Unimportant: Correlation/causation fallacy for underserved areas

[Shredder]

"There is evidence that doctors who grew up in rural areas are more likely to practice in rural areas," said Janet Coffman, research associate at the Petris Center, based at UC Berkeley's School of Public Health, and lead author of the report. "It's a matter of seeking out those health care professionals who want to practice in those communities."

taken from: http://www.berkeley.edu/news/media/releases/2004/06/22_drshortage.shtml

does anyone else see the flawed logic here. ive seen this argument used time after time for rural and underserved both. in other words, docs who grew up in rural/underserved areas tend to practice in rural/underserved areas, therefore they must have always wanted to do that. i think its pretty bogus actually, as theres large potential for confounding variables on which im hesitant to speculate for various reasons

Correlation implies causation logical fallacy

---

Members don't see this ad.

 

[tacrum43]

taken from: http://www.berkeley.edu/news/media/releases/2004/06/22_drshortage.shtml

does anyone else see the flawed logic here. ive seen this argument used time after time for rural and underserved both. in other words, docs who grew up in rural/underserved areas tend to practice in rural/underserved areas, therefore they must have always wanted to do that. i think its pretty bogus actually, as theres large potential for confounding variables on which im hesitant to speculate for various reasons

Correlation implies causation logical fallacy

Well it seems like they would be the most likely to practice there. Possibly because that's where they have family and friends.

 

[Chinorean]

taken from: http://www.berkeley.edu/news/media/releases/2004/06/22_drshortage.shtml

does anyone else see the flawed logic here. ive seen this argument used time after time for rural and underserved both. in other words, docs who grew up in rural/underserved areas tend to practice in rural/underserved areas, therefore they must have always wanted to do that. i think its pretty bogus actually, as theres large potential for confounding variables on which im hesitant to speculate for various reasons

Correlation implies causation logical fallacy

Hmm I think in that quote, it's more like--if you grew up there, you can envision yourself practicing in a rural/underserved area. If you grew up in Laguna Beach, you're not going to see yourself as the ghetto doctor. And idealist doctors tend to travel to third world countries to do charity work.

 

[Shredder]

Well it seems like they would be the most likely to practice there. Possibly because that's where they have family and friends.

the data show that they are the most likely to practice there, thats not in dispute. your 2nd statement is a valid theory, but its not likely that they go on to practice in the same communities where they have family or friends. i believe they just go on to practice in those types of areas in general, but i dont have facts on that, only intuition

Chinorean in response to your comment, i think if you grew up in a bad area you might be especially inclined to escape from that type of environment, to work your way up into nicer areas. basically i think those from underserved areas go on to practice in underserved areas bc they dont have any choice--those places are just less competitive and more accepting of anybody who is willing to go and set up shop. i dont think it has anything to do with good will as med schools and publications like to imply.

the reason i care is bc that necessarily places some bad will on docs who choose not to go to those areas, bc there can only be so much will going around and it has to balance you know, like energy. everyone should be up front about the fact that every doc goes to the best area possible. and i dont mean best according to each individual--there are some universal standards on what constitutes good areas and what constitutes bad ones. theres not consensus but there are standards

 

[dajimmers]

I don't think that anything else will have a stronger correlation than place they were raised for what type of area doctors end up practicing in. Socioeconomic status, race, interest in public health, etc. are other markers, but none are definitely a causation, and I don't know how you'd test for causation anyways. Regardless, the statistics still show that you'll get a bigger chance of getting a rural doc if they came from a rural area...

there are some universal standards on what constitutes good areas and what constitutes bad ones.

I disagree with this. Plenty of people would prefer rural areas over others. What is good to me will be hated by many others. I'd probably rather practice anywhere in Michigan over anywhere in Arizona (not to pick on Arizona, but my perception is that it's very different than my personal preferences).

In order to increase the number of rural docs, you can accept more rural applicants to med school. You can incentivize rural med (like the current program that pays your loans if you practice in a rural area for so long). You can get better rural experiences for students in medical school. And, you can increase their salaries.

 

[LizzyM]

there are some universal standards on what constitutes good areas and what constitutes bad ones. theres not consensus but there are standards

What is good? This is more opinion and philosophy than quantifiable fact.

Some people thrive in crowds, in densely populated places, high rise living with high population turn-over.

Others want
land and a barn where they can work on hobby like restoring classic cars,
a rush hour downtown that doesn't last more than 15 minutes,
the opportunity for a practice that spans generations of the same families,
a social life revolves around church suppers and building relationships.

