Preparing Physicians for Rural Practice: Availability of Rural Training in Rural-Centric Residency Programs

ABSTRACT Background Exposing residents to rural training encourages future rural practice, but unified accreditation of allopathic and osteopathic graduate medical education under one system by 2020 has uncertain implications for rural residency programs. Objective We describe training locations and rural-specific content of rural-centric residency programs (requiring at least 8 weeks of rurally located training) before this transition. Methods In 2015, we surveyed residency programs that were rurally located or had rural tracks in 7 specialties and classified training locations as rural or urban using Rural-Urban Commuting Area (RUCA) codes. Results Of 1849 residencies in anesthesiology, emergency medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, and psychiatry, 119 (6%) were rurally located or offered a rural track. Ninety-seven programs (82%) responded to the survey. Thirty-six programs required at least 8 weeks of rural training for some or all residents, and 69% of these rural-centric residencies were urban-based and 53% were osteopathic. Locations were rural for 26% of hospital rotations and 28% of continuity clinics. Many rural-centric programs (35%) reported only urban ZIP codes for required rural block rotations; 54% reported only urban ZIP codes for required rural clinic sessions, and 31% listed only urban ZIP codes in reporting rural full-time training locations. Programs varied widely in coverage of rural-specific training in 6 core competencies. Conclusions In multiple specialties important for rural health care systems, little rurally located residency training and rural-specific content was available. Substantial proportions of training locations reported to be rural were actually urban according to a common rural definition.

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Family medicine physicians’ report strong support, barriers and preferences for Registered Dietitian Nutritionist care in the primary care setting

Family Practice ◽

10.1093/fampra/cmaa099 ◽

2020 ◽

Author(s):

Lauren R Sastre ◽

Leslie T Van Horn

Keyword(s):

Family Medicine ◽

Online Survey ◽

Interprofessional Collaboration ◽

Health Care Systems ◽

Descriptive Analysis ◽

Strong Support ◽

Full Time ◽

Registered Dietitian ◽

Cross Sectional ◽

Care Systems

Abstract Background Previous studies have examined barriers (e.g. time) for Family Medicine Providers (FMPs) to provide nutrition and lifestyle counseling, however, to date no studies have examined access or interest to Registered Dietitian Nutritionist (RDN) care for patients. Objective The objective of this study was to explore FMP access, referral practices, barriers and preferences for RDN care. Methods A cross-sectional online survey, with content and face validation was conducted with Family Medicine Departments within large academic health care systems in the Southeastern United States. The main variables of interest included: FMP access, interest, current referrals and referral preferences for RDN care, barriers to referrals and overall perceptions regarding RDN care. Descriptive analysis of close-ended responses was performed with SPSS 26.0. Open-ended responses were analysed using inductive content analysis. Results Over half of the respondents (n = 151) did not have an RDN on-site (64%) yet were highly interested in integrating an RDN (94.9%), with reported preferences for full-time on-site, part-time on-site or off-site RDN care (49.1%, 39.5% and 11.4% respectively). The greatest reported barriers to RDN referrals were perceived cost for the patient (64.47%) and uncertainty how to find a local RDN (48.6%). The most consistent theme reported in the open-ended responses were concerns regarding reimbursement, e.g. ‘Insurance does not cover all of the ways I would like to use an RDN’. Conclusions FMPs report interest and value in RDN services despite multiple perceived barriers accessing RDNs care. Opportunities exist for interprofessional collaboration between dietetic and FMP professional groups to address barriers.

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New Partner Recruitment to Rural Versus Urban Ob-Gyn Practices

Health Services Research and Managerial Epidemiology ◽

10.1177/2333392817723981 ◽

2017 ◽

Vol 4 ◽

pp. 233339281772398 ◽

Cited By ~ 1

Author(s):

Michael F. Fialkow ◽

Carrie M. Snead ◽

Jay Schulkin

Keyword(s):

