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Background:The economic impact of a family physician practicing family medicine in rural Alabama is $1,000,000 a year in economic benefit to the community. The economic benefit of those rural family physicians practicing obstetrics has not been studied. This study was designed to determine whether there was any added economic benefit of rural family physicians practicing obstetrics in rural, underserved Alabama. The Alabama Family Practice Rural Health Board has funded the University of Alabama Family Medicine Obstetrics Fellowship since its beginning in 1986.Methods: Family medicine obstetrics fellowship graduates who practice obstetrics in rural, underserved areas were sent questionnaires and asked to participate in the study. The questions included the most common types and average annual numbers of obstetrics/gynecological procedures they performed.Results: Ten physicians, or 77% of the graduates asked to participate in the study, returned the questionnaire. Fourteen common obstetrics/gynecological procedures performed by the graduates were identified. A mean of 115 deliveries were performed. The full-time equivalent reduction in family medicine time to practice obstetrics was 20%.Conclusions: A family physician practicing obstetrics in a rural area adds an additional $488,560 in economic benefit to the community in addition to the $1,000,000 from practicing family medicine, producing a total annual benefit of $1,488,560. The investment of $616,385 from the Alabama Family Practice Rural Health Board resulted in a $399 benefit to the community for every dollar invested. The cumulative effect of fellowship graduates practicing both family medicine and obstetrics in rural, underserved areas over the 26 years studied was $246,047,120. (J Am Board Fam Med 2014;27: 602-610.)

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This paper describes the evaluation of a time-resolved graphite spark source emission spectrometer built for the purpose of determining Ca, Na, and K in nanoliter volume samples of renal fluid. Subnanogram detection limits calculated from the working curve slope and the uncertainty of the sample signal are reported for Ca, Na and K; these detection limits are some three orders of magnitude higher than the shot noise limit. With the use of Li as an internal standard, working curves from 0 to 1 ng of Na, K, and Ca are shown. System performance data are given, and the utility of the analysis is discussed.