Geographic Distribution: Research

Medical School Programs to Increase the Rural Physician Supply: A Systematic Review and Projected Impact of Widespread Replication
Howard K. Rabinowitz, MD et al., Academic Medicine, March 2008
"This report systematically reviews the outcomes of comprehensive medical school programs designed to increase the rural physician supply, and to develop a model to estimate the impact of their widespread replication." Read More...

Rural-Urban Differences in Primary Care Physicians' Practice Patterns, Characteristics and Incomes
William B. Weeks, MD, MS and Amy E. Wallace, MD, MPH, Journal of Rural Health, Spring 2008
"Low salaries and difficult work conditions are perceived as a major barrier to the recruitment of primary care physicians to rural settings." Read More...

Urban-Rural Flow of Physicians
Thomas C. Ricketts, PhD and Randy Randolph, MRP, Journal of Rural Health, Fall 2007
"Physician supply is anticipated to fall short of national requirements over the next 20 years. Rural areas are likely to lose relatively more physicians. Policy makers must know how to anticipate what changes in distribution are likely to happen to better target policies." Read More...

The Diffusion of Physicians
Thomas C. Ricketts and Randy Randolph, Health Affairs, September/October 2008
"Physicians move from place to place over their careers; this is thought to reflect the economic theory that they seek better opportunities to practice. Using national data, this study tracked physician movement between counties classified by physician-to-population ratio and socioeconomic characteristics. Approximately one-quarter of practicing physicians moved in each of two ten-year periods, 1981–1991 and 1991–2001. The overall tendency of movers was to go to places with lower physician-to-population ratios but higher per capita incomes and lower unemployment. These trends, if they continue, may help decrease access to physician care in rural and urban underserved areas." Read More...

A Comprehensive Medical Education Program Response to Rural Primary Care Needs
Michael Glasser, PhD et al., Academic Medicine, October 2008
"This article presents the characteristics and results of the Rural Medical Education (RMED) Program which addresses medical workforce needs focused on reducing rural health disparities. The program is comprehensive in implementing a system of recruitment of candidates from rural backgrounds, offering a rural-focused curriculum, and instituting evaluative components to track outcomes." Read More...

Community Dimensions and HPSA Practice Location: 30 Years of Family Medicine Training
Suzanne B. Cashman, ScD et al., Family Medicine - April 2009
"In 1996, the Institute of Medicine revised the definition of primary care to include "the community context of medical practice." Shortly after, as a way to move beyond the general sentiment that community should factor into a physician's work, Pathman et al identi¬fied and defined four distinct categories of activities (sociocultural aspects of patient care, use of commu¬nity health resources, community-oriented primary care, and community participation and assimilation) through which physicians engage with communities. This framed much of the last decade's discussion about and exploration into physicians' community involvement." Read More…

Are There Enough Doctors in my Community? Perceptions of the Local Physician Supply
Holly Biola, MD MPH, and Donald Pathman, MD MPH, Journal of Rural Health, Spring 2009
"Although physician numbers have increased in counties of all sizes and types over the past 40 years, the imbalance in physician supply between rural and urban areas has also increased. In response to this ongoing disparity, a variety of government programs use incentives to attract physicians to rural shortage areas, offering enticements such as educational loan repayment support and bonus payments for Medicare services. These programs target their resources to communities that have earned official shortage area designations, which are principally based on calculated physician-to-population (PtP) ratios. The assumption, at least implicitly, is that if PtP ratios can be made uniform across communities, then the rural-urban physician maldistribution problem will be solved." Read More…

Do International Medical Graduates (IMGs) "Fill the Gap" in Rural Primary Care in the United States? A National Study
Matthew J. Thompson, MBChB DPhil, et al., Journal of Rural Health, Spring 2009
"Almost 1 in 4 (23%) physicians currently practicing in the United States are international medical graduates (IMGs). The contribution that IMGs make to the medical workforce in the United States has been the focus of intense debate, in particular whether they make up for physician deficits in certain specialties or geographic locations. The presence and extent of this "gap filling" has profound implications for planning the future medical workforce. For example, if IMGs do indeed fill essential gaps in the medical workforce, then any policies to reduce their entry into the United States (such as capping the number of federally funded residency positions) could have deleterious effects on access to medical care, unless they are replaced by an increased output from US medical schools. In contrast, if IMGs simply add to an oversupply of physicians that is poorly distributed among geographic locations and specialties, then reducing IMG numbers may have relatively little negative impact, so long as these maldistributions are addressed by other initiatives such as expanding the National Health Service Corps (NHSC), or support for service initiatives (eg, loan repayment)." Read More…