Rural Communities ◽

Pacific Northwest ◽

Health Care Systems ◽

Rural Practice ◽

Family Status ◽

Rural And Urban ◽

The Pacific ◽

Care Systems ◽

New Recruits ◽

Significant Health

Purpose: The purpose of this pilot study was to investigate the recruitment efforts of practicing obstetrics and gynecology (ob-gyns) from rural and urban practices. Method: The authors surveyed practicing ob-gyns from 5 states in the Pacific Northwest in 2016 about their background, practice setting, practice profile, partner recruitment, and retention. Results: Seventy-three patients completed the study (53.2% response rate). Thirty-seven percent of respondents work in an urban practice and 43% have a rural practice, with the remainder in a suburban setting. A majority of the respondents attempted to recruit a new partner in the past 5 years. Respondents were most interested in experience and diversity in new recruits. Urban respondents, however, were more interested in hiring those with specialized skills (χ2 = 7.842, P = .02) than rural providers who were more interested in partners familiar with their community (χ2= 7.153, P = .03). Reasons most often cited to leave their practice were reimbursement, limited social/marital options, and workload, other than rural providers who more often also cited lack of access to specialty care (χ2= 13.256, P = .001). Rural providers were more likely to cite marital and family status as an advantage to recruitment, whereas urban and suburban providers were more often neutral. Conclusions: Reduced access to care has led to significant health disparities for women living in rural communities. Understanding which providers are most likely to be successful in these settings might help preserve access as our health-care systems evolves.

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Leaving nursing: an event-history analysis of nurses' careers

Journal of Health Services Research & Policy ◽

10.1258/1355819054338924 ◽

2005 ◽

Vol 10 (3) ◽

pp. 150-157 ◽

Cited By ~ 40

Author(s):

David Barron ◽

Elizabeth West

Keyword(s):

Event History Analysis ◽

Maternity Leave ◽

Health Care Systems ◽

Strong Support ◽

Family Care ◽

Nurse Retention ◽

Individual Characteristics ◽

Full Time ◽

Care Systems ◽

The Uk

Objectives: The current shortage of nurses is a major problem for health care systems around the world and has revitalized interest in the dynamics of nurses' careers. This paper investigates the factors associated with qualified nurses in Britain moving to different employment statuses, including jobs outside nursing, unemployment, maternity leave and family care over time. Methods: British Household Panel Survey (BHPS) data collected between 1991 and 2001 were used to estimate the effects of covariates on transition rates between different employment statuses. Results: Individual characteristics associated with shorter tenure in the profession include being male, being younger, having a degree, and having been born in the UK. Many nurses leave to care for their families, which suggests the possibility of returning to the profession at a later date. A number of job characteristics are also related to leaving, including low pay, managerial responsibility, full-time work and lack of opportunities to use initiative. Nurses seem to be particularly vulnerable to leaving early in their careers, but those who survive the first few years are likely to remain in the profession for the rest of their working lives. Conclusions: It is particularly important in policy terms that ability to use initiative is related to leaving nursing for another form of full-time employment and, in particular, to leaving for a better job. This finding is consistent with results from studies of the Magnet hospitals in the US. Taken together, these results suggest that strategies to improve nurse retention must attend to nurses' status, authority and position in the hierarchy if they are to be successful. The results also provide strong support for those who argue that better rates of pay are necessary in order to improve nurse retention.

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A Saga-In-Progress: Challenges and Milestones on Our Way Toward the Nordic Core Values and Principles of Family Medicine/General Practice

Frontiers in Medicine ◽

10.3389/fmed.2021.681612 ◽

2021 ◽

Vol 8 ◽

Author(s):

Johann A. Sigurdsson ◽

Anders Beich ◽

Anna Stavdal

Keyword(s):

Health Care ◽

General Practice ◽

Family Medicine ◽

Academic Discipline ◽

Health Care Systems ◽

Core Competencies ◽

Core Values ◽

Major Step ◽

Joint Statement ◽

Care Systems

Summary: Late in 2020, the Nordic Colleges of General Practice published a joint statement specifying what General Practitioners stand for and intend to act upon, our Core Values and Principles. In this article, the authors describe and analyze challenges and milestones encountered on our 50-year journey toward the creation of that document.The shaping of Family Medicine/General Practice as an academic discipline began in the 1960's. During an initial, descriptive phase, the new specialty was defined, its educational curricula formulated, and the core competencies required to earn the title, Specialist in Family Medicine, were identified. Focus was not yet placed directly on the relationship between viable working principles and values, however.Then, the 1978 WHO Alma Ata Declaration affirmed health to be a fundamental human right, with primary health care as the heart of sustainable health care systems, indirectly mandating that the field of Family Medicine deliver value-based health care. A major step in that process was taken in 2001: The Norwegian College of General Practice launched their statement identifying the seven theses, Sju teser, that characterize the principles, purposes—and core values—of General Practice. Later, the Nordic colleges worked together to formulate the 2020 joint statement.We are confident that Family Medicine will continue to provide sustainable, relationship-based care, and to protect the human side of medicine. Sharing core values and principles can help us mobilize as effective advocates for our discipline and for our patients, the citizens whom we serve.

