Have noticed a few items recently re comparing rural vs international. Not only did international get a networking conf at aafp, they are listed in 1996 Directory (rural is not), and they are listed as a choice for recertifying physicians as an interest (rural is not but sports med, geriatrics, etc are) Seems like the international folks are lobbying well. I hate to compare but....
Also have not gotten a response from Mike Gordon yet by email or voice mail
Our info on rural programs page was not inputted yet as of last week and Shannon is not returning messages. Might get staff to check with Shannon Merritt about this. He has the diskette and noted that this info would get inputted at AAFP meeting or right after.
Am working to tally up changes in OB months over the years in fp programs to see if changes make a difference. Might be the number of deliveries, independent of months of OB but will check it out.
Have also noted that states in most rural need (midwest and south) often still having most trouble with match. Really need a study of match and program creation trends.
Some goals that I sent out to steering committee to consider:
STFM Group on Rural Health Goals for 1996-1997
Robert Bowman and Jeff Stearns, Co-Chairs
1. bulletin board for rural docs and faculty
2. tracking rural interest research project with aamc, aafp
3. strolling through the match supplement for rural interested students
4. Major rural health policy item to aafp congress from several states
A comprehensive report of rural health issues and the role of AAFP in addressing these needs. This report would take into account the recent changes in the practice choice of primary care practitioners (see article on FP changes later in issue), the status of rural medical education, and the use of AAFP resources to meet current and anticipated needs. Including recommendations to the Residency Review Committee regarding rural rotation months, enhancing obstetric requirements, and an emphasis on programs with missions for rural health.
5. Request annual grad survey to include question on rural months done,
ob training numbers, decision for ob or not at graduation - to track
changes, allow monitoring of training trends, predict changes in
those who will choose rural and also those who will deliver
7. Work with students at aafp - work with David Meyers,student chair
8. Combine our efforts for rural presentation at KC stud res,
hope for Friday and Saturday before many residents and program
directors are there
Hope to tape dr. boyer talk for use by fpsig groups
9. Meet with AAFP Education Division and STFM Education group re:
Conference activity and rural workshops/meetings
Predoctoral
Program Directors presentation, discuss rural research, questions
STFM Annual vs Regional meetings- -- ???
Rural Presentation at NCFPR/NCSM FP student/resident in KC
Steering Comm mtg Aug 1997
Rural Networking meeting at AAFP in Chicago in Sept 1997 with
rural committee?
Program director survey change (revised in August each year) to
include mission, required rural months
To interested faculty and STFM Rural Group Steering Committee members:
I have taken the liberty of preparing the following list of possibilities for the coming year. We need your feedback on additions, changes, priority, etc:
1. Communications
Bulletin board for steering committee and interested faculty and rural docs
2. More aafp rural committee liaison
met with Byron Crouse at AAFP
need to set up mutual meetings with committee and staff Mike Gordon
need to set up mutual projects - suggestions to consider to send to Byron and Mike
get rural health to be a title in web page like students, residents
listings under logically organized skeleton.
bulletin board for rural docs and faculty
tracking rural interest research project with aamc, aafp
strolling through the match supplement
Major rural health policy item to aafp congress from several states
Request annual grad survey to include question on rural months done,
ob training numbers, decision for ob or not at graduation
Update, organize OB training info
Tally up changes in OB months over the years in fp programs
3. Work with student leadership in FP - work with David Meyers who is current student chair
met with David at AAFP
discussed continuing rural presentation, hopefully on Fri and Sat, not Thurs at KC
before many residents and program directors are there
discussed doing evening rural presentation/dinner etc. at KC in August
encourage rural subgroups of fp interest groups
Info to students that rural info is on the web page
Taping of dr. boyer talk for use by fpsig
4. Meet with AAFP Education Division and STFM Education group
Conference activity and rural workshops/meetings
Predoctoral
Program Directors
STFM Annual
Rural Presentation at NCFPR/NCSM FP student/resident in KC
Steering Comm mtg Aug 1997
Rural Networking meeting at AAFP in Chicago in Sept 1997
Program director survey change (revised in August each year) to include mission, required rural months
Had a talk with David Meyers (meyersd@mail.med.upenn.edu), current national FP student chair. He is very oriented toward rural. Will get his input regarding electives, home page, etc. Also had a talk with him regarding getting Bob Boyer's talk on tape. Also we should have our fp program listing up on aafp home page within the week. It is under the AAFP Rural Committee item, but not highlighted yet. This will give students more info to choose to match a rural oriented fp program. Also there is a new AAFP Rural Committee staff, Mike Gordon, who will be contacted. Hope to visit him in KC soon. Byron Crouse, of Duluth, is the new AAFP Rural Committee chair, and knows much in this area also. He and I met for about an hour or so and we are both very interested in cooperation. See his article in October American Family Physician.