Is Rochester Minn. a bad area because it is rural?

Who is more likely to practice in rural Minnesota: a guy from Brooklyn, NY or one from Chandler, Minnesota?

Which better understands the culture of the people? who would feel at home there? who could picture himself practicing among those people?

You are insinuating that the med students who come from rural areas are the bottom of the barrel and they return to the only places that they can get jobs. That is insulting and fails to recognize that life style, as well as type of practice one desires (it is hard to be a subspecialist in a rural community, there just isn't enough work in the subspecialty) dictates where one will live and work.

 

[prana_md]

OP: Why do you care? Are you just picking a fight? As we know from your copious posts, you are probably not going to be an FP in a rural area. I'm trying to see what flame-war you're igniting, but I just can't be bothered.

I'm willing to suggest that medical students who grow up in rural areas recognize the dire need for physicians, and feel a connection to rural communities.

You don't even have to had grown up there ... I've been involved with underserved patients in an urban hospital for about 5 years, and the experience has definitely influenced how I see myself practicing medicine.

 

[DropkickMurphy]

Personally I plan on working in the area I grew up in (not in my hometown because it only has 122 people in it), but it has nothing to do with my family being here, or old friends (because most people move away after high school or college) but rather because the land is pretty, cheap, and the people are nice. I would consider a similar area in another state, but my reasons for choosing it have nothing to do with dedication to the place I grew up in obviously.

 

[PhotoMD]

The causes are kind of irrelevant, because the data show that by accepting rural students, you're going to get more rural doctors.

 

[Shredder]

OP: Why do you care? Are you just picking a fight? As we know from your copious posts, you are probably not going to be an FP in a rural area. I'm trying to see what flame-war you're igniting, but I just can't be bothered.

i knew a flame war was a possibility but it wasnt my intention. ive tried to put things gingerly to avoid flames. its within my sdn rights to raise legitimate points if im sincere about them. threads can be closed but personally i think the responsible way to handle undesirable threads is to avoid them

The causes are kind of irrelevant, because the data show that by accepting rural students, you're going to get more rural doctors.

you are correct. regardless of the reasons, it is a means to an end. but when practicing in underserved areas is glorified, doesnt that demean the docs who decide to do plastic surgery in hollywood? you know that those docs are often frowned upon (much like big, glitzy corporations), and is that right? the data do show that correlation, but when causation is implied its simply faulty logic

as for the universal standards that determine the desirability of a location: crime, pollution, drugs, education, etc (there are others that i cant think of at the moment but you get the idea, i hope). i agree that some ppl want barns and others want freeways and such, but nobody wants crime, drugs, and poor education in a location. its just not rational, and any people who do like those are in the fractional minority--not nearly enough to account for all of the ppl who live and work in those areas. thus they are pretty much universal standards of the quality of a location, and it follows that a large number of the ppl in the undesirable locations are not there by choice. LizzyM im actually more bothered by the underserved phenomenon than the rural one--plenty of people do prefer working in rural areas, but few if any prefer working in the typical, urban underserved area. ppl from those areas do tend to be less qualified in the first place, thus they end up eventually practicing there. but statistical tests could be run to determine universal standards of locational desirability

the land is pretty, cheap, and the people are nice

those sound like appealing qualities in a location--none however tend to apply to underserved areas. hey i dont know what im getting at, this can all stop right now if thats desired. im just perturbed by the glorification of underserved areas, as i think it makes ppl look a little bad who say they have no desire whatsoever to practice in those areas or ever set foot in them. and that is what gets to me

 

[LizzyM]

Most rural areas are underserved meaning that they have few doctors per 1,000 population. I can recall getting a post card to recruit a doctor to a community that was 150 miles from the State Capital (which was No-wheresville to begin with).

Some people are altruistic and choose to work in inner-city neighborhoods. Sometimes they live in a tony suburb that is 15-20 miles away; a few, usually the missionary type, buy in the neighborhood and make a life among the poor. Read http://www.lawndale.org/about_poor.html for more information.

 

[Saluki]

Lizzy M is right. There are always going to be people from wealthy backgrounds who choose to practice in poor areas for altruistic reasons (missionary doctors in Africa or India or Christian clinics in inner city Chicago like Lawndale or Christian Community Clinic) However, what the article referred to talks about is that statistics bear out that people from rural areas are more likely to practice in rural areas. I've never lived in a town with more than 50,000 people- that's part of the reason why Mayo appeals to me as a med school- I'd be comfortable there. NYC would be an exciting place to attend med school, but I'd rather get married and raise a family someplace a little smaller...

