Underserved Areas and Pediatric Resident Characteristics: Is There Reason for Optimism?

Published:October 21, 2015DOI:



      To examine whether resident characteristics and experiences are related to practice in underserved areas.


      Cross-sectional survey of a national random sample of pediatric residents (n = 1000) and additional sample of minority residents (n = 223) who were graduating in 2009 was conducted. Using weighted logistic regression, we examined relationships between resident characteristics (background, values, residency experiences, and practice goals) and reported 1) expectation to practice in underserved area and 2) postresidency position in underserved area.


      Response rate was 57%. Forty-one percent of the residents reported that they had an expectation of practicing in an underserved area. Of those who had already accepted postresidency positions, 38% reported positions in underserved areas. Service obligation in exchange for loans/scholarships and primary care/academic pediatrics practice goals were the strongest predictors of expectation of practicing in underserved areas (respectively, adjusted odds ratio 4.74, 95% confidence interval 1.87–12.01; adjusted odds ratio 3.48, 95% confidence interval 1.99–6.10). Other significant predictors include hospitalist practice goals, primary care practice goals, importance of racial/ethnic diversity of patient population in residency selection, early plan (before medical school) to care for underserved families, mother with a graduate or medical degree, and higher score on the Universalism value scale. Service obligation and primary care/academic pediatrics practice goal were also the strongest predictors for taking a postresidency job in underserved area.


      Trainee characteristics such as service obligations, values of humanism, and desire to serve underserved populations offer the hope that policies and public funding can be directed to support physicians with these characteristics to redress the maldistribution of physicians caring for children.


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        • Health Resources and Services Administration
        Fiscal year 2011 justification of estimates for appropriations commitees. Executive summary.
        2010 (Available at:) (Accessed February 7, 2014)
        • Basco W.T.
        • Rimsza M.E.
        • American Academy of Pediatrics Committee on Pediatric Workforce
        Pediatrician workforce policy statement.
        Pediatrics. 2013; 132: 390-397
        • Shipman S.A.
        • Lan J.
        • Chang C.H.
        • et al.
        Geographic maldistribution of primary care for children.
        Pediatrics. 2011; 127: 19-27
        • Shipman S.A.
        • Jones K.C.
        • Erikson C.E.
        • et al.
        Exploring the workforce implications of a decade of medical school expansion: variations in medical school growth and changes in student characteristics and career plans.
        Acad Med. 2013; 88: 1904-1912
        • Xu G.
        • Veloski J.
        • Hojat M.
        • et al.
        Factors influencing primary care physicians' choice to practice in medically underserved areas.
        Acad Med. 1997; 72: S109-S111
        • Porterfield D.S.
        • Konrad T.R.
        • Porter C.Q.
        • et al.
        Caring for the underserved: current practice of alumni of the National Health Service Corps.
        J Health Care Poor Underserved. 2003; 14: 256-271
        • Odom Walker K.
        • Ryan G.
        • Ramey R.
        • et al.
        Recruiting and retaining primary care physicians in urban underserved communities: the importance of having a mission to serve.
        Am J Public Health. 2010; 100: 2168-2175
        • Ross R.
        Fifteen-year outcomes of a rural residency: aligning policy with national needs.
        Fam Med. 2013; 45: 122-127
        • Rieselbach R.E.
        • Crouse B.J.
        • Frohna J.G.
        Teaching primary care in community health centers: addressing the workforce crisis for the underserved.
        Ann Intern Med. 2010; 152: 118-122
        • Bazemore A.W.
        • Goldenhar L.M.
        • Lindsell C.J.
        • et al.
        An international health track is associated with care for underserved US populations in subsequent clinical practice.
        J Grad Med Educ. 2011; 3: 130-137
        • Barnighausen T.
        • Bloom D.E.
        Financial incentives for return of service in underserved areas: a systematic review.
        BMC Health Serv Res. 2009; 9: 86
        • Komaromy M.
        • Grumbach K.
        • Drake M.
        • et al.
        The role of black and Hispanic physicians in providing health care for underserved populations.
        N Engl J Med. 1996; 334: 1305-1310
        • Rabinowitz H.K.
        • Diamond J.J.
        • Veloski J.J.
        • et al.
        The impact of multiple predictors on generalist physicians' care of underserved populations.
        Am J Public Health. 2000; 90: 1225-1228
        • Basco Jr., W.T.
        • Cull W.L.
        • O'Connor K.G.
        • et al.
        Assessing trends in practice demographics of underrepresented minority pediatricians, 1993–2007.
        Pediatrics. 2010; 125: 460-467
        • Tavernier L.A.
        • Connor P.D.
        • Gates D.
        • et al.
        Does exposure to medically underserved areas during training influence eventual choice of practice location?.
        Med Educ. 2003; 37: 299-304
        • Frintner M.P.
        • Mendoza F.S.
        • Dreyer B.P.
        • et al.
        Resident cross-cultural training, satisfaction, and preparedness.
        Acad Pediatr. 2013; 13: 65-71
        • Weissman J.S.
        • Betancourt J.
        • Campbell E.G.
        • et al.
        Resident physicians' preparedness to provide cross-cultural care.
        JAMA. 2005; 294: 1058-1067
        • Greer J.A.
        • Park E.R.
        • Green A.R.
        • et al.
        Primary care resident perceived preparedness to deliver cross-cultural care: an examination of training and specialty differences.
        J Gen Intern Med. 2007; 22: 1107-1113
        • Association of American Medical Colleges
        Medical school graduation questionnaire: student survey on priorities in medical education.
        2009 (Available at:) (Accessed July 15, 2010)
        • Association of American Medical Colleges
        Medical school graduation questionnaire: 2009 program evaluation survey.
        2009 (Available at:) (Accessed July 15, 2010)
        • Weitzman C.C.
        • Freudigman K.
        • Schonfeld D.J.
        • et al.
        Care to underserved children: residents' attitudes and experiences.
        Pediatrics. 2000; 106: 1022-1027
        • Saha S.
        • Guiton G.
        • Wimmers P.F.
        • et al.
        Student body racial and ethnic composition and diversity-related outcomes in US medical schools.
        JAMA. 2008; 300: 1135-1145
        • Eliason B.C.
        • Guse C.
        • Gottlieb M.S.
        Personal values of family physicians, practice satisfaction, and service to the underserved.
        Arch Fam Med. 2000; 9: 228-232
        • Schwartz S.H.
        Universals in the content and structure of values: theoretical advances and empirical tests in 20 countries.
        Adv Exp Soc Psychol. 1992; 25: 1-65
      1. US Department of Health and Human Services, Health Resources and Services Administration. Shortage designation: health professional shortage areas and medically underserved areas/populations. Available at: Accessed January 25, 2013.