Perspectives on Rural Health Workforce Issues: Illinois-Arkansas Comparison
Martin MacDowell, DrPH, et al., Journal of Rural Health, Spring 2009
"Among rural counties in the United States, 65% lack adequate numbers of health professionals with the distribution of physicians favoring urban areas. Rural areas have significant shortages, rural residents are more dependent on public assistance programs, and rural residents must travel farther to see a physician compared with their urban counterparts. Physician specialists are not as plentiful as primary care physicians in rural settings. Overall, recruitment and retention of rural health care professionals remains difficult." Read More…

Commentary: Oversimplifying Primary Care Supply and Shortages
Gary L. Freed, MD MPH and James Stockman, MD, Journal of the American Medical Association, May 13, 2009
"Attempting to ensure an appropriate primary care workforce to meet the needs of the United States is a complex and daunting task that is vital to the ultimate health of the nation. Oversimplifying the nuances of the primary care workforce may result in policies and priorities at odds with needs. For the specialty of pediatrics, it appears that a close to appropriate proportion of trainees continues to enter the primary care arena. Certainly, an erosion of that proportion or in the absolute number of physicians entering pediatrics would require appropriate action to ensure a continued capacity to provide general and subspecialty care to children. Those concerned with workforce adequacy should continue to monitor the situation closely." Read More…

Rural Medicine: Its Own Specialty?
Paul D. Simmons, MD FAAFP, Journal of Rural Health, Summer 2009
"The specialty of family medicine was organized in response to the specialist-heavy medical world of the 1950s. Times have changed. In some urban areas, there is no shortage of primary care physicians and mid-levels to serve the needs of most patients. However, despite one fifth of the US population living in nonmetropolitan areas, only 10% of physicians practice there. Family physicians are the specialists most likely to work in rural areas, but two thirds work in metropolitan areas with populations more than 250,000. Over the last decade, the overall trend has been downward in family medicine residency matches. The American Medical Association estimates that 16,000 more physicians are needed right now to alleviate medical needs in underserved areas. Rural medical care is in trouble, and it is time for rural medicine to become its own specialty." Read More…

Factors That Influence Physicians to Practice in Rural Locations: A Review and Commentary
Darra Ballance, MLIS AHIP et al., Journal of Rural Health, Summer 2009
"Rural populations remain underserved by physicians, despite various efforts by medical schools and other institutions/organizations to correct this disparity. We examined the literature on factors that influence rural practice location decisions by physicians to determine what opportunities exist along the entire educational pipeline to entice physicians to, and retain them in, rural areas. Results reported in the literature favor a multidisciplinary or multi-faceted approach that results in more residents and physicians locating their practices in rural areas. The need to define proven strategies is not the pressing issue; rather, the needs are to define the commitments necessary to implement proven strategies, as well as the will to make physician distribution a priority issue in medical education." Read More…

Does the Under- or Overrepresentation of Minority Physicians across Geographical Areas Affect the Location Decisions of Minority Physicians?
August 2009 – Health Services Research
"Racial diversity has recently been the topic of reports by the Sullivan Commission on Diversity in the Healthcare Workforce and the Institute of Medicine (Institute of Medicine 2004; Sullivan Commission 2004). These reports emphasize the importance of racial/ethnic physician–patient concordance in the provision of quality patient care." Read More..

