center (NEPA AHEC) continues to be challenged in its attempts to provide continuing education to rural physicians, as part of their larger efforts at recruitment and retention.  By partnering with researchers at the University of Scranton, NEPA AHEC was able to systematically collect information better suited to helping them fulfill their mission. This study focuses on clarifying NEPA AHEC’s understanding of the demographics and attitudes toward continuing medical education of the approximately 500 rural physicians in northeast Pennsylvania. A community-based research partnership, consisting of a University of Scranton researcher, a University of Scranton graduate student, and NEPA AHEC’s executive director, developed and distributed a two-part survey to nearly 500 rural physicians in six northeast Pennsylvania counties. This project reports on measures of our rural physician population such as gender, age, years in practice, prior connection to a rural area, internet access, and business and practice organization structures.  It goes on to analyze those measures in conjunction with physician opinions on fulfillment of continuing education needs and intent to stay in current location. The information obtained through this survey and analysis is helping NEPA AHEC to focus efforts on continuing education delivery methods and locations where they are most likely to be effective.

Introduction

In 1970 the Carnegie Commission on Higher Education recommended the establishment of Area Health Educations Centers (AHEC’s) as a national strategy to address, among other things, the shortage of primary care physicians in medically underserved areas.  In 1972 the national AHEC program was established.  Generally, its mission is to improve the quality and supply of health professionals to provide primary care services in areas that are targeted as medically underserved.  AHEC seeks to connect academically-based health professions training programs with the clinical training opportunities inherent in the health services delivery systems of underserved communities.

Currently there are 45 AHEC programs in 43 states.  Each state, and each region within a state, may mold the national mission to meet their specific needs.  The Pennsylvania AHEC program, established by the Pennsylvania State University College of Medicine in 1994, has seven AHEC regions. The Northeast Pennsylvania Area Health Education Center (NEPA AHEC) was incorporated as a 501(c) 3 in July of 1999 and covers nine northern tier counties.

Since its inception, NEPA AHEC has been concerned with the recruitment and retention of rural physicians in order to increase access to primary health care services.  NEPA AHEC plans, develops and coordinates a variety of community-based interdisciplinary training opportunities for health science students and primary care residents in rural and urban medically underserved areas. Recruitment and retention is promoted through practice support programs and community resources development tailored to meet specific needs.  NEPA AHEC has also put considerable effort into the design and implementation of a number of programs to address the continuing medical education (CME) needs of the nearly 500 rural physicians in NEPA.  NEPA AHEC understands that the link between professional competence and professional job satisfaction is essential for the retention of rural physicians, yet these programs have met with only moderate success.

In an attempt to determine more effective ways to provide successful CME programming to the rural physician population in NEPA, NEPA AHEC garnered the services of researchers from the University of Scranton.  This partnership developed over many months and the formative discussions led to the exploration of the following questions:

• What information does NEPA AHEC need or want?
• Who could or should provide this information (target population)?
• What method was best suited to acquire the information?
• What role or roles are the partners to fulfill?
• How is information to be used and/or distributed?

This report summarizes the community-based research process undertaken by NEPA AHEC and the University of Scranton, and the results of that research.

Literature Review

The shortage of rural physicians is a considerable source of stress for the healthcare industry.  Approximately twenty percent of the U.S. population lives in rural areas yet only about nine percent of physicians practice in rural settings[1] [2]. Research regarding the demographics and unique characteristics of this small segment of the physician population suggest that historically rural physicians are more likely to be male than their urban counterparts.  And, they are more likely to have lived or had experience in a rural setting[3] [4]. Other factors influencing the choice to practice in rural settings may include a desire for autonomy and the opportunity for developing close relationships with clients[5].

Since the early 1990’s, researchers across the United States, Canada and Australia have suggested that the recruitment and retention of rural physicians is related to one or both of two factors: Having lived or had life experience in a rural setting and the amount and quality of exposure to medical practice in rural settings they receive at the training and preparatory levels[6] [7] [8] [9] [10] [11] [12] [13]. According to the number one predictor of interest in practicing in rural areas is having a rural background.  Some suggest that physicians with rural backgrounds have a more favorable attitude towards rural living and are more willing to practice in a rural setting.  Others conclude that medical schools with strong rural practice curricula are highly influential in the preparation of physicians for rural practice, including those who have no previous experience in a rural setting.

