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

2020 ◽  
Vol 12 (6) ◽  
pp. 717-726
Author(s):  
Peter Meyers ◽  
Elizabeth Wilkinson ◽  
Stephen Petterson ◽  
Davis G. Patterson ◽  
Randall Longenecker ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Family Medicine ◽  
The United States ◽  
Measurement Tool ◽  
Matched Cohort ◽  
Family Medicine Residency ◽  
Rural Primary Care ◽  
Rural Workforce ◽  
Primary Care Workforce

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.

scholarly journals Addressing the Opioid Crisis: Community Partnerships in Primary Care

PRiMER ◽  
2019 ◽  
Vol 3 ◽  
Author(s):  
Jamie Weinand ◽  
Athena Huckaby ◽  
Olivia Chavez ◽  
Ramona Sharma ◽  
Jeanette Lara ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Family Medicine ◽  
Control Period ◽  
The United States ◽  
Opioid Overdose ◽  
Family Medicine Residency ◽  
Standardized Protocol ◽  
Number Of Patients ◽  
Patients At Risk

Introduction: New Mexico is currently ranked 17th in the United States for drug overdose death rates. Our project seeks to decrease opioid overdose deaths in a community by increasing the number of patients with naloxone in a local family medicine residency clinic. Methods: We developed a protocol wherein providers asked patients at risk of opioid overdose about naloxone access. Free naloxone was distributed in partner with the county health department, accompanied by teaching of use. We reviewed patient encounters during a 45-day control and study period to measure naloxone possession among patients at risk. Results: Nearly two-thirds of patients at risk of opioid overdose had no naloxone. A standardized protocol implemented to distribute an opioid reversal agent doubled naloxone prescribed by providers at visits (10.3%) compared to a control period (4.3%), but lacked statistical significance. Conclusion: Patients in a family medicine residency clinic who were at risk of opioid overdose overwhelmingly did not have naloxone, and a standardized protocol with a community-based partnership increased access to naloxone. Further project data will have implications for ongoing naloxone distribution programs in primary care.

scholarly journals Education and Attitudes on Medical Cannabis in Family Medicine Residency Programs

2020 ◽  
Vol 52 (10) ◽  
pp. 730-735
Author(s):  
Ann M. Philbrick ◽  
Christine Danner ◽  
Abayomi Oyenuga ◽  
Chrystian Pereira ◽  
Jason Ricco ◽  
...  
Keyword(s):  
United States ◽  
Family Medicine ◽  
The United States ◽  
Clinical Experiences ◽  
Medical Cannabis ◽  
Residency Programs ◽  
Family Medicine Residency ◽  
Medicine Resident ◽  
Current State ◽  
Research Alliance

Background and Objectives: Medical cannabis has become increasingly prevalent in the United States, however the extent of family medicine resident education on this topic remains unknown. The objective of this study was to ascertain the current state of medical cannabis education across this population and identify patterns in education based on state legality and program director (PD) practices. Methods: Survey questions were part of the Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey from May 2019 to July 2019. PDs from all Accreditation Council for Graduate Medical Education (ACGME)-accredited US family medicine residency programs received survey invitations by email. Results: A total of 251 (40.7%) PDs responded, with 209 (83.6% [209/250]) reporting at least 1 hour of didactic curriculum regarding cannabis. The most common context was substance misuse (mean 3.0±4.1 hours per 3 years), followed by pain management (2.7±3.4 hours), and management of other conditions (2.1±2.7 hours). Thirty-eight programs (15.2% [38/250]) offered clinical experiences related to medical cannabis, and PDs who had previously prescribed or recommended medical cannabis were more likely to offer this experience (P<.0001). Experiences peaked after 3 to 5 years of medical cannabis legality. PD confidence in resident counseling skills was low overall, but did increase among programs with clinical experiences (P=.0033). Conclusions: The current trajectory of medical cannabis use in the United States makes it likely that residents will care for patients interested in medical cannabis, therefore it is important residents be prepared to address this reality. Opportunities exist for improving medical cannabis education in family medicine residency programs.

scholarly journals Teaching Chronic Pain in the Family Medicine Residency

2018 ◽  
Vol 50 (1) ◽  
pp. 22-27
Author(s):  
Kimberly Zoberi ◽  
Kelly M. Everard
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Family Medicine ◽  
Pain Assessment ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Physician ◽  
Family Medicine Residency