        • Frintner M.P.
        • Mulvey H.J.
        • Pletcher B.A.
        • et al.
        Pediatric resident debt and career intentions.
        Pediatrics. 2013; 131: 312-318
        • American Board of Pediatrics
        Workforce data, 2013–2014: 2013 general diplomate information.
        2014 (Available at:) (Accessed June 10, 2014)
        • Pelligrino E.D.
        Educating the humanist physician.
        JAMA. 1974; 227: 1288-1294
        • Serwint J.R.
        Humanism through the lens of the Academic Pediatric Association.
        Acad Pediatr. 2012; 12: 1-8
        • Block S.
        • Billings J.A.
        Nurturing humanism through teaching palliative care.
        Acad Med. 1998; 73: 763-765
        • Liaison Committee on Medical Education
        LCME consensus statement related to satisfaction with element 3.3, diversity/pipeline programs and partnerships [white paper].
        2015 (Available at: Accessed June 1, 2015)
        • Pathman D.E.
        • Konrad T.R.
        Growth and changes in the National Health Service Corps (NHSC) workforce with the American Recovery and Reinvestment Act.
        J Am Board Fam Med. 2012; 25: 723-733
        • National Resident Matching Program
        Results and Data: 2014 Main Residency Match.
        National Resident Matching Program, Washington, DC2014
        • Freed G.L.
        • Stockman J.A.
        Oversimplifying primary care supply and shortages.
        JAMA. 2009; 301: 1920-1922
        • Institute of Medicine
        Graduate Medical Education That Meets the Nation's Health Needs.
        National Academies Press, Washington, DC2014
        • Morrison E.
        • Cort D.A.
        Analysis in brief: an analysis of the medical school pipeline: a high school aspirant to applicant and enrollment view [document on the internet].
        Association of American Medical Colleges. 2014; (Available at: Accessed June 1, 2015.)