Although the autonomy and attraction of a rural personal and professional lifestyle is appealing to some, it does tend to leave practitioners feeling professionally isolated.  As a result, they attempt to use well formed networks of specialists, depend heavily on all forms of communication and prefer face-to-face contact whenever possible [14] [15] [16]  [17] [18]. Because of the nature of rural practice, maintaining a high level of advanced clinical skills is essential.  In this minimally supportive environment, developing an effective method for doing so is challenging[10] [15] .  Not feeling part of the profession and fear of losing skills play major roles in recruitment and retention [12] [17].  Conversely, confidence and competence in rural practice that professional involvement provides has been correlated with the job satisfaction and retention of rural physicians [10].

The perceptions of professional isolation experienced by rural physicians are further augmented by what some researchers suggest is a more demanding workload than that of their urban counterparts.  This is attributed to fewer practitioners to rely on for on-call or relief, frequent requirements to make house calls or provide sidewalk consultations, and, overall, less time off  [8] [10].[12] [17] [19] According to some, this leads to higher stress levels and burnout.

The frequency of patient interactions in public is in part an issue of access but may also be attributed to other factors (such as culture).  For example, it is not uncommon for patients in rural settings to seek office visits less often than their urban counterparts, and usually only when an illness is well developed [1] [20].

Participating in Continuing Medical Education (CME) is a professional expectation for remaining current in one’s field.  The challenges rural physicians face suggest that fulfilling CME requirements is difficult.  Many physicians receive the majority of their CME from the networks with which they affiliate.  Belonging to a network provides increased professional involvement and CME opportunities [18].  This in turn improves job satisfaction and, potentially, retention.  But the rural physician has fewer choices for affiliation.  Beginning in the late 1990’s managed care networks were pulling out of rural settings because urban settings were more profitable.  And, the scarcity of rural specialists further diminished the benefits of developing rural network affiliations.  Although some of this has and is changing, the connection between network affiliation and CME continues to be a concern for agencies, such as NEPA AHEC, devoted to assisting in the recruitment and retention of rural physicians.

NEPA AHEC decided that in order to improve their strategic planning and maximize their effectiveness, they needed to know more about the demographics and characteristics of the population of rural physicians they serve.  In particular, they wanted information regarding rural physicians’ experience and training in rural settings, the types of networks used for CME, access to CME, job satisfaction and perceptions of CME quality.  They partnered with university researchers to design and distribute a short survey that would address some of their interests.

Design and Methodology

Community Based Research Model

This project used Strand, Marullo, Cutforth, Stoecker and Donohoue’s (2003) model of community-based research (CBR) to inform the design and methodology[21]. Their model notes that CBR is a particular type of resource that colleges and universities can use to assist communities to address pressing problems and is governed by three central principles.  CBR is first a collaborative enterprise among academics, researchers, and the community.  Second, CBR uses multiple methods and sources of acquiring knowledge and information and authenticates these various methods and sources.  Finally, the goal of CBR is social action leading to social change for achieving social justice.

The partners in this project consisted of the executive director of NEPA AHEC, a researcher from the University of Scranton, and a University of Scranton graduate student.  As previously stated, this partnership developed over many months. Partners used a variety of communication methods including email, phone and in-person contact.  Care was taken to consistently represent the needs of the NEPA AHEC while attempting to maintain as much research design and methodology rigor as possible.

The partnership spent considerable time on determining and refining what NEPA AHEC wanted to know.  A preliminary list of questions was developed and distilled.  As a result of this process, it was decided that a survey was the best method of acquiring the information that NEPA AHEC believed they needed in order to better serve the ~500 rural physicians in NEPA.  Several months were spent on survey development.

The retention of rural physicians in Northeast Pennsylvania is a core concern for NEPA AHEC. Although many of the decisions NEPA AHEC makes regarding how to best address this concern are based on fact, the partnership realized that there continue to be areas for improved decision-making that would benefit from additional structured information.

