Practicing with the urban underserved. A qualitative analysis of motivations, incentives, and disincentives
L. B. Li, S. D. Williams and D. L. Scammon
Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City.
OBJECTIVE: To investigate the personal characteristics and professional
experiences of medical providers working with medically underserved urban
populations. DESIGN: Focus groups of primary care providers. SETTING:
Public and private clinics in Salt Lake City, Utah, in which the providers
had ongoing relationships with medically underserved patients.
PARTICIPANTS: Twenty-four providers (11 men and 13 women), including 12
physicians (three family physicians, seven pediatricians, and two
psychiatrists), one dentist, three physician assistants, and eight nurse
practitioners participated in three focus groups. MAIN OUTCOME MEASURE:
Interpretative analysis of verbatim quotations regarding personal beliefs,
feelings, and practice experiences. RESULTS: Participants revealed a strong
sense of service to humanity and pride in making a difference. They thrive
on the challenge of creatively dealing with their patients' complex human
needs with limited health care resources. Factors critical to survival in
an urban underserved setting include a hardy personality style, flexible
but controllable work schedule, and multidisciplinary practice team. The
camaraderie and synergy of teams generate personal support and
opportunities for continuing professional development. CONCLUSIONS:
Increasing the numbers of health care professionals wanting to work with
the medically underserved may be facilitated through refining admissions
criteria to schools for health care professionals to include values and
personality characteristics, emphasizing within curricula the important
skills and practice styles necessary to work with underserved patients, and
ensuring that underserved practice environments provide support through
multidisciplinary teams and structured work hours. These potentially
effective approaches could increase success in recruiting and retaining
health care professionals to work with medically underserved patients.