 

[DropkickMurphy]

I never said anything about serving a rural or so described "underserved" community. Do I plan on living in a rural community? You bet your left a--cheek I do. Do I plan on working there as some form of primary care doc? Not unless I do horrible in medical school and on the boards and have no other choice. Having observed many, many, many hours with primary care doctors I must say it takes a special kind of person to do that kind of work, and I know for certain that I am not one of them. Now if I go into a specialty that is needed in the area I live in, I might do a day or two per week of office hours out there so that people do not have to travel so far, but that's as close to being the "town doc" as I want to get.

As for "underserved"- the PC term for "sh-thole" or "ghetto"- well there's obviously a reason that other doctors do not want to be there, so obviously therefore is a reason I will not be there either.

 

[glp]

im not exactly sure what point you are trying to make. however, i do think that there is a causal relationship between growing up in a rural/undersreved area and developing a practice in a similar environment. as i am sure you are aware, it is very difficult to prove causality with empirical data. i also do not think it is wise to imply that people who practice in rural/underserved areas do so out of circumstance and not by choice, ie they are inferior physicians who can do no better. im also do not why you have such animosity toward the emphasis on recruiting physicians for these areas. it is hard to argue that social welfare in increased more by another plastic surgeon in hollywood than by an FP in rural america.

 

[Shredder]

As for "underserved"- the PC term for "sh-thole" or "ghetto"- well there's obviously a reason that other doctors do not want to be there, so obviously therefore is a reason I will not be there either.

i didnt want to say it outright but im glad you did. no doctors want to be there by choice. i know you didnt say rural or underserved--you have a certain type of location you like and want to work in. but i dont think anyone (or very very few) likes working in underserved areas, as it is portrayed. the point im trying to make is that nobody or close to nobody wants to work in underserved areas, they just end up there. and the fact that they are glorified is uncalled for

plastic surgeons in hollywood cater to the tv and film stars that everyone in america idolizes, and that factors into social welfare

 

[popolus]

i didnt want to say it outright but im glad you did. no doctors want to be there by choice. i know you didnt say rural or underserved--you have a certain type of location you like and want to work in. but i dont think anyone (or very very few) likes working in underserved areas, as it is portrayed. the point im trying to make is that nobody or close to nobody wants to work in underserved areas, they just end up there. and the fact that they are glorified is uncalled for

plastic surgeons in hollywood cater to the tv and film stars that everyone in america idolizes, and that factors into social welfare

Seriously, do you believe people do not want to work in underseved areas?? I will have you know that there are still plenty of people both rich and poor from all walks of life who just want to help people, I know it is hard for you to believe that there are still selfless people on this earth, but there are! Believe me I have met plenty Docs who were working in areas where they did not have to be. I personally know a havard educated doc. top 10% of his class that went into FP and practices in what you will term as " s**hole" but they do it for the love of people. I could go on and on but I will end with a hope that there are more future doctors out there that think differently than the way you always present everything as .......

 

[Shredder]

Seriously, do you believe people do not want to work in underseved areas?? I will have you know that there are still plenty of people both rich and poor from all walks of life who just want to help people, I know it is hard for you to believe that there are still selfless people on this earth, but there are! Believe me I have met plenty Docs who were working in areas where they did not have to be. I personally know a havard educated doc. top 10% of his class that went into FP and practices in what you will term as " s**hole" but they do it for the love of people. I could go on and on but I will end with a hope that there are more future doctors out there that think differently than the way you always present everything as .......

that harvard top 10% doc would do better for society to go to the position where he is most needed--some top notch hospital doing cutting edge work and research. instead hes likely doing rote work in some underserved area, covering fevers and rashes, which any doc can do. in fact you could even say hes displacing the work of some other doc who is only qualified to do that type of work. is that point of view reasonable? to answer your question--i do believe people do not want to work in underserved areas, and that most do it due to lack of other options. i present things differently but its good to avoid groupthink--challenging conventional ways of thinking, if you will. its called true diversity

 