Target Population

NEPA AHEC decided to survey approximately 500 physicians that represent the entire population of rural physicians served by their organization.  It was determined that they could be accessed through the hospital and medical systems located in the target area.  Although NEPA AHEC serves nine counties, for purposes of this study, researchers eliminated surveying physicians practicing in the counties with substantial urban populations.

The Survey

A two-part, twenty-eight item survey was designed to assist with attending to the following queries:

1. Describe the demographics of the rural physician population in NEPA.
2. Delineate characteristics that might assist AHEC to improve their ability to service this population.
3. How satisfied is this population with their ability to fulfill their CME requirements?
4. What is the extent to which medical specialties, practice organizations, and/or affiliation influence (or impact) the perceived fulfillment of the CME expectations of rural physicians in NEPA?
5. What types of internet access does this population currently have and use?

Part One of the survey recorded demographic information such as age, gender, medical specialty, years in practice, practice setting and affiliation, and internet access.  Part Two measured attitudes toward continuing medical education (CME) opportunities, practice settings, affiliations, and internet access on a scale of 1 to 6 with 1 representing strongly disagree and 6 representing strongly agree.

Items were pilot tested with 10 physicians and hospital staff outside the target area and suggestions incorporated.  A detailed item analysis was not attempted due to time and budgetary constraints and because the results were not intended for generalizing to other populations.  The pilot resulted in rewording several items, modifying the cover letter, and dropping the use of a web site for distribution (although this option was retained for one of the facilities that requested it).

Survey Distribution

Community-based research seeks to involve community partners in the data collection process and is open to a variety of approaches[21]. The intent is to balance the rigor of the research design and methodology with the potential to draw out useful information.

Surveys were distributed by NEPA AHEC to 489 rural physicians at five hospitals and medical systems serving the target area.  A letter supporting the survey research was developed to accompany the survey.  NEPA AHEC worked with “champions” at each of the five sites to have a significant leader (such as the CEO or medical director) sign the letter to be distributed to the physicians at that particular site.  All sites distributed hard copies of the surveys except one facility that distributed them by both interoffice mail and email.

Each site presented a unique distribution challenge in that what was considered an acceptable method of distribution and collection at one facility was not necessarily acceptable at another.  Persons designated by the facility as the primary contact through which the mode of distribution would be determined also varied from one site to another and may or may not have been the same person contacted regarding the letter.

There were several additional barriers to distribution worth mentioning.  First, timing for distribution was controlled by the site contact person and the facility. Second, there was no single way to effectively reach all physicians at a particular site.  For example, some physicians never read email; others never read hard copy.  Third, even though the survey took under 10 minutes to complete, the physicians’ tight schedules and the fact that they are already heavily surveyed made them a particularly difficult population to successfully survey.

Results

Of the four hundred eighty-nine (489) surveys distributed to five (5) medical systems that service six non-urban counties in NEPA, one hundred thirty-three (133) completed surveys were returned.  This represents a 27% overall return rate with individual medical system return rates ranging from 17-42%

The demographics from Part 1 of the survey are provided in Table 1.  As expected, respondents are primarily male (78.9%) between the ages of 41 and 60.  However cross tabulating age and gender reveals that the disparity in gender changes with age.  The youngest age group (31-40) is has a more even gender distribution than all other age groups (Table 2).  This demographic offers potentially helpful information for NEPA AHEC’s strategic planning and program designing.

Nearly two thirds of respondents (64%) have practiced for more than 15 years yet only slightly more than one third (36.8%) report having practiced in the current rural location for 15 or more years (Table 1).  Similarly, 37.8 % of those who have practiced more than 15 years have also remained in the current location for 15 or more years (Table 3).  The largest percentage of practitioners who have recently come to this rural practice location (0-3 years in current location) are those who have been in practice 6-15 years (7.1%).  It is not known whether these respondents are new to a rural practice setting, new to the area or simply new to their current practice locations.  Since NEPA AHEC is involved with resident placement assistance, information from these interactions may help AHEC to further explore and better understand this population’s issues related to recruitment and retention.

