What factors influence health professions trainees’ preferences for employment in rural Appalachia? a qualitative study to inform the design of a discrete choice experiment

Bibliographic Data

ID15328526
AuthorsChris Gillette (0000-0002-8623-1285, Department of PA Studies, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, corresponding author), Joachim Ostermann (0000-0002-8236-9500, Arnold School of Public Health, University of South Carolina, corresponding author), Aylin A Aguilar (0009-0009-4925-1015, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine), Sarah Jane O’Neal (Wake Forest University), Sarah O’Neal (Department of PA Studies, Wake Forest, University School of Medicine), CHRIS EVERETT (Medical College of Wisconsin), Dawn Caviness (Cabarrus Family Medicine Residency Program, Atrium Health), Esita Patel (0000-0002-4175-3864, Center for Advanced Practice, Atrium Health, Department of Implementation Science, Wake Forest University School of Medicine), Laiton R Steele (0000-0001-6861-7398, Wake Forest University), Laiton Steele (Department of PA Studies, Wake Forest, University School of Medicine), Dawn M Goel (Marshall University), Dawn Goel (Marshall University), Quazi Minhaz Tabassum (0009-0002-2073-3116, University of North Carolina at Charlotte)
Year2026
Volume31
Issue1
Pages2649666-2649666
Publication date2026-03-26
Open AccessYes
TypeARTICLE
VenueMedical Education Online (JOURNAL)
Journal identifiersISSN: 1087-2981 • E-ISSN: 1087-2981
PublisherTaylor & Francis (PUBLISHER • GB)
DOI10.1080/10872981.2026.2649666
PMID41885115
OpenAlexW7140401500
LanguageEN
References cited25

Optimizing the geographic allocation of health care providers has the potential to improve health care access and health outcomes for rural populations. To inform the design of a discrete choice experiment (DCE) survey to elicit health professions trainees' preferences for rural practice, this formative research aimed to: (1) elicit factors that influence job selection among health profession trainees, including medical residents physician assistant (PA) and nurse practitioner (NP) students, (2) identify how these trainees evaluate trade-offs for rural job placement and (3) inform attribute selection for inclusion into a future DCE to identify health professions trainees' preferences for rural practice. Third- and fourth-year medical residents, PA students, and NP students completed an in-depth semi-structured interview, an adaptive choice-based conjoint exercise, and a ranking exercise. Inductive and deductive coding and reflexive thematic analysis were used to analyze the data. We reached thematic saturation after 22 interviews ( n = 14 PA, n = 6 residents, n = 2 NP). We identified multiple domains across two major themes: (1) job-related attributes and (2) community-related attributes. Job-related attribute domains included: (1) team dynamics, management/leadership, and clinical decision support, (2) onboarding and professional development, and (3) compensation package/remuneration. Community-related covered two attribute domains included: (1) amenities and social environment and (2) rurality and commute time. Participants were willing to trade non-pecuniary factors against salary and loan repayment. We identified 10 attributes for potential inclusion in the DCE. This study identified several viable factors for potential inclusion as attributes in a DCE. Several of these factors have yet to be explored in a policy environment and may aid the design of rural healthcare recruitment strategies

Conjoint analysis · Health care · Inclusion (mineral · Qualitative research · Ranking (information retrieval · Rurality · Salary · Thematic analysis · Workforce · Cultural Competency in Health Care · Diversity and Career in Medicine · Global Health Workforce Issues

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