Association Between Having a Highly Educated Spouse and Physician Practice in Rural Underserved Areas.

Physician undersupply in rural areas remains a problem, despite efforts to improve the workforce distribution. 1 Rural origin , age, and sex have been linked to physician choice of rural settings. 2 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. 3 We investigated the prevalence of physicians with highly educated spouses and whether having such a spouse was associated with working in rural underserved areas. Methods | The Dartmouth institutional review board determined that the study did not involve human participants. We studied a 1% sample of all employed physicians aged 25 to 70 years working in the United States every 10 years from 1960 to 2000 (n = 19 668) obtained from the Decennial Census, and every year from 2005 to 2011 (n = 55 381) from the American Community Survey. 4 Both surveys used comparable questions , included all household members, and had response rates of more than 95%. We identified spouses reporting 6 or more years of college (before 1990) or a master's degree or higher (1990 and later). Comparable information on primary place of work was available for 2005 to 2011. Using the Health Resources and Services Administration's Geospatial Data Warehouse, we determined whether each rural census block was in a (geographically defined) primary care Health Professional Shortage Area (HPSA). 5 Physicians who worked in prespeci-fied groups of census blocks with more than half the rural population in a shortage area were classified as working in a rural HPSA. The proportion of married physicians with highly educated spouses was calculated for each year and plotted, along with a linear trend estimated by simple linear regression. Sampling weights were provided by the census. For 2005 through 2011, we estimated logistic regression models of the likelihood of working in a rural HPSA comparing physicians married to a highly educated spouse with other married physicians (reference group) and single physicians. Odds ratios (ORs) were estimated adjusting for physician age, race/ethnicity, and sex. Tests were based on 2-tailed t tests using a P value of less than .05 for significance, and accounted for use of sampling weights and clustering of observations within households. Analyses were performed using Stata (StataCorp), version 13.1. Results | The proportion of married physicians with highly educated spouses increased from 8. P for trend <.001) (Figure). In every year, …