Characteristics of Medical Deserts and Approaches to Mitigate Their Health Workforce Issues: A Scoping Review of Empirical Studies in Western Countries

Abstract

Background: Medical deserts are considered a problematic issue for many Western countries which try to employ multitude of policies and initiatives to achieve a better distribution of their health workforce (HWF). The aim of this study was to systematically map research and provide an overview of definitions, characteristics, contributing factors and approaches to mitigate medical deserts within the European Union (EU)-funded project "ROUTE-HWF" (a Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies). Methods: We performed a scoping review to identify knowledge clusters/research gaps in the field of medical deserts focusing on HWF issues. Six databases were searched till June 2021. Studies reporting primary research from Western countries on definitions, characteristics, contributing factors and approaches were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies according to the four defined outcomes. Results: Two-hundred and forty studies were included (n=116, 48% Australia/New Zealand; n=105, 44% North America; n=20, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n=171, 71%), characteristics (n=95, 40%), contributing factors (n=112, 47%), and approaches to mitigate medical deserts (n=87, 36%). Most medical deserts were defined by the density of the population in an area. Contributing factors to HWF issues in medical deserts consisted in work-related (n=55, 23%) and lifestyle-related factors (n=33, 14%) of the HWF as well as sociodemographic characteristics (n=79, 33%). Approaches to mitigate them focused on training adapted to the scope of rural practice (n=67, 28%), HWF distribution (n=3, 1%), support/infrastructure (n=8, 3%) and innovative models of care (n=7, 3%). Conclusion: Our study provides the first scoping review that presents and categorizes definitions, characteristics, contributing factors and approaches to mitigate HWF issues in medical deserts. We identified gaps such as the scarcity of longitudinal studies to investigate the impact of factors contributing to medical deserts, and interventional studies to evaluate the effectiveness of approaches to mitigate HWF issues.

Medical deserts in Spain—Insights from an international project

“…The Spanish experiences are therefore in line with those from other Western countries, as indicated by Flinterman et al (2023). 6 Actions focused on attracting and retaining physicians to work in rural and/or remote areas are urgently needed in Spain. A recent analysis, based on European countries experiences comparison showed that these should cover various stages of professional life and aim at improving medical workers' work-life balance and reducing their professional isolation.…”

“…They can be broadly categorized into those focused-on education (at both under and post-graduate level), introducing innovative models of care and providing professional and infrastructural support. The Spanish experiences are therefore in line with those from other Western countries, as indicated by Flinterman et al (2023). 6 Actions focused on attracting and retaining physicians to work in rural and/or remote areas are urgently needed in Spain.…”

“…A scoping review of an international literature was conducted to identify and map the empirical research on medical desert characteristics, contributing factors and approaches to mitigate them. 6 The results of the review were used to develop a questionnaire to be distributed among health workforce experts from European countries to gain more insight into the national context of medical deserts. The questionnaire covered three main parts (all focused on a given country and/or region): (i) characteristics of medical deserts and criteria for their definition, (ii) reasons and causes of medical deserts, (iii) approaches to eliminate or mitigate medical deserts.…”

“…In a recent literature review they are defined as (i) rural areas, (ii) underserved areas or (iii) by applying a measure of distance or time to a health facility, or a combination of these characteristics. 6 In Spain, the issue of progressing depopulation of mostly interior, rural provinces, called 'Empty Spain' (España Vaciada) has been on the national policy agenda for many years now. 7 Due to the high concentration of people in urban areas, many vast and unpopulated regions lack access to essential local services like health clinics, schools, and supermarkets.…”

Tackling medical deserts: unearthing factors that influence medical students’ attitudes and the path forward

“…Through an anonymous online questionnaire developed based on insights from previous research, the study surveyed final-year medical students regarding their attitudes towards working in medical deserts [6,7]. Data analysis was conducted using R programming language, with statistical significance set at a P value of <0.05.…”