Deborah J Russell1, Elizabeth Wilkinson2, Stephen Petterson3, Candice Chen4, Andrew Bazemore5. 1. is Senior Research Fellow, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia. 2. is former Junior Analyst, Robert Graham Center for Policy Studies in Family Medicine and Primary Care. 3. is Affiliate Faculty, The George Washington University Milken Institute School of Public Health. 4. is Associate Professor, The George Washington University Milken Institute School of Public Health. 5. is Senior Vice President of Research and Policy, American Board of Family Medicine, and Co-Director, Center for Professionalism and Value in Health Care.
Abstract
Background: Rural US populations face a chronic shortage of physicians and an increasing gap in life expectancy compared to urban US populations, creating a need to understand how to increase residency graduates' desire to practice in such areas. Objective: This study quantifies associations between the amount of rural training during family medicine (FM) residencies and subsequent rural work. Methods: American Medical Association (AMA) Masterfile, AMA graduate medical education (GME) supplement, American Board of Family Medicine certification, Accreditation Council for Graduate Medical Education (ACGME), and Centers for Medicare and Medicaid Services hospital costs data were merged and analyzed. Multiple logistic regression measured associations between rural training and rural or urban practice in 2018 by all 12 162 clinically active physicians who completed a US FM residency accredited by the ACGME between 2008 and 2012. Analyses adjusted for key potential confounders (age, sex, program size, region, and medical school location and type) and clustering by resident program. Results: Most (91%, 11 011 of 12 162) residents had no rural training. A minority (14%, 1721 of 12 162) practiced in a rural location in 2018. Residents with no rural training comprised 80% (1373 of 1721) of those in rural practice in 2018. Spending more than half of residency training months in rural areas was associated with substantially increased odds of rural practice (OR 5.3-6.3). Only 4% (424 of 12 162) of residents spent more than half their training in rural locations, and only 5% (26 of 436) of FM training programs had residents training mostly in rural settings or community-based clinics. Conclusions: There is a linear gradient between increasing levels of rural exposure in FM GME and subsequent rural work.
Background: Rural US populations face a chronic shortage of physicians and an increasing gap in life expectancy compared to urban US populations, creating a need to understand how to increase residency graduates' desire to practice in such areas. Objective: This study quantifies associations between the amount of rural training during family medicine (FM) residencies and subsequent rural work. Methods: American Medical Association (AMA) Masterfile, AMA graduate medical education (GME) supplement, American Board of Family Medicine certification, Accreditation Council for Graduate Medical Education (ACGME), and Centers for Medicare and Medicaid Services hospital costs data were merged and analyzed. Multiple logistic regression measured associations between rural training and rural or urban practice in 2018 by all 12 162 clinically active physicians who completed a US FM residency accredited by the ACGME between 2008 and 2012. Analyses adjusted for key potential confounders (age, sex, program size, region, and medical school location and type) and clustering by resident program. Results: Most (91%, 11 011 of 12 162) residents had no rural training. A minority (14%, 1721 of 12 162) practiced in a rural location in 2018. Residents with no rural training comprised 80% (1373 of 1721) of those in rural practice in 2018. Spending more than half of residency training months in rural areas was associated with substantially increased odds of rural practice (OR 5.3-6.3). Only 4% (424 of 12 162) of residents spent more than half their training in rural locations, and only 5% (26 of 436) of FM training programs had residents training mostly in rural settings or community-based clinics. Conclusions: There is a linear gradient between increasing levels of rural exposure in FM GME and subsequent rural work.
Authors: Therese Zink; Bruce Center; Deborah Finstad; James G Boulger; Lillian A Repesh; Ruth Westra; Raymond Christensen; Kathleen Dwyer Brooks Journal: Acad Med Date: 2010-04 Impact factor: 6.893
Authors: Srinivas Kondalsamy-Chennakesavan; Diann S Eley; Geetha Ranmuthugala; Alan B Chater; Maree R Toombs; Deepak Darshan; Geoffrey C Nicholson Journal: Med J Aust Date: 2015-01-19 Impact factor: 7.738
Authors: Matthew R McGrail; Peter M Wingrove; Stephen M Petterson; John S Humphreys; Deborah J Russell; Andrew W Bazemore Journal: Rural Remote Health Date: 2017-04-28 Impact factor: 1.759