Care in the Country: A Historical Case Study of Long Term Sustainability in 4 Rural Health Centers
Brad Wright, American Journal of Public Health, September 2009
"The health care system in the rural United States faces many challenges. Compared with urban populations, rural residents are more likely to be low income, uninsured, and in poor health. Per capita federal spending on rural health, despite an arguably greater need for services, is not quite half that for health care nationally. Limited resources impose financial constraints on rural primary care programs that provide a large amount of uncompensated care, which in turn threatens organizational sustainability. Rural primary care programs are the sole source of health care in many communities; thus their survival is vitally important." Read More…

Persistent Primary Care Health Professional Areas (HPSAs) and Health Care Access in Rural America
September 2009 - WWAMI Rural Health Research Center
"This study examines the degree to which persistence of primary care HPSA designation in rural counties is associated with lower population socioeconomic status and deficiencies in access to health care services." Read More…

The Doctor Can't See You Now: New York's Physician Shortage Grows
December 2009 – Healthcare Association of New York State
"Physician shortages threaten many New York residents' access to health care. While steps have been taken to begin to address this recognized problem, more state and federal action is needed to increase the number of primary care physicians, as well as physicians in other specialties that are in demand. Further, New York State must explore alternative ways to deliver care to underserved populations." Read More...

Survey of Care for the Underserved: A Control Group Study of Practicing Physicians Who Were Graduates of The Ohio State University College of Medicine Premedical Postbaccalaureate Training Program
January 2010 – Academic Medicine
"Premedical postbaccalaureate programs (PBPs) are designed to enhance the academic readiness of students with undergraduate degrees in order to improve their chances for successful admission into and completion of medical school. PBPs that focus on preparing underrepresented minority (URM) and disadvantaged students for successful completion of medical school enhance physician workforce diversity. Historically, URM physicians have reported a greater interest in establishing practices that provide care for underserved communities." Read More…

Health Extension in New Mexico: An Academic Health Center and the Social Determinants of Disease
January 2010 – Annals of Family Medicine
"New Mexico is a large, rural, multiethnic state with the second highest uninsured rate in the nation, 30 of its 33 counties federally are designated Health Profession Shortage Areas, and 60% of the population lives in rural or frontier communities with variable access to services. The University of New Mexico (UNM) Health Sciences Center (UNMHSC) surveyed rural community health leaders on how the UNMHSC might better serve their health needs. The results were sobering." Read More…

Funding Growth Drives Community Health Center Services
February 2010 – Health Affairs
"Federally qualified health centers play a major role in providing health care to the underserved, and will remain an important part of the health care safety net even under reforms that will increase the number of Americans with health insurance. We show that the investments made in federally qualified health centers during 1996–2006 clearly translated into an increase in services available to patients, including mental health and substance abuse treatment and counseling and staffing." Read More…

The Impact of a Clinic Move on Vulnerable Patients with Chronic Disease: A Geographic Information Systems (GIS) Analysis
January 2010 – Journal of the American Board of Family Medicine
"Primary health care clinics are bound to the patients they serve by geography, an essential lesson rarely emphasized in preparing resident trainees for community practice.1 Policy makers promote access to a personal physician for all their constituents, and it is essential that providers understand their service areas and the impact of geography on those they serve. Residency clinics are the training ground for these skills but have traditionally lacked the tools necessary to demonstrate and contextualize caring for patients within the broader community." Read More…

American Board of Family Medicine (ABFM) Maintenance of Certification: Variations in Self-Assessment Modules uptake within the 2006 Cohort
January 2010 – Journal of the American Board of Family Medicine
"In its recent shift to a Maintenance of Certification for Family Physicians (MC-FP) paradigm, the American Board of Family Medicine provides diplomates completing 3 self assessment modules (SAMs) in the first 3 years (or first stage of MC-FP) a pathway to extend their recertification cycle to 10 years provided additional requirements are met, versus a 7-year cycle for "non-completers." We use geographic information systems to report on variations in SAM participation and completion in a single cohort of diplomates followed during their first stage of MC-FP to better understand the communities impacted, barriers to uptake, and urban-rural differences." Read More…

The Role of a Rural Medical School Campus in Developing a Sense of Place: The First 10 Years
March 2010 – Family Medicine
"Most medical schools are now increasing class size and/or start¬ing regional campuses to address the anticipated physician shortage. Maldistribution is also an issue, with only 9% of physicians prac¬ticing in rural areas where 20 % of Americans live. Previous studies have shown that rural upbringing and small-town medical training are associated with rural practice." Read More…

Medical Education Futures Study

George Washington University School of Public Health and Health Services

Josiah Macy Jr. Foundation

Geographic Distribution: Research