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Tuttle, John

Urban, Stanley T.

Whitman, Maureen

Willison, Bruce

Marijuana legalization in the United States, both recreationally or medicinally, has increased its use in adults, yet the full impact of cannabinoid molecules found in marijuana on endogenous signaling pathways is unknown. Cannabinoid signaling has been tied to metabolism and pancreatic islet function, which is responsible for maintaining euglycemia

Tobias, Janelle M.

English

Developing optically-cleavable targeted (OCT)-ligands: a chemigenetic approach for studying endocannabinoid signaling in pancreatic islets

This was a survey study to identify financial and financial-adjacent incentives for students to work in rural areas in the future. Higher salary and loan forgiveness were most frequently ranked as highly influential. Flexible schedule and more time off were the most frequently selected incentives. Rural recruitment should focus on both financial and quality of life incentives to fill provider gaps in rural areas

Quimby, Elizabeth

Oregon Health & Science University 
School of Medicine 
Scholarly Projects Final Report 
Title (Must match poster title; include key words in the title to improve electronic search capabilities.)  
Incentivizing Students to Work in Rural Areas – What Could Work 
Student Investigator’s Name 
Liz Quimby 
Date of Submission (mm/dd/yyyy) 
3/16/24 
Graduation Year 
2024 
Project Course (Indicate whether the project was conducted in the Scholarly Projects Curriculum; 
Physician Scientist Experience; Combined Degree Program [MD/MPH, MD/PhD]; or other course.) 
Scholarly Projects Curriculum 
Co-Investigators (Names, departments; institution if not OHSU) 
n/a 
Mentor’s Name 
Dr. Eric Wiser 
Mentor’s Department 
Family medicine 
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Concentration Lead’s Name 
Dr. Buckley 
Project/Research Question 
Which financial and financial adjacent incentives will encourage students to work in rural areas in 
the future? 
Type of Project (Best description of your project; e.g., research study, quality improvement project, 
engineering project, etc.)  
Survey Study 
Key words (4-10 words describing key aspects of your project) 
Financial incentives, financial-adjacent incentives, rural practice, survey, medical students 
Meeting Presentations  
If your project was presented at a meeting besides the OHSU Capstone, please provide the meeting(s) name, 
location, date, and presentation format below (poster vs. podium presentation or other).  
n/a 
Publications (Abstract, article, other)  
If your project was published, please provide reference(s) below in JAMA style.  
n/a 
Submission to Archive 
Final reports will be archived in a central library to benefit other students and colleagues.  Describe any 
restrictions below (e.g., hold until publication of article on a specific date).  
n/a 
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Next Steps 
What are possible next steps that would build upon the results of this project? Could any data or tools 
resulting from the project have the potential to be used to answer new research questions by future medical 
students? 
 
Further data analysis for additional demographics. Increased distribution to other schools and regions to 
identify possible regional differences. Surveying current residents or attending and compare findings to 
medical student data.  
 
 
 
 
Please follow the link below and complete the archival process for your Project in addition to submitting 
your final report. 
 
https://ohsu.ca1.qualtrics.com/jfe/form/SV_3ls2z8V0goKiHZP  
 
Student’s Signature/Date (Electronic signatures on this form are acceptable.) 
This report describes work that I conducted in the Scholarly Projects Curriculum or alternative academic 
program at the OHSU School of Medicine. By typing my signature below, I attest to its authenticity and 
originality and agree to submit it to the Archive. 
Mentor’s Approval (Signature/date) 
X
M en tor N a m e
 
 
 
 
 
 
  
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Report: Information in the report should be consistent with the poster, but could include additional 
material.  Insert text in the following sections targeting 1500-3000 words overall; include key figures and 
tables.  Use Calibri 11-point font, single spaced and 1-inch margin; follow JAMA style conventions as 
detailed in the full instructions. 
 
Introduction (≥250 words)  
 
There is a growing shortage of physicians and other care providers in rural areas of the United States. 
According to the National Rural Health Association, nearly 20% of the US population lives in rural areas, 
however, only 11% of physicians live in those areas. There are only 13.1 physicians per 10,000 people in 
rural areas, compared to 31.2 in urban areas. Specialty care is also heavily concentrated in urban areas with 
263 specialty providers per 100,000 people, whereas rural areas only have 30 specialists per 100,000 
people. Additionally, as the rural physician workforce ages, more physicians will be retiring but with fewer 
replacements. Fewer younger physicians are practicing in rural areas, with more than half at least 50 years 
old, and more than a quarter over 60. Patients who live in rural areas are faced with increased barriers to 
receiving care and often are required to travel great distances to access care. The lack of providers in rural 
areas leads to worse health outcomes: rural residents are more likely to die from cardiovascular disease, 
chronic lung disease, and unintentional injury as well as having delays in diagnosis of cancers. Rural 
residents, when compared to urbanites, are more likely to be uninsured, older, poorer, and have lower life 
expectancies. 
Research shows that students who grow up in rural areas are more likely to return and work in those areas 
upon graduation. However, with the increasing shortage of physicians, recruitment of students from non-
rural backgrounds will be required to prevent further gaps in care. There has been little research specifically 
on recruiting students from urban/suburban areas and what would incentivize them to work in rural areas . 
 
