Family Medicine Spokane Rural Training Track: 24 years of rural-based graduate medical education

Twenty percent of the US population lives in rural communities, but only about 9% of the nation's physicians practice in those communities. There is little doubt that the more highly specialized physicians are, the less likely they are to practice or settle in rural areas. There is clearly a population threshold below which it is not feasible for specialist (in contrast to generalist) physicians to pursue the specialty in which they have trained. Much of rural America falls below that threshold. This leaves large geographic areas of America to the primary care physician. The proportional supply of family physicians to specialists increases as urbanization decreases. Family physicians are the largest single source of physicians in rural areas. Family medicine residency programs based in rural locations provide a critical mechanism for addressing rural primary care needs. Graduates from rural residency programs are three times more likely to practice in rural areas than urban residency program graduates. There are two primary goals of training residents in rural areas: producing more physicians who will practice in rural areas and producing physicians who are better prepared for the personal and professional demands of rural practice. Rural Training Tracks, where the first year of residency is completed in an urban setting and the second and third years at a rural site (1-2 model), initially proposed by Family Medicine Spokane in 1985, have been highly successful in placing and maintaining more than 70% of their graduates in rural communities. Similar and modifications of the "Spokane RTT model" have been established around the country. Now, more than 24 years of educational experience has been accumulated and can be applied to further development of these successful family medicine residency programs.     

Predicting career decisions in primary care medicine: a theoretical analysis

Entering the 1960s, more than half of the medical doctors in the United States were family physicians, pediatricians, or general internists. Today, about one-third of all U.S. physicians are primary care practitioners. Although opinions vary on the optimal ratio of primary care to specialty physicians, in the mid-1990s, the consensus among leaders in medicine was that more primary care physicians would be needed to ensure access to quality care. The target output of graduates was set for a minimum of 50% primary care physicians, and medical school admission committees responded. The present study examines research related to career decision making in primary care medicine. We address career decision making in primary care with the expectation that selection of a medical residency is based on multiple factors, and multivariate statistical techniques comprise the most appropriate statistical procedure for developing predictive models of medical student residency choice. Additional multivariate studies for simultaneous analysis of multiple dependent and multiple independent variables are needed to determine whether health policy planners and medical schools should continue to address the distribution of primary care physicians through medical school admissions. Further to enabling prediction, researchers must renew efforts to base investigations on theoretical models, summarizing and organizing previous research, and providing one another with means to focus future studies while building on previous work.     

Relationship between US medical school admission policy and graduates entering family practice

Rural areas in the United States continue to lack an adequate supply of primary care doctors, particularly family physicians, despite the oversupply of physicians nationally. Previous studies have provided strong evidence that students from rural backgrounds, as well as those who expressed an interest at the time of medical school admission for a career in family medicine, are significantly more likely to eventually practise family medicine in rural areas than their peers. US medical schools were classified into three groups based on their written selection factors for preferentially admitting students into the graduating class of 1982. Of those schools with selection factors for students from both a rural background and an interest in a future career in family medicine, 23.7% of their graduates entered family medicine training programmes. This compares with 14.5% of graduates from schools with a preference for students from a rural background, and 12.4% from all other schools (P less than 0.001). Coupled with previous data which shows that family physicians from rural areas are more likely to eventually practise in rural areas than their peers, preferentially admitting students from rural backgrounds interested in a career in family medicine could help to solve the problem of the shortage of primary care physicians in rural areas in the US.     

An analysis of medical students' residency and specialty choices

The contemporary geographic maldistribution of physicians and shortages in some specialty areas is a persistent problem facing United States federal and state wide health planners. This paper attempts to illustrate some of the formal and informal processes of the selection of specialties and residency programs based on a survey of senior students of 37 selected American medical schools at the time of the National Residency Matching Program in 1982. Results of a factor analysis on influences on specialty choice produced two major clusters of medical students; those predominantly influenced in specialty choice by the faculty and other senior physicians (sponsorship), and those predominantly influenced by the social dimension of the physicians' role (social responsibility). These medical specialty choice orientations were also systematically related to either choice of specialty vs primary care medicine, to a life-style or status related choice of residency program, and to students' perceptions regarding a program's evaluation of a candidate. The results of the survey suggested that students who chose primary care were more apt to be influenced by sources outside of the medical school. These findings raise questions regarding the efficacy of medical school curriculum in motivating career choices in primary care. This is particularly important in view of the stated need to increase the proportion of medical school graduates choosing primary care careers.     