[popolus]

that harvard top 10% doc would do better for society to go to the position where he is most needed--some top notch hospital doing cutting edge work and research. instead hes likely doing rote work in some underserved area, covering fevers and rashes, which any doc can do. in fact you could even say hes displacing the work of some other doc who is only qualified to do that type of work. is that point of view reasonable? to answer your question--i do believe people do not want to work in underserved areas, and that most do it due to lack of other options. i present things differently but its good to avoid groupthink--challenging conventional ways of thinking, if you will. its called true diversity

When someone presents a different view point it is "group think" when you do it, you prefer to call it challenging and true diversity, interesting!. Anyway your assertion that becuase someone went to havard they should be doing research is laughable, you actually believe that routine doctor work is easy? I beg to differ, dealing with people is in my estimation more difficult than conventional intelluctual achievments. Why do you think many schools take the interview so seriously? I will venture to say that anyone with a decent MCAT score can handle medical school academically as well as your so called cutting edge research, but not everyone can deal with people in the way that is acceptable. I am sure stories about jerky doctors have been discused to no end. So my friend, just becuase you think an idea might be challenging or insightful does not make it so

 

[finch]

that harvard top 10% doc would do better for society to go to the position where he is most needed--some top notch hospital doing cutting edge work and research. instead hes likely doing rote work in some underserved area, covering fevers and rashes, which any doc can do.

Sure, any doctor may be capable of doing this work, however, most are not- that is why the area is underserved. The cutting edge treatments developed by doctors at big research hospitals don't do much good for the people who don't have a doctor to administer them.

 

[LizzyM]

I'll say it again, I hope Shredder shares all his fascinating ideas with every medical school interviewer he encounters this season.

 

[C.P. Jones]

I'd probably rather practice anywhere in Michigan over anywhere in Arizona (not to pick on Arizona, but my perception is that it's very different than my personal preferences).

so i considered making a new user name of "Arizona" and then reply to you all angry b/c you were bashing me, but i'm too lazy...picture it though

 

[DropkickMurphy]

Many of us, the premeds who make up the membership of this forum- I'm guessing more than 95% of us- are only willing to say what we think the ADCOM's want to hear on here, for fear that the roving admissions personnel who visit this site might put two and two together and realize we aren't the next Albert Schweitzer as many of us would like them to believe.

Frankly there is nothing wrong with being honest and admitting that you have what would be possibly misconstrued as "self-serving" secondary reasons for going into medicine- the desire to live in a better part of town, the desire to be duly rewarded for years of hard work and long hours spent in trying and stressful conditions, etc. There is nothing wrong with not wanting to serve the gangbangers, crackheads and prostitutes of the ghetto- in fact it is ingrained in every last one of us to avoid these kinds of people from a very early age.

Now anyone who is willing to go in and serve these people should be thanked for their service, but it does not make them any more of a physician than a FP doc serving a wealthy community. Health care is health care, regardless of the setting. A desire to serve others is (or at least should be) requisite for a career in health care, and is not diminished by serving a population that can afford to pay for it. In my case, I honestly don't care who I treat but I do care that I am safe, secure and that I can keep a roof over my family's head.

 

[Shredder]

Sure, any doctor may be capable of doing this work, however, most are not- that is why the area is underserved.

nah, its underserved bc the incentives to serve it arent strong enough. if they were it would be served just fine. most docs would be offended if you told them they werent capable of practicing in underserved areas. also, harvard and other top notch schools are in the business of producing cutting edge docs and researchers, and leaders. it brings the schools fame, money, and prestige. even schools have their agendas

sometimes through my candor i step on toes. sorry for this, but i dont think the truth should ever be shied away from even if its unpleasant

 

[MoosePilot]

Their standards for "underserved" are ridiculous, too. My home county is "underserved" according to AAMC, but my hometown was the doctor mecca in the county. It's weird.

Basically, I'd do my best to never practice in a ghetto, but I'd prefer rural to urban after my military commitment is complete.

 

[DropkickMurphy]

Personally I have yet to see a Harvard graduate that was anywhere near head and shoulders above the rest of their follow physicians in terms of bedside manner, clinical ability or even general knowledge. Good physicians, yes, but I think great physicians are set apart by dedication to the art, rather than what their diploma says.

