Rural Workforce Years: Quantifying the Rural Workforce Contribution of Family Medicine Residency Graduates

Abstract

Background Rural regions of the United States continue to experience a disproportionate shortage of physicians compared to urban regions despite decades of state and federal investments in workforce initiatives. The graduate medical education system effectively controls the size of the physician workforce but lacks effective mechanisms to equitably distribute those physicians. Objective We created a measurement tool called a “rural workforce year” to better understand the rural primary care workforce. It quantifies the rural workforce contributions of rurally trained family medicine residency program graduates and compares them to contributions of a geographically matched cohort of non-rurally trained graduates. Methods We identified graduates in both cohorts and tracked their practice locations from 2008–2018. We compared the average number of rural workforce years in 3 cross sections: 5, 8, and 10 years in practice after residency graduation. Results Rurally trained graduates practicing for contributed a higher number of rural workforce years in total and on average per graduate compared to a matched cohort of non-rural/rural training tack (RTT) graduates in the same practice intervals (P < .001 in all 3 comparison groups). In order to replace the rural workforce years produced by 1 graduate from the rural/RTT cohort, it would take 2.89 graduates from non-rural/RTT programs. Conclusions These findings suggest that rural/RTT-trained physicians devote substantially more service to rural communities than a matched cohort of non-rural/RTT graduates and highlight the importance of rural/RTT programs as a major contributor to the rural primary care workforce in the United States.

Medicare Support for Dental and Podiatry Graduate Medical Education Programs

“…26 However, as residency training is not required for dentists as it is with physicians and podiatrists, the "if you build it, they will come" strategy may have different outcomes for this workforce compared with the physician workforce, in which evidence has demonstrated that future practice locations are associated with the location of GME. 4,27 The residency requirement difference may also be a contributing factor associated with the state-by-state variation in dental and podiatry positions and related Medicare GME support, with 6 states receiving no dental or podiatry GME support, and the remaining states and territories and the District of Columbia receiving GME payments per person by state, territory, or district population that ranged from $0.05 to $14.24. However, interest in dental residency programs is strong.…”

Rural Residency Training as a Strategy to Address Rural Health Disparities: Barriers to Expansion and Possible Solutions

“…26 Future federal training investments should be targeted toward programs or other innovative place-based alternatives to traditional GME funding that yield a high return on investment in rural communities. 3,4 An example would be increased and long-term funding for the THC program that is not dependent on Congressional appropriations.…”

“…3 While many factors affect the supply and distribution of physicians, graduate medical education (GME) funding is a major determining factor. [4][5][6] According to the Congressional Research Service, ''the size of the federal investment in GMEestimated at $16 billion in 2015-makes it a policy lever often considered to alter the health care workforce and impact health care access.'' 7 Unfortunately, the current distribution of GME funds do not align with rural workforce needs.…”

“…Given the complexity of GME organization and financing, we have included definitions of key concepts and terminology used in this article in the online supplementary data. 4,[12][13][14][15][16][17]…”

The Role of Rural Graduate Medical Education in Improving Rural Health and Health Care

“…Place-based training has demonstrated favorable workforce outcomes for rural practice, for example, as evidenced by the outcomes of 1+2 Rural Training Tracks (RTTs). 8,9 Training With and For Rural Communities Community competence in family medicine is grounded in the effectiveness of primary care. Evidence for this is perhaps best recognized in the work of Barbara Starfield's four "Cardinal C's of Primary Care."…”