Family medicine: a medical care alternative for Latin America

This paper presents the experience of a residency in family medicine organized 7 years ago by the medical school of the Universidad Autónoma de Nuevo León, Mexico. The residency aims to prepare physicians to provide primary health care. In efforts to teach graduate students the social as well as the biological causes of diseases most commonly reported at the primary care level, graduate students take courses in clinical disciplines, social and behavioral sciences and public health. In its training methodology the program combines teaching, service and research. By now, the department of family medicine has graduated five classes of specialists, all of whom are working in the field of family medicine at the primary level. This fact is particularly worth noticing in a country where there are thousands of unemployed/underemployed physicians. It is suggested that family physicians are satisfying an unmet medical demand of many thousands of Mexicans, and that the care provided by them is less expensive and of better quality than the same care provided by other specialists.     

The effect of federal grants on medical schools' production of primary care physicians.

OBJECTIVES. Title VII of the Health Professions Educational Assistance Act of 1976 was created to encourage the production of primary care physicians. This study explored recent trends in the proportion of US medical school graduates entering primary care in relationship to Title VII funding. METHODS. The American Medical Association Physician Masterfile was used to determine the specialty choice of all students graduating from American medical schools between 1960 and 1985. RESULTS. The proportion of graduates entering primary care rose from 19.7% in 1967 to 31.1% in 1976 and remained stable for the subsequent decade. The increase occurred before implementation of Title VII. Rural, state-owned medical schools with departments of family medicine tend to produce a greater proportion of primary care physicians than urban private schools without family medicine departments. CONCLUSIONS. The values of American medical schools and the reward structure of American medical practice favor the production of specialists over primary care physicians. Although Title VII helped to encourage and sustain the development of primary care educational programs at both the medical student and graduate levels, an increase in the proportion of primary care physicians will require fundamental changes.     

Entry of US medical school graduates into family medicine residencies: 2010-2011 and 3-year summary

This is the 30th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family medicine residency programs. This retrospective analysis based on data reported to the AAFP from medical schools and family medicine residency programs shows approximately 8.0% of the 17,081 graduates of US medical schools between July 2009 and June 2010 were first-year family medicine residents in 2010, compared to 7.5% in 2009 and 8.2% in 2008. Medical school graduates from publicly funded medical schools were more likely to be first-year family medicine residents in October 2010 than were residents from privately funded schools (9.6% versus 5.4%). The Mountain and West North Central regions reported the highest percentage of medical school graduates who were first-year residents in family medicine programs in October 2010 (14.3% and 11.3%, respectively); the New England and Middle Atlantic regions reported the lowest percentages (5.6% and 5.3%, respectively). Approximately four in 10 of the medical school graduates (40.3%) entering a family medicine residency program as first-year residents entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the 3-year average percentage from each medical school of graduates entering family medicine residencies and the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family medicine residency programs in 2010.     

Preparing physicians for careers in primary care internal medicine: 17 years of residency experience.

The objective of this survey was to demonstrate whether a primary care track internal medicine residency program emphasizing community-based health care of the urban sick poor trains physicians who will continue to practice in general internal medicine or similar fields. Thirty-five primary care residents (100% of graduates) who trained from 1976 through 1993 in the Adult Primary Care Track of the Internal Medicine Residency Program at St. Vincent''s Hospital, New York were used as participants.     

Entry of US medical school graduates into family medicine residencies: 2004-2005 and 3-year summary

This is the 24th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family medicine residency programs. Approximately 9.2% of the 15,895 graduates of US medical schools between July 2003 and June 2004 were first-year family medicine residents in 2004, compared with 9.3% in 2003 and 10.3% in 2002. Medical school graduates from publicly funded medical schools were more likely to be first year family medicine residents in October 2004 than were residents from privately funded schools, 10.8% compared with 6.5%. The West North Central and the Mountain regions reported the highest percentage of medical school graduates who were first-year residents in family medicine programs in October 2004 at 14.9% and 12.8%, respectively; the New England and Middle Atlantic regions reported the lowest percentages at 6.6% and 5.2%, respectively. Nearly half of the medical school graduates (46.8%) entering a family medicine residency program as first-year residents in October 2004 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family medicine residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.     

Entry of US medical school graduates into family medicine residencies: 2005-2006 and 3-year summary

This is the 25th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family medicine residency programs. Approximately 8.4% of the 16,066 graduates of US medical schools between July 2004 and June 2005 were first-year family medicine residents in 2005, compared with 9.2% in 2004 and 9.3% in 2003. Medical school graduates from publicly funded medical schools were more likely to be first-year family medicine residents in October 2005 than were residents from privately funded schools, 9.9% compared with 5.8%. The Mountain and the West North Central regions reported the highest percentage of medical school graduates who were first-year residents in family medicine programs in October 2005 at 13.3% and 12.7%, respectively; the New England and Middle Atlantic regions reported the lowest percentages at 5.2% and 5.6%, respectively. Nearly half of the medical school graduates (47.3%) entering a family medicine residency program as first-year residents in October 2005 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family medicine residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.     