 

[glp]

that harvard top 10% doc would do better for society to go to the position where he is most needed--some top notch hospital doing cutting edge work and research. instead hes likely doing rote work in some underserved area, covering fevers and rashes, which any doc can do. in fact you could even say hes displacing the work of some other doc who is only qualified to do that type of work. is that point of view reasonable? to answer your question--i do believe people do not want to work in underserved areas, and that most do it due to lack of other options. i present things differently but its good to avoid groupthink--challenging conventional ways of thinking, if you will. its called true diversity

your ideas arent radical, they are standard response from anyone who has studied economics but hasnt lived in the real world. not everything works like our micro book said it would. if someone chooses to work in an underserved area, it most likely means that the altruistic component of medicine (doing the same work for less money) is more important to them. i think that is admirable.

 

[popolus]

your ideas arent radical, they are standard response from anyone who has studied economics but hasnt lived in the real world. not everything works like our micro book said it would. if someone chooses to work in an underserved area, it most likely means that the altruistic component of medicine (doing the same work for less money) is more important to them. i think that is admirable.

You said it right! I will venture to say he/she will change some of thier views when they live in the real world and realize that things are not that always cut and dry

 

[osli]

Coming from a "rural" and underserved area, I also plan on staying here after med school to practice. I have no real desire to do primary care, and would much rather specialize in a surgical area, or perhaps something like cardiology. They do have those even in rural areas, you know?

As for motivations, it is pretty simple. I won't pretend that my motivations are shared by all doctors wanting to stay in or go to rural areas, but here they are: family and friends, low cost of living, low crime rate, and beautiful countryside that I'm obviously used to since I grew up there. Some people who grow up in cities have rural shock when moving to the country - and the opposite is true as well. You couldn't pay me enough to live in NY, DC, or LA. Been to all of those places numerous times, have no desire at all to live in a large city. For me personally, the family and friends thing is the most important. Cost of living is nice as well. As for suggesting that doctors go rural because that is the only place they are competitive is insulting and laughable. I have confidence that I could go into practically any specialty in any city in the US (assuming I'm accepted to med school, of course ), but I'd rather stay here where houses are 1/4 the cost, thank you very much.

 

[DropkickMurphy]

While I am far from close with my family, I couldn't agree more with some of the points you made. I agree that I could easily be competitive in any specialty in any city (Why you ask? Because I am ME j/k) but after having lived in Washington DC for two years, you couldn't pay me enough or otherwise coax me into living in a big city again. Love visiting them but I wouldn't live there.

 

[finch]

nah, its underserved bc the incentives to serve it arent strong enough. if they were it would be served just fine. most docs would be offended if you told them they werent capable of practicing in underserved areas. also, harvard and other top notch schools are in the business of producing cutting edge docs and researchers, and leaders. it brings the schools fame, money, and prestige. even schools have their agendas

sometimes through my candor i step on toes. sorry for this, but i dont think the truth should ever be shied away from even if its unpleasant

Sorry, I guess I wasn't very clear in my post. What i meant to say is that although virtually all doctors are capable of providing basic healthcare in underserved areas, most doctors choose not to do this work. The obvious result is that there is a shortage of primary care doctors in underserved areas. For this reason I feel that the Harvard doc providing rural primary care should be commended. Although he isn't doing research at a big name medical center, he has stepped up to fill a role that would otherwise be empty, and is providing care to people who would otherwise go untreated. He certainly isn't taking a job away from anybody- if there was any shortage of jobs for rural primary care practioners, we wouldn't be having this discussion.

 

[Shredder]

He certainly isn't taking a job away from anybody- if there was any shortage of jobs for rural primary care practioners, we wouldn't be having this discussion.

hmm, good point, i slipped up. i still think he does a greater benefit to society by practicing to his fullest potential--at some cutting edge place. is it really necessary for me to clarify cutting edge. so his practicing below his fullest potential comes at a cost. top tier grads are supposed to push medicine forward and make breakthroughs. docs in underserved places just dont really do that, its not the right environment. i think harvard would frown--inwardly if not outwardly--to see grads running off to underserved areas. its doesnt serve the schools agenda best. its different if they go there or to other countries to revamp entire healthcare systems and make overhauls. but simple, day to day practicing isnt the same as that.

 

[DropkickMurphy]

Why? Because it doesn't fulfill some Skull and Bones behind the scenes control of Ivy League medicine theory you happen to subscribe to? I like you Shredder, but man you're really going out on a limb with this.....

