College of Public Health students graduating
Kentucky and Appalachia Public Health Training Center

Georgianne Tiu

Focusing on Physician Shortages: KAPHTC-Supported Practicum Experience at Appalachian Regional Healthcare

Georgianne Tiu is working on a Doctor of Public Health (DrPH) degree in the Department of Health Management and Policy at the University of Kentucky. Growing up in Harlan County, Kentucky, she learned firsthand about the difficulties that a physician shortage can create for a rural population. This knowledge led her to pursue applied research which may impact physician recruitment and retention to underserved areas. Working under the auspices of the 10-hospital Appalachian Regional Healthcare (ARH) system she undertook qualitative and quantitative research with physicians and their spouses to discover what factors relate to physician choices to come, to stay, or to leave the region. Georgianne shadowed recruiters, helped with recruitment events, attended practitioner staff meetings, conducted focus groups, and surveyed all the physicians and their spouses inthe ARH system.

Two osteopathic schools in the area have helped with recruitment in recent years, but many of those graduates still do leave the state. “International graduates haveshown that they are willing to fill the gap. According to a VP, there are about 60-65% international medical graduates in the ARH system, which is comprised of 10 hospitals.” If they are fulfilling J-1 Visa requirements, these providers need to practice in an underserved area for only three years, which impacts continuity and satisfaction with health care for the population. Plus, as Georgianne notes, “many patients get really attached to their doctors.” Solving the physician shortage will support the population and also physicians themselves, since patient loads are heavier in underserved areas.

“ARH has a whole department committed to finding physicians to come down and practice. Recruitment is a challenge still, but the biggest challenge is retention. There has been quite a lot of research on recruitment, but not so much on retention. For this population, my research supports previous literature that social integration rather than just cultural integration is a big factor in retention. My hypothesis is that the spouse is a big influence on retention. That is the gap I am trying to fill. Hopefully my research will help with recruitment and retention strategies and policies.”

“In places like Harlan, we struggle with so many avoidable and preventable chronic health diseases, and so many people have low incomes. Residents in rural Appalachia often struggle with poor health outcomes because of the social determinants of health there, just as we learn about in textbooks. But actually seeing it firsthand and trying to do something about it is what most empowers me. When I first walked in to the hospital to do this practicum, I realized that I was getting a degree that could actually prepare me to help people. I hope that after I graduate I will be able to help vulnerable populations such as the residents in rural Central Appalachia, close the health disparities gap through translating research into policy and practice.”