Montana State University

Study: Physicians married to highly educated spouses less likely to work in rural areas

March 1, 2016 -- From MSU News Service

Montana State University nursing professor Peter Buerhaus is co-author on a study that finds that married physicians with highly educated spouses are less likely than other married physicians to practice in rural underserved areas. The study was published today in the Journal of the American Medical Association. MSU photo by Kelly Gorham.

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BOZEMAN - Married physicians with highly educated spouses are less likely to practice in rural underserved areas, according to a new study published today in the Journal of the American Medical Association. Montana State University nursing professor Peter Buerhaus is co-author on the study.

The study examined 1 percent of all employed physicians ages 25 to 70 years working in the U.S. every 10 years from 1960 to 2000, and every year from 2005 to 2011, based on data from the Decennial Census and the American Community Survey, respectively.

The study found that the proportion of married physicians who are married to highly educated spouses – or what the paper’s authors refer to as “power couples” – increased from 8.8 percent in 1960 to 54.1 percent in 2010.

Compared with other married physicians, those with highly educated spouses were significantly less likely to work in a rural Health Professional Shortage Area. Single physicians were also less likely to work in rural underserved areas, as were physicians who were young, women, black or Hispanic.

Buerhaus said the results illustrate a growing headwind facing policymakers who are striving to find ways to induce physicians to practice in rural areas, particularly rural Health Professional Shortage Areas.  

He added that the study’s authors suggest policies –– such as provisions that enable physicians to use telemedicine to practice in rural underserved areas without relocating to those areas –– are necessary to help counter the shortage of physicians serving in rural areas.

Buerhaus noted that other recently published studies suggest that nurse practitioners may also be an important part of the solution.

“Other recently published studies show that nurse practitioners are more likely than physicians to practice in rural areas and underserved areas,” Buerhaus said. “Because people living in these areas are nearly three times more likely to have inadequate access to primary care, policy makers need to broaden their approach and consider increasing the number of nurse practitioners as a means to provide health care to these populations.” 

Buerhaus also pointed to another recent study that found that patients with a nurse practitioner as a primary care provider are less costly to Medicare than patients with a physician primary care provider.

“Using nurse practitioners, physician assistants, tele-health care, changing the way care is delivered by organizations and by teams of clinicians and non-clinicians, locating medical schools in rural areas, and exposing physicians and nurses to rural health early in their education, all are needed to overcome the persistent problem of inadequate access to primary care,” Buerhaus said.

The study’s lead author is Douglas O. Staiger, the John French Professor in Economics at Dartmouth. Co-authors include Buerhaus; Samuel M. Marshall, a former undergraduate student at Dartmouth who is now a graduate student at Arizona State University; David C. Goodman at the Geisel School of Medicine at Dartmouth; and David I. Auerbach at Vanderbilt University.

Buerhaus will discuss the paper’s findings, as well as associated research, at the university’s upcoming Café Scientifique, set for 6 p.m. Thursday, March 3, at the Baxter Hotel Ballroom in downtown Bozeman. The event is free and open to the public.

Contact: Peter Buerhaus, (406) 994-2681 or

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