Overall, slightly less than half of these practitioners report receiving non-urban medical training (43.6%) (Table 1).  Further analysis of the data regarding ‘non-urban medical training’ and ‘local where raised’ suggests that those raised in strictly urban settings were much less likely to have received non-medical training (16%) than those who were raised in a rural setting (77.8%).  Those raised in suburban or small town settings were fairly evenly split between receiving and not receiving non-urban medical training (Table 4). In light of the literature, this is important because 84% of those raised in an urban setting and more than half of those raised in suburban and small town settings chose to practice in a non-urban setting despite not having received any formal non-urban medical training.

Even more interesting, and potentially more helpful for NEPA AHEC planning, is that of those who are new to the area, considerably more were raised in urban settings (Table 5).  And, as the number of ‘years in current location’ increases, so does the percent of practitioners raised in small town and rural settings, while decreasing for urban and suburb raised practitioners.  Since urban raised practitioners report the greatest lack of non-urban medical training, some consideration for the 0-3 years in current location group may be indicated.  Further support for targeting this group is seen when ‘local where raised’ and ‘years in current location’ are crosstabulated with responses to “I plan to continue to practice in my current or similar practice organization for the next 5 years” (Table 6).  In the 0-3 ‘years in current location’ group who were raised in an urban setting, only 50% agree or strongly agree with the notion of continuing in this type of practice setting.  All other groups range from 62% to 100% agreement (based on adding percent agree and strongly agree responses).

Originally, NEPA AHEC expected that physicians were fulfilling their CME most often through their affiliations or business structures.  More than half of the respondents (57.1%) practice in corporate business structures that are non-managed care (Table 1).  Single proprietorship and managed care corporations make up slightly more than 10% of respondents (8.3% & 2.3%, respectively).  But several minimally successful attempts at providing CME opportunities through affiliations caused NEPA AHEC to rethink their approach.  Therefore, survey information regarding other possible venues was sought.  These included medical specialties, practice organizations, and professional societies.

Twenty-eight medical specialties were reported, however only the six with frequencies greater than five percent of total responses are used for the purposes of this study: Internal Medicine, Family Practice, Pediatrics, Emergency Medicine, OB/Gyn, and Anesthesiology, in descending order of frequency.

More than half (55.6%) report participation in a multiple specialty practice organization. Approximately a quarter are involved in single specialty practices and the remaining respondents are engaged in solo practices (Table 1).

Regarding the use of professional societies for CME, the demographic data in Table 1 also shows that respondents access CME opportunities most often through their national societies (72.2%) and less often through their state societies (35.3%).  NEPA AHEC does not generally work through these organizations but with more detailed information it was likely NEPA AHEC could reach the 24% who reported accessing CME opportunities through their practice organizations.  So the data was analyzed by crosstabulating ‘practice organization’ with ‘county of practice’ and those who reported accessing CME opportunities through their practice organizations (Table 7).  The information gleaned from this analysis can assist NEPA AHEC in targeting their resources more effectively.  For example, of those who responded ‘yes’ to accessing CME through their practice organizations, 80% of multi-specialty groups, 75% of single specialty groups, and 100% of solo practitioners practice in Counties 1 and 2.

Insert Table 7

To better understand the quality of the CME opportunities accessed through their practice organizations, respondents were asked to provide their level of agreement with four statements:

• I most often engage in continuing medical education opportunities at my practice organization.
• My practice organization provides adequate opportunities for continuing medical education.
• I believe that my continuing medical education needs are being met through my current practice organization.
• I seek continuing medical education opportunities outside my current practice organization

Table 8 presents an overall perspective on each of these statements and Table 9 provides a non-parametric correlation matrix calculation using the scaled responses to the statements.  Although there is a statistically strong positive correlation between the first three statements, a review of the data in Table 8 suggests that there is not overall satisfaction with the adequacy or quality of the CME opportunities offered through practice organizations.  NEPA AHEC may better serve this population by targeting those who are currently seeking CME fulfillment outside their current practice organization.

