In Reply Drs Hustedde and Wendling are correct to point out that rural origin is well known to be one of the strongest predictors of physician practice in rural areas. However, the data set used for the study had no information on physician origins beyond state of birth. Less than 1% of physicians were born in a rural county.1 Therefore, accounting for this variable in the analysis (even if it was strongly correlated with a spouse’s education) could not have had much effect on the estimated association of spousal education with rural practice. Thus, the lack of data on rural origins is unlikely to be a significant limitation of the study.
Staiger DO. Highly Educated Spouses and Physician Practice in Rural Areas—Reply. JAMA. 2016;316(6):664. doi:10.1001/jama.2016.6724