 

[Shredder]

Why? Because it doesn't fulfill some Skull and Bones behind the scenes control of Ivy League medicine theory you happen to subscribe to? I like you Shredder, but man you're really going out on a limb with this.....

dartmouth? i interviewed there, its one of my top choices. its far out but it has a great biz school. yeah i hate this thread, to really express it would require personal conversation. dartmouth and browns med schools arent regarded commensurately with their undergrad schools, thats all. the main point wasnt so much about rural, which some ppl like (super rural is pushing it a little), but really about underserved, which nobody really likes. yet its made to seem as if ppl do like it, via correlation and causation. people from underserved areas do on average tend to be less highly qualified as applicants, med students and docs, and thus are more likely to practice in less competitive underserved areas. im not sure how much of it has to do with desire, but i surmise not as much as its made to seem. thats about it, in summary. if that causes inflammation then i cant really do any better without bending the truth.

oh you werent talking about dartmouth, i used context clues poorly. top tier schools in any field, whether undergrad or biz or law, expect graduates to be a different breed. it reflects better on the schools for their grads to go on to prominent positions. in turn that brings more prestige and money to schools. i dont see how thats unreasonable logic; schools are just as agenda oriented as everyone else is, regardless of what is said and what is not said. i think its fair to say that harvard is more proud of bill frist and george bush (mba, and political affiliations aside) than the relatively obscure harvard grads in underserved area X. it doesnt have to be behind the scenes at all--on the contrary i think schools would much prefer in front of the scenes

 

[Faust]

the data show that they are the most likely to practice there, thats not in dispute. your 2nd statement is a valid theory, but its not likely that they go on to practice in the same communities where they have family or friends. i believe they just go on to practice in those types of areas in general, but i dont have facts on that, only intuition

Chinorean in response to your comment, i think if you grew up in a bad area you might be especially inclined to escape from that type of environment, to work your way up into nicer areas. basically i think those from underserved areas go on to practice in underserved areas bc they dont have any choice--those places are just less competitive and more accepting of anybody who is willing to go and set up shop. i dont think it has anything to do with good will as med schools and publications like to imply.

the reason i care is bc that necessarily places some bad will on docs who choose not to go to those areas, bc there can only be so much will going around and it has to balance you know, like energy. everyone should be up front about the fact that every doc goes to the best area possible. and i dont mean best according to each individual--there are some universal standards on what constitutes good areas and what constitutes bad ones. theres not consensus but there are standards

You have a whole lot to learn kid! "work your way up into nicer areas" "best area possible" "less competitive" you seem to be using a very skewed and weak false illusory economic lingo to argue against what is. YOur use of binary language-- "good" and "bad"--makes me laugh. What is your point, man? Don't front on trying to be somewhat of an intuitive intellectual kid, it is bad for your health!

Damn this is got to be one of the funniest things I read all week.

 

[MarzMD]

Or maybe MD's from disadvantaged backgrounds want to work in a similar area in order to improve the health of those who have shared similar circumstances. I think it is very dangerous assumption that those who chose to practice in these areas have no other choice. Personally, I do not want to "escape from that type of environment", but instead give back to these type of communities by providing my services. I think that the mentality you are displaying in this thread illustrates one of the major problems with healthcare today.
I do not follow your logic on why it would place bad will on MD's that do not choose to practice in underserved areas. Your whole argument is that MD's that work in underserved areas should not be praised because

1. they work there because they have no other choice
2. because they have no other choice, their reasons are not at all altruistic
3. giving them this false praise makes other MD's look bad

I find your conclusions to be very uninformed and off base.

 

[MDCali]

basically i think those from underserved areas go on to practice in underserved areas bc they dont have any choice--those places are just less competitive and more accepting of anybody who is willing to go and set up shop. i dont think it has anything to do with good will as med schools and publications like to imply.

the reason i care is bc that necessarily places some bad will on docs who choose not to go to those areas, bc there can only be so much will going around and it has to balance you know, like energy. everyone should be up front about the fact that every doc goes to the best area possible. and i dont mean best according to each individual--there are some universal standards on what constitutes good areas and what constitutes bad ones. theres not consensus but there are standards

Anybody who places bad will on a doctor for practicing as say a plastic surgeon in Hollywood would be just as mistaken as you are in your statement that the doctors who work in underserved areas do so only b/c they don't have any other choice. I know doctors who graduated from UCSF but were working in underserved communities. Why were they working in such areas instead of a more comfortable area? They obviously had choices. THey did however, live in comfortable neighborhoods. Anyways, from what I have seen, there are plenty of doctors working in underserved areas for altruistic reasons, and not because they can't find work somewhere else.