National data on Family Physicians from Robert C. Bowman, M.D. (my work, not from any association) Datasources include the Masterfile and association databases.
Doubling Up Distribution - Family medicine consistently doubles (or more) distribution to rural and underserved location. Current inequities have long made physician distribution difficult. Losses of new family physicians make it impossible.
Declining Rural Populations - Mayday 23 represents the world changing from a rural to an urban majority. In the United States, the states that cross from rural to urban have the greatest decline in rural born medical school admissions.
Primary Care Years: New Measures of Total Workforce Contribution
Family Medicine Standards and Constants - ratios of family physicians and reasons
Facilitating Physician Distribution - it is possible to demonstrate that family medicine distributes beyond birth origins, that family medicine doubles rural and underserved distribution, and that specific family medicine forms of inner city or rural graduate training distribute even above birth origins and simple family medicine choice.
Failure To Launch - even when the nation tries to not admit physicians from certain populations, family physicians manage to gain admission and distribute at the highest levels
Family Medicine Physician Distribution - national tables and graphics
Five Periods of Health Policy and Physician Career Choice - family medicine choice is a result of health policy impacts as interpreted and influenced by major medical centers (that hire half of family physicians each year). When the nation has supported primary care, family medicine, and health care for lower and middle income populations, the nation has increased choice of family medicine. When the nation has limited other GME options other than family medicine, the choice of family medicine went through the roof and the graduates stayed in family medicine despite "forced choice"
Health Care Workforce Estimates PA, NP, MD, DO compared to FM
Same State Birth To Practice Tables
Rural Recruitment and Retention Factoids
Rural and Urban Comparison of all FP graduates as of 2003 by state locations and RUCA coding
Patterns of Distribution - Distributional Medical Schools graduate distributional physicians and this effect is enhanced with distributional Health Policy Impacting Physician Career Choice
Instate Retention of Family Physicians: Dependable Primary Care Workforce Retained Within States
Divisions in Physician Career and Location Choice Related to Age at Graduation - Changes in the United States mean that physicians layer out by socioeconomics, age, and scores into three different career types: those that emphasis people, direct patient care, and generalist focus; those that those that distribute and those that do not.
Major Medical Centers MMCs are medical school zip codes or zip codes with 75 or more active physicians, undercounted since not including other providers Underserved areas have poverty levels of 20% or more, or a federal designation (CHC, NHSC, whole county)
See Top Workforce Outcomes
Rankings to see the huge advantage for family medicine
Careers listed for family medicine in Family L list serve so far (variety, but
remember 98% stay in FM as primary
specialty)
FPs are 8% of major medical center physicians, 23% in urban underserved
or served areas, and 31 - 100% for rural areas, increasing in concentration
as income, education, facilities, and health care coverage all decrease
Robert C. Bowman, M.D.
rbowman@unmc.edu
The students who tend to choose family medicine depend more upon state education to be able to access college, much less medical education. When choosing students who are more likely to become family physicians, there are important .Primary care physicians in rural and higher poverty areas are critical for health care access. Career choice of family medicine and office-based internal medicine, office-based pediatrics, and medicine-pediatrics is important. Side Effects of Selecting for Family Medicine
Studies involving Superselection or specialized admissions (Physician Shortage Area Program PSAP, Duluth Plus RPAP and Accelerated Family Medicine Training Programs) reveal that females choose rural in the same % and also the same distribution to smaller town sizes with special selection and/or special training programs. Otherwise the effect of gender is slightly greater choice of primary care and urban poverty primary care and slightly less choice of rural locations. Family Medicine and Physician Distribution In states where rural males do not access higher education, female family medicine graduates may have higher rates of choice of rural location. This again has to do with origins and distribution of education more than gender. Ethnicity Gender and Rural Practice Choice
From National Center for Rural Health Professions in Rockford IL
each doctor or dentist in rural IL generates 1.94 additional jobs due to
business and household spending
every nurse means 1.3 additional jobs
every dollar earned by the doctor, dentist, or nurse means $1.59 generated
in the local economy
health care jobs were 9.2% of all local income in rural IL, in many cases
second only to schools
16% of rural Illinois residents were employed in health care and related
fields
Other data notes about 1 to 2 million dollars in economic impact for each
rural family physician each year depending upon how many facilities are
impacted in the community (hospital, clinic, pharmacy, nursing home)
Decreasing Rural FP Physicians There is an overall decline in total numbers of rural FP graduates with all three categories showing decreases. Declines in those choosing isolated rural locations is a critical concern for the nation.
Gender and Ethnicity in FP Graduates 1997 There have been declines of FP grads who are white male, Hispanic male, and Native. White females are steady and Asian females are increasing, particularly international grad females from India, Pakistan, and China. Rural graduation rates of FP residents range from 5% for US born Asian grads to 50% for Native FP grads. Generally about 15% chose rural in allopathic private schools and international schools. Allopathic public is about 30 % and osteopathic 35 45%.
Increasing International FP Graduates from Near International Sources Over 90 Ross University graduates finished allopathic FP programs in 2003. American University and St. George's increased their contribution to 50 - 60 FP graduates each year in 2002 and 2003. The FP output of all international medical schools near the US, the ones most likely to include US citizens (50 70%) desiring to return to the US, tripled from 2000 to 2003.
Family medicine has moved into almost every facet of medical education,
but are we shaping the process or being shaped by it?
Academic Impacts on Family Physicians
Will family medicine use the expertise that it has gathered to prop up decaying walls or develop new forms of education and practitioners?
Will we follow the lead of some nations to create medical schools that will serve rural and underserved populations or even perhaps a new type of physician?
By the numbers: Rural Doctors and Rural Economies