Methods (≥250 words)  
 
A 15-question adaptive survey was created using the Qualtrix platform. Students were recruited via email 
invitation to the OHSU SOM listserv. Utilizing Likert scales, participants were asked their likelihoods to 
practice medicine in the future without incentives. Participants were then asked to select  any financial and 
financial adjacent incentives from a list of 10 that would be influential in their decisions to practice in a 
rural area. After these selections were made, participants ranked their incentives based on how influential 
it would be. Free text boxes were provided for any additional financial or financial adjacent incentives not 
previously listed. Finally, with their top incentive offered, participants were again asked their likelihoods for 
practicing in rural areas. Demographic data and prior rural experiences were also collected.  
 
Results (≥500 words)  
  
Upon closure of the survey, there were 199 responses. Of those, 48 were from urban areas, 124 suburban 
areas, and 27 rural areas. The rural participants were excluded from the remainder of the study. 
Demographic data showed a predominance of female respondents (n=144), versus male (n=41), and non-
binary/other gender (5). There was a fairly even distribution of respondents from different class sizes: 
med24 (n=44), med 25 (n=32), med 26 (n= 48), med27 (36), and prefer not to say (n=2). Respondents 
identified primarily as Caucasian (n=115), Asian (n=37), multiracial/biracial (n=10), Hispanic/Latino (n=7), 
other (n=5), black/African American (n=4), Native American/Alaskan Native (n=2), prefer not to answer 
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(n=2). The majority of participants did not have any prior rural exposure (n=103), compared to a prior 
experience in rural area (n=64).  
 
 
 
Without an incentive, students were less likely to practice in a rural area in the future. However, with their 
top incentive, students were significantly more likely to practice in a rural area in the future (p=0.005).  
 
 
 
The incentives most frequently ranked highly (1st, 2nd, 3rd), were greater than market average salary 
(85.8%), loan forgiveness (78.5%), and flexible schedule (68.4%). These highly ranked incentives may 
illustrate the rising costs of medical education and desire for financial stability. However, when looking at 
the incentives selected the most overall, flexible schedule (n=139) and increased vacation days (n=137). 
These could indicate a shift in medical culture as a whole, with a focus more on work life balance.  
 
 
 
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While participants who primarily grew up in rural areas were excluded from the study, there was interest in 
seeing if shorter term rural exposure had an impact on likelihood of working in a rural area in the future. If 
participants had prior rural exposures, they free texted where they were and how long they spent. These 
ranged from a few weeks to several years, both domestically and internationally. Prior rural exposure had a 
more even distribution of responses without incentive, and demonstrated a rightward shift towards more 
likely with top incentive. Offering incentives in the prior rural exposure subgroup, was statistically 
significant (p=0.005). A similar rightward shift was seen in the no rural exposure group. Offering top 
incentive in this subgroup was also statistically significant (p=0.01).  
 
 
 
Additional subgroup analysis was performed based on anticipated specialty. Participants provided free text 
answers to anticipated specialty. Undecided was an option and included in the non-surgical group. Similar 
rightward trends were seen in both groups when offered their top incentive. Offering incentives was 
statistically significant in both the non-surgical group (p=0.005) and surgical group (p=0.005). 
 
0
10
20
30
40
50
Extremely
Unlikely
Unlikely Neither likely
nor unlikely
Likely Extremely
Likely
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Figure 3: Likelihood of rural practice based on 
prior rural exposure 
Rural Exposure (no incentive) Rural Exposure (Top Incentive)
No Rural Exposure (no incentive) No Rural Exposure (top incentive
0
10
20
30
40
50
60
70
Extremely
Unlikely
Unlikely Neither likely
nor unlikely
Likely Extremely
Likely
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Figure 4: Likelihood of rural practice based on 
anticipated specialty 
Non-Surgical (no incentive) Non-Surgical (top incentive)
Surgical (no incentive) Surgical (top incentive)
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Table 1. Free texted incentives  Count 
Flexible Schedule (time off, telework, longer appointments) 10 
Distance to larger cities 10 
Affordable Childcare 8 
Access to outdoors/natural beauty 8 
Access to entertainment, activities, resources 7 
Community atmosphere, cultural connections 7 
Diversity in community and patient population 7 
Research opportunities 6 
Proximity to family, friends, spouses 6 
Sociopolitical climate 6 
Healthy workplace culture 6 
Clear partnerships with larger hospitals 5 
Housing stipend 4 
Good schools for children 4 
Location  4 
Improved reimbursement rates for procedures and services rendered 3 
Moving stipend/relocation bonus 3 
Adequate staffing 3 
Mentorship available 2 
Women’s Health Benefits 2 
Additional funding for research, community projects, conferences 2 
Food stipend 1 
Retirement benefits 1 
Transportation stipend 1 
Ability to participate in academic medicine 1 
Safety of city/community  1 
Dating opportunities 1 
Short commute to workplace 1 
Hospital investment in community outreach 1 
Increased physician autonomy in healthcare system 1 
Good training at institution  1 
 
Free texted incentives, both financial and financial-adjacent provided additional insight into other factors 
that could influence working in rural areas. Individual responses were sorted into broader categories or 
related themes, as listed in the above table. Out of the top ten categories, three were related to the 
workplace, while the remaining seven were related to quality of life. The majority of responses and 
categories were related to life outside of work. These data indicate that considering the needs of the whole 
person is important in recruitment, rather than solely focusing on the workplace.  
 