Finally, AHEC was curious regarding rural physicians’ access to the internet because of its potential value to assist in the fulfillment of CME requirements.  As noted in Table 1, respondents overwhelmingly designated that they have high speed internet access at both home and office.  A small percentage use dial-up access with a smaller percentage indicating they have no access at either home or office.  Sixty-eight percent of those with high speed access and 55% of those with dial up access agree or strongly agree with the statement that “My current internet access is sufficient for my continuing medical education needs”.  Yet only about 20% with high speed access and 44% with dial up access plan to upgrade their internet access within the next 5 years.

Conclusions

Outcomes from community-based research projects are meant to affect social change for the good of the community.  NEPA AHEC’s determination to improve their ability to increase rural physician interest in their CME programming, and to maximize their resources to make that happen, caused them to seek assistance from, and to partner with, researchers at the University of Scranton.  The data collected from the two-part survey helped NEPA AHEC to better understand the physicians’ demographics as well as their perceptions regarding rural practice and the fulfillment of their continuing medical education needs.  It was also meant to compliment NEPA AHEC’s efforts to focus on the recruitment and retention of rural physicians by providing a research-based place to start.

The data provided adequate information to begin to answer all five research questions, yet throughout this process additional questions arose that had the potential to impact NEPA AHEC’s strategic planning.  For example, it was not initially thought that ‘county’ would be a variable worth consideration.  However, as the analysis unfolded, it became clearer that the counties were enough different that breaking the data down by county gave NEPA AHEC better information.  Further analysis will be tailored to NEPA AHEC’s strategic interests and could serve as a place to initiate further research.

The data provided adequate information to begin to answer all five research questions, yet throughout this process additional questions arose that had the potential to impact NEPA AHEC’s strategic planning. For example, it was not initially thought that ‘county’ would be a variable worth consideration. However, as the analysis unfolded, it became clearer that the counties were enough different that breaking the data down by county gave NEPA AHEC better information. Further analysis will be tailored to NEPA AHEC’s strategic interests and could serve as a place to initiate further research.

 

Tables

Table 1. Percent responses to demographic part of survey

	%	%	%	%	%	%
Gender	Male	Female
	78.9	15.8
Age	31-40	41-50	51-60	Over 60
	15.8	33.1	36.1	14.3
County	County 1	County 2	County 3	County 4	County 5	County 6
	38.3	21.8	.8	2.3	15	9.8
Years in Practice	0-5	6-15	16-25	Over 25
	8.3	25.6	35.3	28.6
Years at Current Location	0-3	4-8	9-15	Over 15
	20.3	15	25.6	36.8
Received Non-urban Medical Training	Yes	No
	43.6	54.1
Local Where Raised	Urban	Suburban	Small Town	Rural
	20.3	37.6	25.6	13.5
Medical Specialties	Internal Medicine	Family Practice	Pediatrics	Emergency Medicine	OB/Gyn	Anesthesiology
	12.8	9.8	8.3	6.8	5.3	5.3
Practice Organizations	Multiple Specialties	Single Specialties	Solo Practice
	55.6	27.8	15.8
Business Structure (Affiliations)	Single Proprietor	Partnership	Managed Care Corp	Corp, Non-Managed Care
	8.3	24.8	2.3	57.1
Professional Societies used for CME	National	State	County	Practice Org	Independent Practice Assoc	Other
	72.2	35.3	10.5	24.1	11.3	26.3
%	High Speed	Dial Up	None	No Response
Home	76.7	14.3	3.8	5.3
Office	85.7	6.8	3.8	3.8

Table 2.Percent gender by age group

	Male	Female	Total
Age
31-40	9.6%	7.2%	16.8%
41-50	28.8%	4.8%	33.6%
51-60	32.8%	4.0%	36.8%
Over 60	12.0%	.8%	12.8%

Table 3. Crosstabulation: years in practice*years in current location

Yrs in Practice	Yrs in Current Location	0-3	4-8	9-15	over 15	Total
% Total Yrs in Practice	% Total Yrs in Current Location	20.3%	15%	25.6%	36.8%
0-5 8.3%		5.5%	3.1%			8.7%
6-15 25.6%		7.1%	4.7%	14.2%		26.0%
16-25 35.3%		3.1%	3.9%	10.2%	18.9%	36.2%
over 25 28.6%		4.7%	3.1%	2.4%	18.9%	29.1%
Total		20.5%	15.0%	26.8%	37.8%	100.0%

