Ll. Hicks et al., EFFECTS OF 2ND OFFICE AND HOSPITAL CONSULTING PRACTICES OF PHYSICIANSON RURAL COMMUNITIES, The Journal of rural health, 13(3), 1997, pp. 179-189
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.