Entry of US medical school graduates into family medicine residencies: 2006-2007 and 3-year summary

This is the 26th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family medicine residency programs. Approximately 8.5% of the 16,110 graduates of US medical schools between July 2005 and June 2006 were first-year family medicine residents in 2006, compared with 8.4% in 2005 and 9.2% in 2004. Medical school graduates from publicly funded medical schools were more likely to be first-year family medicine residents in October 2006 than were residents from privately funded schools, 10.1% compared with 6.0%. The West North Central and the Mountain regions reported the highest percentage of medical school graduates who were first-year residents in family medicine programs in October 2006 at 12.4% and 10.7%, respectively; the New England and Middle Atlantic regions reported the lowest percentages at 5.7% and 5.6%, respectively. Nearly half of the medical school graduates (49.2%) entering a family medicine residency program as first-year residents in October 2006 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family medicine residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.     

Entry of US medical school graduates into family medicine residencies: 2003-2004 and 3-year summary

This is the 23rd report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family medicine residency programs. Approximately 9.3% of the 15,704 graduates of US medical schools between July 2002 and June 2003 were first-year family medicine residents in 2003, compared with 10.3% in 2002 and 10.9% in 2001. Medical school graduates from publicly funded medical schools were more likely to be first-year family medicine residents in October 2003 than were residents from privately funded schools, 10.6% compared with 7.0%. The West North Central and the Mountain regions reported the highest percentage of medical school graduates who were first-year residents in family medicine programs in October 2003 at 15.2% and 11.7%, respectively; the New England and Middle Atlantic regions reported the lowest percentages at 6.2% and 5.3%, respectively. Nearly half of the medical school graduates (46.1%) entering a family medicine residency program as first-year residents in October 2003 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family medicine residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.     

Entry of US medical school graduates into family medicine residencies: 2007-2008 and 3-year summary

This is the 27th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family medicine residency programs. Approximately 8.3% of the 16,300 graduates of US medical schools between July 2006 and June 2007 were first-year family medicine residents in 2007, compared with 8.5% in 2006 and 8.4% in 2005. Medical school graduates from publicly funded medical schools were more likely to be first-year family medicine residents in October 2007 than were residents from privately funded schools, 10.0% compared with 5.6%. The West North Central and the Mountain regions reported the highest percentage of medical school graduates who were first-year residents in family medicine programs in October 2007 at 12.2% and 11.9%, respectively; the New England and Middle Atlantic regions reported the lowest percentages at 5.5% and 4.7%, respectively. Nearly half of the medical school graduates (46.5%) entering a family medicine residency program as first-year residents in October 2007 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family medicine residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.     

Physician supply and distribution in the USA

The rising cost of US health care has precipitated some close examination as to the supply, distribution, and specialty choice of the physician workforce. It is an issue of considerable concern as America struggles to control health-care expenditures by shifting resources away from specialty medicine. Central to this problem are the various programmes and incentives which have encouraged an excess number of residency positions and specialty training. Examines the consequences of an unregulated medical school structure and provides an overview of current policy alternatives designed to increase the number of primary care physicians, correct the problems of physician maldistribution, and limit the overall number of medical school graduates.     

Results of the 2006 National Resident Matching Program: family medicine

The results of the 2006 National Resident Matching Program (NRMP) reflect a currently stable level of student interest in family medicine residency training in the United States. Compared with the 2005 Match, 26 more positions (with the same number of US seniors) were filled in family medicine residency programs through the NRMP in 2006, at the same time as four more (five fewer US seniors) in primary care internal medicine, one fewer in pediatrics-primary care (12 more US seniors), and four more (19 more US seniors) in internal medicine-pediatric programs. Many different forces, including student perspectives of the demands, rewards, and prestige of the specialty; the turbulence and uncertainty of the health care environment; lifestyle issues; and the impact of faculty role models continue to influence medical student career choices. Two more positions (nine more US seniors) were filled in categorical internal medicine. Two fewer positions (11 fewer US seniors) were filled in categorical pediatrics programs. The 2006 NRMP results suggest that interest in family medicine and primary care careers continues to be stable. With the needs of the nation calling for the roles and services of family physicians, family medicine matched too few graduates through the 2006 NRMP to meet the nation's needs for primary care physicians.     