Table 4. Crosstabulation: local where raised*non-urban medical training

		Local where raised
		Urban	Suburban	Small town	Rural	Total
Non-urban medical training	% of Total	20.3	37.6	25.6	13.5	100
	Count	4	23	16	14	57
Yes	% within local where raised	16	46	25.6	13.5	44.9
	Count	21	27	18	4	70
No	% within local where raised	84	54	52.9	22.2	55.1

Table 5. Crosstabulation: years in current location*local where raised

yrs in current location		local where raised				Total
		urban	suburban	small town	rural
0-3	Count	11	7	6	1	25
	% within local where raised	40.7%	14.3%	18.2%	5.6%	19.7%
4-8	Count	3	9	3	4	19
	% within local where raised	11.1%	18.4%	9.1%	22.2%	15.0%
9-15	Count	5	18	7	4	34
	% within local where raised	18.5%	36.7%	21.2%	22.2%	26.8%
over 15	Count	8	15	17	9	49
	% within local where raised	29.6%	30.6%	51.5%	50.0%	38.6%
Total	Count	27	49	33	18	127
	% within local where raised	100.0%	100.0%	100.0%	100.0%	100.0%
	% of Total	21.3%	38.6%	26.0%	14.2%	100.0%

Table 6. Crosstabulation: I plan to continue to practice in my current or similar practice organization for the next 5 years. * local where raised * yrs in current location

			local where raised
yrs in current location			urban	suburban	small town	rural	Total
	I plan to continue to practice in my current or similar practice organization for the next 5 years.
0-3	agree	Count	2	5	3	1	11
		% within local where raised	20.0%	83.3%	50.0%	100.0%	47.8%
		% of Total	8.7%	21.7%	13.0%	4.3%	47.8%
	strongly agree	Count	3	1	2		6
		% within local where raised	30.0%	16.7%	33.3%		26.1%
		% of Total	13.0%	4.3%	8.7%		26.1%
4-8	agree	Count	2	5		2	9
		% within local where raised	66.7%	55.6%		50.0%	47.4%
		% of Total	10.5%	26.3%		10.5%	47.4%
	strongly agree	Count		2	3	1	6
		% within local where raised		22.2%	100.0%	25.0%	31.6%
		% of Total		10.5%	15.8%	5.3%	31.6%
9-15	agree	Count	3	6	3	2	14
		% within local where raised	60.0%	35.3%	42.9%	50.0%	42.4%
		% of Total	9.1%	18.2%	9.1%	6.1%	42.4%
	strongly agree	Count	2	6	3	2	13
		% within local where raised	40.0%	35.3%	42.9%	50.0%	39.4%
		% of Total	6.1%	18.2%	9.1%	6.1%	39.4%
over 15	agree	Count	3	6	6	2	17
		% within local where raised	37.5%	42.9%	37.5%	22.2%	36.2%
		% of Total	6.4%	12.8%	12.8%	4.3%	36.2%
	strongly agree	Count	4	4	4	4	16
		% within local where raised	50.0%	28.6%	25.0%	44.4%	34.0%
		% of Total	8.5%	8.5%	8.5%	8.5%	34.0%
	Total	Count	8	14	16	9	47
		% of Total	17.0%	29.8%	34.0%	19.1%	100.0%

 

Table7. Crosstabulation: practice organization type* county* practice organization used for CME

