Decisions to Practice in Rural Areas Among Mental Health Care Professionals

This survey study assesses factors associated with mental health care professionals choosing to practice in rural locations.


Introduction
Rural areas of the US have long-standing inequities in mental health outcomes and access to services, due partly to rural mental health workforce shortages. 1,2Health care professionals have multifaceted reasons for choosing rural practice; however, previous research has not differentiated by professional type and had relatively small sample sizes. 3,4Research exploring rural health care practice more broadly has found that the most salient factor associated with choosing rural practice is having grown up in a rural area, but that other significant factors include financial incentives, practice characteristics, and training experiences. 5is study uses data from licensed mental health professionals to ask 2 questions.First, what factors are associated with mental health professionals choosing to practice in rural areas?Second, do those factors differ by professional type?We hypothesize practice location considerations differ by rurality and professional type.20) 1203 ( 25) 10 ( 24) 287 ( 28) 27 ( 22) 257 ( 23) Abbreviation: LADC, licensed alcohol and drug counselor.
a The total counts include professionals who were currently practicing in a position related to their license and did not have missing values on the dependent variable (urban or rural area of practice).The total counts may vary slightly from question to question because of item nonresponse.
b Family considerations scale ranges from 1 to 9; area/lifestyle considerations scale ranges from 1 to 10. Higher scores indicate more importance placed on each consideration.
c Data are given for respondents who rated each item as very important.Response options were very important, somewhat important, not important at all, and did not apply to me.

+ Supplemental content
Author affiliations and article information are listed at the end of this article.

Open Access.
This is an open access article distributed under the terms of the CC-BY License.1).Most rural professionals grew up in a small town or rural area, with the

Discussion
This findings of this survey study suggest that policy interventions to address rural mental health workforce shortages should focus on bolstering the pathway of rural residents entering practice, but other efforts need to be tailored depending on professional type.Limitations of this study include that the data are from only 1 state and do not account for care delivered virtually (ie, telehealth).
However, the variation we identified in factors associated with rural mental health care practice indicates a need for a targeted and multifaceted recruitment strategy.

Table 1 .
Demographic Characteristics and Distributions on Independent and Dependent Variables This survey study was approved by the institutional review boards of the University of Minnesota and Minnesota Department of Health (MDH).The survey used in this study is mandated in Minnesota state statute and it is obligatory for respondents; however, MDH assures respondents that their responses are private and cannot be shared at the individual level.This study adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting JAMA Network Open.2024;7(6):e2421285.doi:10.1001/jamanetworkopen.2024.21285(Reprinted) June 17, 2024 1/4 Downloaded from jamanetwork.comby guest on 06/22/2024 Methods We ran binary logistic regression models to estimate the associations of the independent variables with the dependent variable: rural practice location.We estimated separate adjusted models for each of the 4 different professional groups.All analyses were conducted in SPSS software version 29.0.0.0 (IBM) with 1-tailed hypothesis tests.Significance was set at P < .05.Data were analyzed from December 27, 2023, and February 22, 2024.Results There were 8908 professionals (mean [SD] age, 46.7 [12.4] years; 6992 [79%] female) in this study.Most professionals were practicing in urban areas, with psychologists least likely to be practicing in rural areas (43 of 1142 psychologists [4%]) and LADCs most likely to practice in rural areas (128 of 1214 LADCs [10%]) (Table

Table 2 .
Adjusted Odds of Practicing in Rural LocationDecisions to Practice in Rural Areas Among Mental Health Care Professionals highest rates among LADCs (92 LADCs [75%]).Having autonomy in one's practice was most commonly endorsed as a very important consideration when deciding where to work and practice (Table1).
a Measured per 1-unit increase in the importance level rated for the item.JAMA Network Open | Health Policy