The hypothesis of a positive relationship between physicians' empathy and patients' clinical outcomes was confirmed, suggesting that physicians' empathy is an important factor associated with clinical competence and patient outcomes.

All identified comprehensive medical school rural programs have produced a multifold increase in the rural physician supply, and widespread replication of these models could have a major impact on access to health care in thousands of rural communities. The current recommendation to expand U.S. medical school class size represents a unique and timely opportunity to replicate these programs.

The PSAP, after more than 22 years, has had a disproportionately large impact on the rural physician workforce, and this effect has persisted over time. Based on these program results, policymakers and medical schools can have a substantial impact on the shortage of physicians in rural areas.

These results are the first to show long-term rural primary care retention that is longer than the median duration. This outcome combined with previously published outcomes show that the PSAP represents the only program that has resulted in multifold increases in both recruitment (eight-fold) and long-term retention (at least 11-16 years). In light of recent national recommendations to increase the total enrollment in medical schools, allocating some of this growth to developing and expanding programs similar to the PSAP would make a substantial and long lasting impact on the rural physician workforce.

ObjectivesThis study was designed to investigate psychometric properties of the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and to examine correlations between its scores and measures of overall satisfaction with physicians, personal trust, and indicators of patient compliance.Methods: Research participants included 535 out-patients (between 18-75 years old, 66% female). A survey was mailed to participants which included the JSPPPE (5-item), a scale for measuring overall satisfaction with the primary care physician (10-item), and demographic questions. Patients were also asked about compliance with their physician’s recommendation for preventive tests (colonoscopy, mammogram, and PSA for age and gender appropriate patients).Results: Factor analysis of the JSPPPE resulted in one prominent component. Corrected item-total score correlations ranged from .88 to .94. Correlation between scores of the JSPPPE and scores on the patient satisfaction scale was 0.93. Scores of the JSPPPE were highly correlated with measures of physician-patient trust (r >.73). Higher scores of the JSPPPE were significantly associated with physicians’ recommendations for preventive tests (colonoscopy, mammogram, and PSA) and with compliance rates which were > .80). Cronbach’s coefficient alpha for the JSPPPE ranged from .97 to .99 for the total sample and for patients in different gender and age groups.Conclusions: Empirical evidence supported the psychometrics of the JSPPPE, and confirmed significant links with patients’ satisfaction with their physicians, interpersonal trust, and compliance with physicians’ recommendations. Availability of this psychometrically sound instrument will facilitate empirical research on empathy in patient care in different countries.

Despite major changes in health care in recent decades, Jefferson's PSAP continues to represent a successful model for substantially increasing the supply and distribution of rural family physicians. Especially with the forthcoming expansion in health insurance, access to care for rural residents will require an increased supply of providers. These results may also be important for medical schools planning to develop similar rural programs, given the new Rural Physician Training Grants program.

Three factors known at the time of medical school matriculation have a powerful relationship with rural practice three decades later. Relatively few students without predictors practice in rural areas, which is particularly significant given subsequent factors known to be related to rural practice--for instance, rural curriculum, residency location, or spouse. These results have major implications for the role of the medical school admissions process in producing rural physicians.

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