Background and Objectives: Chronic pain is a significant condition affecting many Americans. Primary care physicians play an important role in chronic pain management, but many residents and physicians feel poorly prepared to manage it. Methods: Data were collected as part of the 2016 Council of Academic Family Medicine Educational Research Alliance (CERA) Program Director Survey, which was sent electronically to 484 program directors in the United States. The authors sought to determine whether residency directors’ attitudes about treating chronic pain were associated with the amount of time devoted to teaching family medicine residents about chronic pain assessment, therapy (use of opioids, use adjuvant pain medications, use of other nonopioids, use of nonpharmacological treatments), and risk management (risk assessment, use of pain management contracts, informed consent when prescribing opioids, and urine drug monitoring). Attitudes were assessed by asking whether: (1) chronic pain is best managed by a primary care physician (PCP); (2) prescribing opioid medications is time consuming; (3) prescribing opioids is high-risk; (4) prescribing opioids contributes to opioid misuse; and (4) effective nonopioid treatments exist. An additional question assessed confidence in treating chronic pain. Results: The response rate was 53%. The average family medicine residency devotes about 33 hours to education about pain management topics including 5.4 hours on chronic pain assessment, 16.2 hours on therapy, and 11.4 hours on risk assessment. Residency directors’ belief that there are effective nonopioid treatments for chronic pain was the only attitude item that was associated with teaching about chronic pain. Conclusions: Residency directors’ attitudes do not predict the time devoted to teaching chronic pain in family medicine residencies.

scholarly journals Assessment of Changes in Rural and Urban Primary Care Workforce in the United States From 2009 to 2017

2020 ◽  
Vol 3 (10) ◽  
pp. e2022914
Author(s):  
Donglan Zhang ◽  
Heejung Son ◽  
Ye Shen ◽  
Zhuo Chen ◽  
Janani Rajbhandari-Thapa ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
The United States ◽  
Rural And Urban ◽  
Primary Care Workforce

A Typology of Primary Care Workforce Innovations in the United States Since 2000

Medical Care ◽  
2014 ◽  
Vol 52 (2) ◽  
pp. 101-111 ◽  
Author(s):  
Asia Friedman ◽  
Karissa A. Hahn ◽  
Rebecca Etz ◽  
Anna M. Rehwinkel-Morfe ◽  
William L. Miller ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
The United States ◽  
Primary Care Workforce

scholarly journals Integrating mental health professionals in residencies to reduce health disparities

2017 ◽  
Vol 52 (3) ◽  
pp. 286-297 ◽  
Author(s):  
Emilee Delbridge ◽  
Max Zubatsky ◽  
Jocelyn Fowler
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Disparities ◽  
Family Medicine ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Mental Health Treatment ◽  
The United States ◽  
Health Treatment ◽  
Family Medicine Residency

Health disparities in primary care remain a continual challenge for both practitioners and patients alike. Integrating mental health services into routine patient care has been one approach to address such issues, including access to care, stigma of health-care providers, and facilitating underserved patients’ needs. This article addresses examples of training programs that have included mental health learners and licensed providers into family medicine residency training clinics. Descriptions of these models at two Midwestern Family Medicine residency clinics in the United States are highlighted. Examples of cross-training both medical residents and mental health students are described, detailing specific areas where this integration improves mental health and medical outcomes in patients. Challenges to effective integration are discussed, including larger system buy-in, medical providers’ knowledge of mental health treatment, and the skills for clinical providers to possess in order to present mental health options to patients. Patients who traditionally experience multiple barriers to mental health treatment now have increased access to comprehensive care. As a result of more primary care clinics ascribing to an integrated care model of practice, providers may benefit from not only increased coordination of patient services but also utilizing behavioral health professionals to address health barriers in patients’ lives.

scholarly journals Entrustable Professional Activity Utilization: A CERA Study of Family Medicine Residency Program Directors

2019 ◽  
Vol 51 (6) ◽  
pp. 471-476
Author(s):  
Jennie B. Jarrett ◽  
Jumana Antoun ◽  
Memoona Hasnain
Keyword(s):  
United States ◽  
Medical Education ◽  
Family Medicine ◽  
Residency Program ◽  
Online Survey ◽  
Assessment Tool ◽  
The United States ◽  
Professional Activity ◽  
Assessment Framework ◽  
Family Medicine Residency

Background and Objectives: Entrustable professional activities (EPAs) is a novel assessment framework in competency-based medical education. While there are published pilot reports about utilization and validation of EPAs within undergraduate medical education (UME), there is a paucity of research within graduate medical education (GME). This study aimed to explore the landscape of EPAs within family medicine GME, particularly related to the understanding of EPAs, extent of utilization, and benefits and challenges of EPAs implementation as an assessment framework within family medicine residency programs (FMRPs) in the United States. Methods: A cross-sectional survey, as part of the 2017 Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) Family Medicine Residency Program (FMRP) Director omnibus online survey was conducted in fall, 2017. ACGME-accredited FMRP directors were invited by email to participate. Results: The survey response rate was 53.1% (267/503). Overall, 90.1% (237/263) of FMRP directors were aware of EPAs as an assessment framework and 82.8% (197/238) understood the principles of EPAs, but 39.9% (95/238) were not confident in utilizing EPAs. Only 15.1% (36/238) of FMRP directors reported currently employing EPAs as an assessment tool. Identified benefits of EPAs use included increased transparency and congruence of expectations between learners and FRMP as well as facilitation for formative feedback. Identified barriers of EPA incorporation included difficulty integrating EPAs into the current assessment framework and faculty development. Conclusions: While EPAs are well recognized and understood by FMRP directors, there is significant lack of utilization of this assessment framework within FMRP in the United States.

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