EFFECTS OF 2ND OFFICE AND HOSPITAL CONSULTING PRACTICES OF PHYSICIANSON RURAL COMMUNITIES

This research examined the prevalence of second offices and hospital c onsulting practices of physicians in Missouri, the characteristics of physicians participating in such practices, the change in availability of services through these practices, the characteristics of counties and hospitals involved, and the practice organization of participating physicians. The assessment of the factors was conducted within the co nceptual framework of community and physician characteristics, practic e form and organization, and health system resources. In 1993, 64 of t he 93 nonmetropolitan counties in Missouri, gained, on average, 1.3 fu ll-time equivalent physicians through second office and hospital consu lting practices. Eighteen nonmetropolitan counties lost, on average, 0 .4 full-time equivalent physicians through these practices; 11 nonmetr opolitan counties were not affected. The majority of physicians engage d in these two types of practices are nonprimary care specialists. Con sequently, in addition to the net contribution to total physician serv ice availability, many nonmetropolitan counties gained access locally to a wider variety of specialty services. This change in availability of physician services, not generally incorporated in decisions, needs to be considered when policy efforts are undertaken to change the spat ial and specialty distribution of physicians.