Expected benefits of streamlining undergraduate medical education by early commitment to specific medical specialties

Undergraduate medical education is too long; it does not meet the needs for physicians’ workforce; and its content is inconsistent with the job characteristics of some of its graduates. In this paper we attempt to respond to these problems by streamlining medical education along the following three reforms. First, high school graduates would be eligible for undergraduate medical education programs of 4 years duration. Second, medical school applicants would be required to commit themselves to a medical specialty and choose one of four undergraduate paths: (1) “Interventions/consultations” path that would prepare its graduates for residencies in secondary and tertiary specialties, such as cardiology and surgery, (2) “continuous patient care” path for primary care specialties, such as family medicine and psychiatry, (3) “diagnostic laboratory medicine and biomedical research” path that would prepare for either laboratory-based careers, such as pathology, biochemistry and bacteriology, or research in e.g., immunology and molecular genetics, and (4) “epidemiology and public health” path that would include population-based research, preventive medicine and health care administration. Third, the content of each of these paths would focus on relevant learning outcomes, and medical school graduates would be eligible for residency training only in specialties included in their path. Hopefully, an early commitment to a medical specialty will reduce the duration of medical education, improve the regulation of physicians’ workforce and adapt the curricular content to the future job requirements from medical school graduates.     

Results of the 2008 National Resident Matching Program: family medicine

The results of the 2008 National Resident Matching Program (NRMP) reflect a currently stable level of student interest in family medicine residency training in the United States. Compared with the 2007 Match, 91 more positions (with 65 more US seniors) were filled in family medicine residency programs through the NRMP in 2008, at the same time as 10 fewer (one fewer US senior) in primary care internal medicine, eight fewer positions were filled in pediatrics-primary care (10 fewer US seniors), and 19 fewer (27 fewer US seniors) in internal medicine-pediatrics programs. Multiple forces, including student perspectives of the demands, rewards, and prestige of the specialty, the turbulence and uncertainty of the health care environment, lifestyle issues, and the impact of faculty role models, continue to influence medical student career choices. Thirty-one more positions (20 fewer US seniors) were filled in categorical internal medicine. Thirty more positions (84 fewer US seniors) were filled in categorical pediatrics programs. The 2008 NRMP results suggest that while interest in family medicine experienced a slight increase in the number of students choosing the specialty, interest in other primary care careers continues to decline. With the needs of the nation calling for the roles and services of family physicians, family medicine still matched too few graduates through the 2008 NRMP to meet the nation's needs for primary care physicians.     

农村订单定向医学生就业与规培:两年跟踪分析

目的:跟踪分析两届订单定向医学生毕业后两年的就业与规培情况,探讨首届定向生规培结束后能否"回乡"履约,并提出政策建议。方法:选取中西部四所医学院校,分别对2015届305名和2016届435名订单定向生在毕业当年建立队列,随后连续两年开展随访调查和深入访谈。结果:当前订单定向毕业生履约率高于99%,工作落实率高于98%,2015届和2016届定向生编制落实的比例分别为86.7%和93. 8%,参加规培的比例分别为97. 4%和68. 3%,规培期间月总收入分别为3 879元和3 783元。结论:与首届定向生相比,2016届毕业生的工作及编制待遇落实更为顺畅,但是出现与家乡所在地签约率下降、定向工作地点限制过严、部分定向生参加规培未得到有效落实等问题。相关部门应尽早明确规培与"回乡"的转接办法,充分调动地方政府的积极性,促进定向生履约。     

Cultural sensitivity training among foreign medical graduates

OBJECTIVES: To examine the effectiveness of culture sensitivity training for foreign-trained medical graduates licensed to practice in Ontario, Canada. DESIGN: A study of pretest-post-test design was conducted to determine the effect of cultural sensitivity training on newly immigrated physicians licensed in Canada. Twenty-four physicians, those who had passed the medical licensing exam in 1996 and had not yet started their residency program, were given 15 hours of cultural sensitivity training and were considered the experimental group. This group was compared with a control group of 24 physicians who had passed the licensing exam and were in the process of completing residency. SETTING: University of Toronto. SUBJECTS: Foreign-trained medical graduates. RESULTS: Both groups completed the Cross-Cultural Adaptability Inventory both before and after the training of the experimental group. Statistical significance in three subscales of the Open-Mindedness/Flexibility, Emotional Resilience and Perceptual Acuity dimensions were demonstrated in the experimental group as compared with the control group. CONCLUSIONS: In order for Canada to mould professional and effective physicians great care must be taken in the design and process of cultural sensitivity programmes to enhance both knowledge and skills. Follow-up should be undertaken to compare their effectiveness with the control group.     

Entry of US medical school graduates into family practice residencies: 1999-2000 and 3-year summary

This is the 19th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 13.4% of the 16,143 graduates of US medical schools between July 1998 and June 1999 were first-year family practice residents in 1999, compared with 15.4% in 1998 and 16.6% in 1997. Medical school graduates from publicly funded medical schools were almost twice as likely to be first-year family practice residents in October 1999 than were residents from privately funded schools, 16.2% compared with 9.3%. The West North Central region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1999 at 20.6%; the Middle Atlantic and New England regions reported the lowest percentages at 7.7% and 8.0%, respectively. Nearly half of the medical school graduates (48.4%) entering a family practice residency program as first-year residents in October 1999 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family practice residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.