Discussion (≥500 words)  
 
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Given the significant physician shortage in rural United States, increased recruitment and retention of 
physicians is crucial to reduce barriers to care and improve rural health outcomes. Current efforts for 
recruitment and retention are not sufficient in combating the ever-growing shortage of providers in rural 
areas. Identifying appropriate incentives for providers who are not from rural areas, will be essential for 
recruitment and retention. Data from this study suggests that quality of life measures and financial-
adjacent incentives are being given increasing consideration when pursuing future work environments. 
While financial incentives such as increased salary and loan forgiveness were ranked highly, this pattern 
may be more prominent in medical students who are facing increasing financial burdens while obtaining 
their medical education. Financial considerations may be less important further along in one’s medical 
career. Data from this study is encouraging in that providing a top incentive is highly likely to encourage 
work in rural areas, irrespective of future specialty or prior rural exposure.  
 
Limitations of this study primarily resolve around the sampled population. Data was from a single, US based 
medical school. Data could differ dramatically if survey was performed in an international medical school, 
as work visas could be a significant incentive for those populations. The medical school sampled was in a 
more liberal city and state; Incentives to work in rural areas could differ significantly compared to other 
states who have differing rural populations and sociopolitical climates. Additionally, respondents were 
primarily white and female, which did not provide an accurate representation of all medical students in the 
United States. The sub group analysis was also based on small data sets, whose statistical significance may 
differ in a bigger sample size. Finally, medical students were the primary audience for this study. However,  
residents and attending physicians are more likely to be recruited to rural positions, as  current rural 
residency options remain few at time of data collection. Incentives collected at his stage of education may 
not represent motivations later on life.  
 
Areas of future research include increased sampling of different medical schools throughout the Pacific 
Northwest region, greater United States, and internationally. Incentives might have regional and 
international differences. This study focused on the incentives for physicians, however, there are multiple 
other healthcare providers that are essential for the overall healthcare system to function properly. Rural 
needs are not exclusive to medical care only. Obtaining perspectives from other healthcare providers would 
be useful in having comprehensive care in rural areas.  
 
Conclusions (2-3 summary sentences)  
 
Higher salary and loan forgiveness were the incentives most frequently rated highest , however, flexible 
schedule and increased vacation days were the most frequently selective incentives. Providing a top-rated 
incentive was significant in increasing likelihood of rural practice in the future. While financial incentives 
are important for recruitment, financial adjacent and quality of life incentives should seriously be 
considered for future recruitment efforts in rural areas.  
 
References (JAMA style format)  
1. About Rural Health Care - NRHA. Accessed October 21, 2021. 
https://www.ruralhealth.us/about-nrha/about-rural-health-care 
2. Attracting the next generation of physicians to rural medicine. AAMC. Accessed August 31, 
2021. https://www.aamc.org/news-insights/attracting-next-generation-physicians-rural-
medicine 
3. Dall T, Reynolds R, Chakrabarti R, Chylak D, Jones K, Iacobucci, W. The Complexities of Physician 
Supply and Demand: Projections From 2019 to 2034. AAMC. Accessed August 31, 2021. The 
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Complexities of Physician Supply and Demand: Projections from 2019 
thttps://www.aamc.org/data-reports/workforce/data/complexities-physician-supply-and-
demand-projections-2019-2034o 2034 | AAMC. 2019. 
4. Jaret P. Attracting the next generation of physicians to rural medicine. AAMC. Accessed August 
31, 2021. https://www.aamc.org/news-insights/attracting-next-generation-physicians-rural-
medicine  
5. Rourke JTB, Incitti F, Rourke LL, Kennard M. Keeping family physicians in rural practice. 
Solutions favoured by rural physicians and family medicine residents. Can Fam Physician. 
2003;49:1142-1149. 
6. Rural Practice, Keeping Physicians In (Position Paper). Accessed August 31, 2021. 
https://www.aafp.org/about/policies/all/rural-practice-keeping-physicians.html 
7. Skinner L, Staiger DO, Auerbach DI, Buerhaus PI. Implications of an Aging Rural Physician 
Workforce. N Engl J Med. 2019;381(4):299-301. doi:10.1056/NEJMp1900808 
 
 


Incentivizing students to work in rural areas – what could work

This project was created as the final project for Narrative Competence for Health Professionals, an interprofessional course for students across all OHSU schools and programs. This project was created as part of Narrative Competence for Health Professionals, an interprofessional education course. </p

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Developing optically-cleavable targeted (OCT)-ligands: a chemigenetic approach for studying endocannabinoid signaling in pancreatic islets

Incentivizing students to work in rural areas – what could work

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