Graduate Medical Education Programs Offering Shared Residency Positions 1996 1997

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ISBN 13 :
Total Pages : 78 pages
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Download or read book Barriers to Residency Training of Physicians in Rural Areas written by and published by . This book was released on 1998 with total page 78 pages. Available in PDF, EPUB and Kindle. Book excerpt: EXECUTIVE SUMMARY: Despite the rising number of physicians in the U.S., even relative to the size of the population, physicians continue to disproportionally locate their practices in urban areas. In 1965, there was one nonfederal, patient care physician for every 807 persons in the U.S.; this ratio had reached one patient care physician for every 455 persons in 1996 (Randolph, 1997). Rural communities, however, have not shared equitably in that increase. While 24% of Americans live in nonmetro counties, only 11% of patient care physicians practice in those counties; this proportion has fallen since 1980 (Randolph, 1997). Consequently, residents of rural areas are far more likely to live in health personnel shortage areas than are urban residents. Although allopathic and osteopathic family medicine residency graduates are much more likely than other primary care residency graduates to locate in rural areas, the proportion and number of family medicine graduates doing so have been declining over the past decade (American Association of Medical Colleges, 1995). Many factors contribute to the imbalance in the distribution of physicians, including: the type of training chosen, the location of medical training sites, physicians' lifestyle preferences, and aspects of rural communities such as the strength of their economies and health care delivery systems. Training physicians in rural areas has been advocated as one strategy to attempt to increase the numbers of rural physicians. This report summarizes what is known about rural graduate medical education (GME) in family medicine, general internal medicine, pediatrics, obstetrics and gyneconology, and general surgery. It identifies barriers to rural graduate medical training and proposes actions that might be taken to reduce or remove those barriers. LITERATURE REVIEW - LIMITED PUBLISHED DATA; MOST RURAL GME IN FAMILY MEDICINE: A review of the literature reveals a dearth of information on either allopathic or osteopathic graduate medical education in rural areas. Several case-reports describe elective rotations and rural continuity clinics in general internal medicine and pediatrics residencies, and a few of these offer anecdotal reports of outcomes concerning the practice locations of the graduates of these programs. We found no published reports of organized rural training experiences in general surgery or obstetrics and gynecology. The literature did show that 15% of physicians in small rural counties are osteopathic physicians, despite their comprising only 5% of all U.S. physicians (Simpson & Simpson, 1994). Allopathic and osteopathic family practitioners are equally likely to choose rural practice, but only 11% of allopathic graduates become family practitioners, whereas 46% of osteopathic graduates do so. A larger, but still quite modest, literature report on rural training experiences in allopathic family medicine. About half of all family medicine residencies offer some type of rural experience and 40% have a required rural rotation (Bowman & Penrod, 1998). Family medicine has developed both three-year residencies based entirely in rural areas with the expressed mission of training physicians for rural practice, and "rural training track" (RTT) residency programs. In RTTs, residents spend their first year of training in a larger, more urban setting, then spend their last two years training in a much smaller, rural setting, though they usually rotate back to the larger setting for some experiences in these latter two years. The limited evidence available indicates that most RTT graduates establish practices in rural areas. A survey of 96% of all family medicine residencies suggested that being located in a more rural state, being located in a smaller population center, having an explicit mission for rural health care, and having a required rural rotation all increased the likelihood that graduates of a program would locate in a rural area (Bowman & Penrod, 1998). INTERVIEWS WITH PERSONS INVOLVED WITH RURAL GME: We interviewd persons involved with rural graduate medical education at a number of sites. Most of the people interviewed were in family medicine, as most rural training activity appears to occur in family medicine, but we also spoke with persons involved with rural training in general internal medicine, pediatrics, and general surgery. FINANCIAL BARRIERS RELATED TO MEDICARE GME FUNDING ARE THE BIGGEST PROBLEM: By far, financial obstacles present the greatest identified barriers to increasing rural training opportunities. All GME programs depend on Medicare GME funding paid to teaching hospitals. GME funding is directly related to the hospital volume of Medicare patients and goes predominantly to states with large urban populations through urban hospitals. For example, for every Medicare enrollee in New York, hospitals receive $62 in GME payments, while the comparable amount for Idaho hospitals is $1.02. Many aspects of the GME funding ...