What happens when you select and train students and residents for rural family medicine?
Here is the distribution comparing the effect of rural background and rural background plus specific rural training. Large rural is RUCA 4 – 6, rural is RUCA 7 – 9, and Isolated rural is RUCA 10. The urban focused codes are 1 – 3, 4.1, 7.1, and 10.1. These figures involve only the FP graduates from these locations. The key column in the far right, noting those who have chosen the most rural locations. Those graduating over 6.1%, the US population in such areas, are doing well. Note that the rural nature of each state can impact rural location, but the impact of admissions plus training can do better than usual methods, even allowing for rurality of the state.
|
FP Grads 1997 - 2003 |
Urban |
Large Rural |
Rural |
Isolated Rural |
|
Duluth med school (rural + FP admissions) |
96 |
24 |
32 |
25 |
|
U of MN Minneapolis (traditional admissions) |
239 |
23 |
38 |
13 |
|
Duluth med school grads doing any FP % |
54.2% |
13.6% |
18.1% |
14.1% |
|
U of MN grads doing any FP program % |
76.4% |
7.3% |
12.1% |
4.2% |
|
UNMC Accelerated (rural admit + training) |
31.3% |
18.8% |
28.5% |
28.1% |
|
UNMC RTT (rural admit + training) |
11.1% |
33.3% |
25.9% |
29.6% |
|
South Dakota FP (rural admit) |
53.4% |
11.6% |
14.6% |
20.4% |
|
South Dakota RTT n=5 (rural admit + training) |
0% |
20% |
20% |
60% |
|
All FP Grads 1997 - 2003 % |
78.9% |
9.1% |
8.2% |
3.8% |
|
US population 1998 est |
77.6% |
9.3% |
6.9% |
6.1% |
The Duluth graduates that chose family medicine are much more likely to choose family medicine and all three rural location categories, particularly the most isolated rural locations by over 3 to 1 compared to U of MN. This also illustrates the numbers needed to train concept by Rabinowitz with twice as many to isolated rural with 3 times the FP docs trained, not to mention the class size comparisons at the medical school level where the Duluth class of 45 is far fewer than the 180 at U MN. Rural selections and rural medical education are efficient uses of med ed resources.
Comparisons with the table below reveal the difference in outcomes. A separate analysis of Duluth med school graduates choosing Duluth FP residency had the same outcomes.
UNMC rural programs are completely dependent upon rural background students. The department converted from traditional to specialized rural and urban tracks. The success of this effort resulted in a national award Outstanding Rural Health Program Award in 2001 Goes to UNMC Family Medicine
South Dakota's numbers show the impact of rural background on isolated rural graduation, and also the impact of RTT training. Sadly the state was unable/unwilling to support such efforts that would have likely met state needs much better, since early indications were that it would have exceeded UNMC's efforts in graduating FP docs for the isolated rural locations in greatest need. Some South Dakota locations are depending more and more on international physicians even though SD leads the nation in choice of FP by its medical students and is a top contender for highest rural percentage of FP graduates.
Other charts comparing FP Distribution at Family Medicine Physician Distribution