			County of Practice						Missing	Total
	practice organization		County 1	County 2	County 3	County 4	County 5	County 6
Yes	multi-specialty group	Count	16				1	1	2	20
		% within practice organization	80.0%				5.0%	5.0%	10.0%	100.0%
		% within county of practice	100.0%				100.0%	50.0%	100.0%	66.7%
		% of Total	53.3%				3.3%	3.3%	6.7%	66.7%
	single-specialty group	Count		6	1			1		8
		% within practice organization		75.0%	12.5%			12.5%		100.0%
		% within county of practice		75.0%	100.0%			50.0%		26.7%
		% of Total		20.0%	3.3%			3.3%		26.7%
	solo practice	Count		2						2
		% within practice organization		100.0%						100.0%
		% within county of practice		25.0%						6.7%
		% of Total		6.7%						6.7%
	Total	Count	16	8	1		1	2	2	30
		% within practice organization	53.3%	26.7%	3.3%		3.3%	6.7%	6.7%	100.0%
		% within county of practice	100.0%	100.0%	100.0%		100.0%	100.0%	100.0%	100.0%
		% of Total	53.3%	26.7%	3.3%		3.3%	6.7%	6.7%	100.0%
No	multi-specialty group	Count	35	1		2	3	2	8	51
		% within practice organization	68.6%	2.0%		3.9%	5.9%	3.9%	15.7%	100.0%
		% within county of practice	100.0%	4.8%		66.7%	15.8%	18.2%	88.9%	52.0%
		% of Total	35.7%	1.0%		2.0%	3.1%	2.0%	8.2%	52.0%
	single-specialty group	Count		14		1	8	4	1	28
		% within practice organization		50.0%		3.6%	28.6%	14.3%	3.6%	100.0%
		% within county of practice		66.7%		33.3%	42.1%	36.4%	11.1%	28.6%
		% of Total		14.3%		1.0%	8.2%	4.1%	1.0%	28.6%
	solo practice	Count		6			8	5		19
		% within practice organization		31.6%			42.1%	26.3%		100.0%
		% within county of practice		28.6%			42.1%	45.5%		19.4%
		% of Total		6.1%			8.2%	5.1%		19.4%
	Total	Count	35	21		3	19	11	9	98
		% within practice organization	35.7%	21.4%		3.1%	19.4%	11.2%	9.2%	100.0%
		% within county of practice	100.0%	100.0%		100.0%	100.0%	100.0%	100.0%	100.0%
		% of Total	35.7%	21.4%		3.1%	19.4%	11.2%	9.2%	100.0%

Table 8. Percent responses to CME and practice organizations statements

		strongly disagree/ disagree	slightly disagree	slightly agree	strongly agree/agree
I most often engage in continuing medical education opportunities at my practice organization		39.1%	9.8%	19.5%	31.6%
My practice organization provides adequate opportunities for continuing medical education		19.4%	9.3%	25.6%	45.7%
I believe that my continuing medical education needs are being met through my current practice organization		24%	16.5	20.3%	39.1%
I seek continuing medical education opportunities outside my current practice organization		52.4%	11.3%	13.7%	22.5%

Table 9. Spearman correlation: CME and practice organizations

		I most often engage in continuing medical education opportunities at my practice organization.	I believe that my continuing medical education needs are being met through my current practice organization	My practice organization provides adequate opportunities for continuing medical education.	I seek continuing medical education opportunities outside my current practice organization.
I most often engage in continuing medical education opportunities at my practice organization.		1.000	.431**	.249**	.075
Sig.		.	.000	.004	.408
N		133	133	129	124
I believe that my continuing medical education needs are being met through my current practice organization			1.000	.399**	.005
Sig.			.	.000	.955
N			133	129	124
My practice organization provides adequate opportunities for continuing medical education.				1.000	.153
Sig.				.	.089
N				129	124
I seek continuing medical education opportunities outside my current practice organization.					1.000
Sig.					.
N					124

** Correlation is significant at the .01 level (2-tailed).

*Correlation is significant at the .05 level (2-tailed).

 

 

Rhonda Waskiewicz is is an allied health practitioner, educator and administrator who is interested in the development and implementation of community-based participatory research opportunities. She is currently an assessment consultant to academic and non profit organizations. This research was conducted while she was the Associate Dean of the Panuska College of Professional Studies at the University of Scranton.

Vera Walline is Executive Director of the Northeast PA Area Health Education Center.  She has over 25 years experience in planning, executing, and evaluating community health programs, in Scotland, Israel, and Pennsylvania.

Matthew Bain is currently employed as the Training and Safety Supervisor for C & S Wholesale Grocers, Inc., the second largest distribution company in the United States.  He was a graduate student in Human Resources Administration at the time of this research project.

For more information please contact:
Rhonda A. Waskiewicz
570 472-3605 (home)  570 479-4127 (cell)
rhonw@ptd.net