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Money Matters: A Three-Step Process for Using Budget Data in Program Evaluation to Assess the Design and Management of a Novel Public Health Program

Health Promotion Practice ◽

10.1177/15248399211028150 ◽

2021 ◽

pp. 152483992110281

Author(s):

Justin Uhd ◽

Amy DeGroff ◽

Krishna Sharma

Keyword(s):

Public Health ◽

Program Design ◽

Health Care Systems ◽

Cancer Control ◽

Control Program ◽

Full Time ◽

Step Process ◽

Personnel Costs ◽

Care Systems ◽

Cancer Control Program

We applied a three-step process, abstracting and analyzing program budgets to examine how Colorectal Cancer Control Program (CRCCP) awardees are structuring their programs and to assess the fidelity of program design to the CRCCP public health model. We reviewed 23 state, one tribal organization, and six university awardee budgets. We assessed resource allocations, staffing structures, and contracted partners and their activities. Awardees allocated 83% of all funds to contracts and personnel. Program managers were the most budgeted personnel type across three measures: number of people, full-time equivalency, and personnel costs. Awardees not only contracted with health care systems and clinics (39% of all contracts) but also contracted other partner types. Contractors were mainly funded to implement evidence-based interventions (25%) and conduct evaluation (24%). Program design varied among awardees in the number of staff (0–22), number of full-time equivalencies (0–5.4), and the number of contracts (1–11) budgeted. State awardees budgeted more resources to contracts, compared with university awardees (57% vs. 31%), while universities budgeted more for total personnel costs (41% vs. 30%). We learned that awardees designed their programs with fidelity to the CRCCP model. Although implementation approaches varied, overall results suggest implementation requires a combination of internal capacities and contracted partners. Budgets provide opportunities to use already existing program data to evaluate program design, partnerships, and planned activities.

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Joint Guidelines for Protected Nonclinical Time for Faculty in Family Medicine Residency Programs

Family Medicine ◽

10.22454/fammed.2021.506206 ◽

2021 ◽

Vol 53 (6) ◽

pp. 443-452

Author(s):

Simon Griesbach ◽

Mary Theobald ◽

Karyn Kolman ◽

Kim Stutzman ◽

Sarah Holder ◽

...

Keyword(s):

Family Medicine ◽

Time Allocation ◽

Task Force ◽

Health Care Systems ◽

Well Being ◽

Program Directors ◽

National Guidelines ◽

Residency Programs ◽

Protected Time ◽

Care Systems

Background and Objectives: Family medicine faculty face increasing expectations for clinical productivity. These expectations impinge on academic and education time and make it difficult to pursue research or scholarly activities. A task force convened by the Society of Teachers of Family Medicine created national guidelines to protect nonclinical time for family medicine faculty. Methods: The task force reviewed existing guidelines for protected time, as well as data on current and past distribution of time for faculty in academic medicine, including a specific look at family medicine. Based on the evidence and expert opinion from task force members and leaders of family medicine organizations, the task force developed eight consensus recommendations. Results: The guidelines include recommendations for allocation of protected time for program directors, associate program directors, and core faculty. These represent best practices to ensure programs have appropriate time to devote to the nonclinical duties of training and educating residents, while also promoting innovation in education, faculty well-being, and faculty retention. discussion: Faculty require nonclinical time for resident development, curriculum creation and maintenance, program assessment, and scholarship. Without these functions, programs can’t meet accreditation requirements or fulfill their responsibility to develop strong family physicians. Residency programs, sponsoring institutions, universities, health care systems, and accrediting bodies should use these recommendations to develop budgets that provide appropriate time allocation to enhance faculty wellness, reduce turnover, and meet organizational missions and objectives around education and providing care for communities.

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