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

Schmitz, David

doi:10.22454/fammed.2021.792533

Cited by 6 publications

(8 citation statements)

References 11 publications

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“…Rural physicians may need to maintain a broader SOP and develop specific skills over the course of their careers to meet rural community needs. 27,28 These findings provide evidence for the value of current and future initiatives to strengthen and expand the availability of rural residency programs. Rurally-trained physicians, who are more likely to practice in rural areas over the course of their careers, 16 can be uniquely valuable to rural communities due to their broad scope of training and preparation to care for rural populations.…”

Section: Discussionmentioning

confidence: 85%

Rural Versus Urban Family Medicine Residency Scope of Training and Practice

Pollack

Andrilla

Peterson

et al. 2023

Fam Med

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Background and Objectives: Little is known about how rural and urban family medicine residencies compare in preparing physicians for practice. This study compared the perceptions of preparation for practice and actual postgraduation scope of practice (SOP) between rural and urban residency program graduates. Methods: We analyzed data on 6,483 early-career, board-certified physicians surveyed 2016-2018, 3 years after residency graduation, and 44,325 later-career board-certified physicians surveyed 2014-2018, every 7 to 10 years after initial certification. Bivariate comparisons and multivariate regressions of rural and urban residency graduates examined perceived preparedness and current practice in 30 areas and overall SOP using a validated scale, with separate models for early-career and later-career physicians. Results: In bivariate analyses, rural program graduates were more likely than urban program graduates to report being prepared for hospital-based care, casting, cardiac stress tests, and other skills, but less likely to be prepared in some gynecologic care and pharmacologic HIV/AIDS management. Both early- and later-career rural program graduates reported broader overall SOPs than their urban-program counterparts in bivariate analyses; in adjusted analyses this difference remained significant only for later-career physicians. Conclusions: Compared with urban program graduates, rural graduates more often rated themselves prepared in several hospital care measures and less often in certain women’s health measures. Controlling for multiple characteristics, only rurally trained, later-career physicians reported a broader SOP than their urban program counterparts. This study demonstrates the value of rural training and provides a baseline for research exploring longitudinal benefits of this training to rural communities and population health.

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Section: Discussionmentioning

confidence: 85%

Rural Versus Urban Family Medicine Residency Scope of Training and Practice

Pollack

Andrilla

Peterson

et al. 2023

Fam Med

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“…This lack of alignment between the United States' largely federally funded GME system and societal needs has led to calls for increased social accountability. [24][25][26][27] Family physicians already stand out from other primary care clinicians in their higher propensity to choose rural practice, 6 and rural family medicine residency training can further address primary care workforce imbalances. Meanwhile, nurse practitioners (NPs) and physician assistants (PAs) also constitute significant proportions of rural primary care workforce supply, and the numbers of NP and PA education programs continue to expand, 28,29 offering more opportunities to implement and test rural place-based training strategies in these disciplines.…”

Section: Discussionmentioning

confidence: 99%

“…Given that roughly one in five persons in the United States resides in a rural area, the fact that only 4.0% of our sample population—about one fifth of rural family physicians in our study—had trained in rural residency programs underscores the disproportionate concentration of residency education in urban areas and the small numbers of rural residency programs and positions by comparison. This lack of alignment between the United States' largely federally funded GME system and societal needs has led to calls for increased social accountability 24–27 . Family physicians already stand out from other primary care clinicians in their higher propensity to choose rural practice, 6 and rural family medicine residency training can further address primary care workforce imbalances.…”

Section: Discussionmentioning

confidence: 99%

Growing a rural family physician workforce: The contributions of rural background and rural place of residency training

Patterson

Shipman

Pollack

et al. 2023

Health Services Research

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ObjectiveTo determine the distinct influences of rural background and rural residency training on rural practice choice among family physicians.Data Sources and Study SettingWe used a subset of The RTT Collaborative rural residency list and longitudinal data on family physicians from the American Board of Family Medicine National Graduate Survey (NGS; three cohorts, 2016–2018) and American Medical College Application Service (AMCAS).Study DesignWe conducted a logistic regression, computing predictive marginals to assess associations of background and residency location with physician practice location 3 years post‐residency.Data Collection/Extraction MethodsWe merged NGS data with residency type—rural or urban—and practice location with AMCAS data on rural background.Principal FindingsFamily physicians from a rural background were more likely to choose rural practice (39.2%, 95% CI = 35.8, 42.5) than those from an urban background (13.8%, 95% CI = 12.5, 15.0); 50.9% (95% CI = 43.0, 58.8) of trainees in rural residencies chose rural practice, compared with 18.0% (95% CI = 16.8, 19.2) of urban trainees.ConclusionsIncreasing rural programs for training residents from both rural and urban backgrounds, as well as recruiting more rural students to medical education, could increase the number of rural family physicians.

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“…[1][2][3] Residency training in rural and underserved settings has been shown to increase physicians' sense of preparedness for and entry into rural practice. [4][5][6][7][8][9][10][11] Recent data has suggested that rural graduate medical education (GME) increases the likelihood of rural practice for trainees of both urban and rural backgrounds. 7 Up to 45% of rural family medicine graduates enter rural practice, and trainees who spend more than 50% of graduate training in rural areas are five times more likely to enter rural practice.…”

Section: Introductionmentioning

confidence: 99%

Ten-Year Outcomes: Community Health Center/Academic Medicine Partnership for Rural Family Medicine Training

Castro,

Roberts,

Hawes

et al. 2024

Fam Med

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Background and Objectives: The widening gap between urban and rural health outcomes is exacerbated by physician shortages that disproportionately affect rural communities. Rural residencies are an effective mechanism to increase physician placement in rural and medically underserved areas yet are limited in number due to funding. Community health center/academic medicine partnerships (CHAMPs) can serve as a collaborative framework for expansion of academic primary care residencies outside of traditional funding models. This report describes 10-year outcomes of a rural training pathway developed as part of a CHAMP collaboration. Methods: Using data from internal registries and public sources, our retrospective study examined demographic and postgraduation practice characteristics for rural pathway graduates. We identified the rates of postgraduation placement in rural (Federal Office of Rural Health Policy grant-eligible) and federally designated Medically Underserved Areas/Populations (MUA/Ps). We assessed current placement for graduates >3 years from program completion. Results: Over a 10-year period, 25 trainees graduated from the two residency expansion sites. Immediately postgraduation, 84% (21) were in primary care Health Professional Shortage Areas (HPSAs), 80% (20) in MUA/Ps, and 60% (15) in rural locations. Sixteen graduates were >3 years from program completion, including 69% (11) in primary care HPSAs, 69% (11) in MUA/Ps, and 50% (5) in rural locations. Conclusions: This CHAMP collaboration supported development of a rural pathway that embedded family medicine residents in community health centers and effectively increased placement in rural and MUA/Ps. This report adds to national research on rural workforce development, highlighting the role of academic-community partnerships in expanding rural residency training outside of traditional funding models.

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

Cited by 6 publications

References 11 publications

Rural Versus Urban Family Medicine Residency Scope of Training and Practice

Rural Versus Urban Family Medicine Residency Scope of Training and Practice

Growing a rural family physician workforce: The contributions of rural background and rural place of residency training

Ten-Year Outcomes: Community Health Center/Academic Medicine Partnership for Rural Family Medicine Training

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