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Experience of Commitment: A Phenomenological Study of the Lived Experience of Primary Care Physician Commitment for Practice in Urban Medically Underserved Communities Open Access

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Nationally, over 84 million Americans live in areas that do not have access to a sufficient number of primary care providers, with the majority being in low socioeconomic urban areas. Many physicians who are recruited or choose to practice in these areas leave after several years, while others remain. Limited empirical research has addressed the experiences of the physicians who choose to stay.Choosing to maintain a career practice in these communities indicates a commitment. For this study, commitment is defined as the psychological force that binds an individual to a target or course of action of relevance to that target. There is limited understanding of physicians’ experiences that lead to and sustain their commitment to practice in underserved communities.This hermeneutic phenomenological study explored the experience of physician commitment to practice long-term in an urban medically underserved community. It explored how this process developed in these physicians, as well as the influences that strengthened and/or weakened commitment. In-depth interviews of eleven primary care physicians who practice in underserved cities for seven years or greater were analyzed. Four primary findings emerged from this study:1. The primary commitment of these physicians was to underserved communities in general and their specific community. The secondary commitment was to their practice clinic organization.2. The essence of the experience of physician commitment for practice in urban medically underserved communities involved: embracing satisfying activities; actualizing their individual values; enacting their identity; and facing/resolving challenges.3. Commitment developed over time through the merging of two prerequisite commitments: the commitment to be a physician and the commitment to the underserved. Family, religious upbringing, mentors, and the nontraditional educational route to and/or through medical school contribute to development of the commitment to practice. 4. Commitment is sustained through embracing satisfying activities, actualizing values, enacting identity, and facing challenges. There is an intersection in all parts of the commitment experience that is reinforcing. This study shows the complexity of the commitment of physicians practicing in underserved communities, broadens the view of commitment as it is applied to organizations, and has implications for policies for health professional retention.

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