Rec 1 - We should appreciate the chance to give some input and should do so. Also David Meyers, the Student Chair, has a great interest in rural and would be a help. He is at meyersd@mail.med.upenn.edu
I hope that the academy plans to do more than publish and distribute this monograph. Works such as these are best done in conjunction with a plan to distribute them in seminars and conferences where sessions about rural health are held. The STFM Regional conferences are, and have been some of the best opportunities for this. RAP, Program Directors, Predoc, NCFPR/NCSM, and the annual meetings are other good ones.
Specific recs -
the new chapter one - after intro comments and a mention of when folks choose rural, and student opportunities such as Texas' Statewide Preceptorship (check with state academy), AMSA's HPDP(contact #), the Appalachian Preceptorship), then next step is choosing a rural-oriented family practice residency. this can be taken from the following research collected by our Group (needs a change in writing as this was followed by FP program listings):
Rural Programs in Family Medicine Residencies
In the past decade about 600-700 residents each year have chosen rural practice. This number has not changed despite increases in the number of residents and programs. Studies show that programs without rural emphasis graduate far fewer residents into rural practice. For example, programs with no required rural months graduated 24.4% into rural practice while those with only 2 months graduated nearly twice as many rural physicians (45.6%). Programs with no rural mission graduated an average of 21.3 % into rural practice while those with a mission graduated 50.9% rural. Those with 2 months of OB graduated 23.8% rural while those with 5 or more months graduated 42.7%. The choice of a residency with rural months, rural programs, more ob months, or a higher rural graduation rate keeps the rural option open. Faculty doing rural programs can also use the information to improve their curricula and network with other faculty who are doing rural programs.
The basis of this information is a national survey of family practice residency program directors regarding the rural components of their programs beginning in 1994. A total of 326 programs responded to five mailings and other requests by phone and fax. Data from the 62 newest programs was excluded because the programs had no graduates. The remaining 43 programs that did not respond were mostly in large urban areas, leaving a response rate of 326/369 or 88%. The dependent variable used in the study was the percentage of graduates who chose towns of less than 25,000 that were not adjacent to a larger metropolitan city. The survey asked the program director to record the total number of residents graduating in 1992, 1993, or 1994 as well as the number of residency graduates choosing a town < 25,000 not adjacent to a metropolitan area.
1. Examine the Rural Graduation Rate of the Program
A key question is how successful the program is in producing rural physicians. This percentage is listed by program. Please note that the programs are listed by state (two letter abbreviation).
2. Examine the Rural Emphasis of the Program
Programs with the most rural graduates tended to have the following characteristics (in order of significance by multiple regression analysis) p value
1. Programs with more required rural months .0001
2. A program site in a more rural state .0001
3. Programs with a mission for rural health .0006
4. Programs with more required months of OB .0018
5. Programs with fewer other residencies
(no difference between solo programs and up to 2 other residencies
but with 3 or more there are less rural graduates)
6. Programs in cities with smaller populations .0148
7. Programs with rural training tracks .0409
The final regression model explained 46% of the variance.
Care has been taken to prepare this as accurately as possible, but information does change, particularly about Rural Tracks and fellowships. As of 1996, over 154 FP residencies have some required rural component, 38 had ambulatory rural and 146 had a required block rotation (29 had both). There are 26 rural training tracks of some type with 18 planned. FP Programs employ 791 former rural physicians as faculty out of a total of 2582 total MD/DO faculty. FP residents provided at least 4300 months of medical services to rural communities in 1995.
Back to other recommendations:
- p 16 - Two of the top means of finding a practice and information on loan repayments and scholarships are not mentioned, I would start with them:
State Office of Rural Health. All states with rural practice opportunities have an Office of Rural Health. The ORH lists current practice opportunities and often has the most current information about scholarships and loan repayments. Contact your state department of health for further information.
NCFPR/NCSM. Be sure to attend this meeting of the students and residents each summer in Kansas City. Since 1988 there has been a presentation specifically for those who are interested in rural practice. At this presentation, students receive information about residency programs that prioritize preparation for rural practice. Residents can find out about obstetrical and rural fellowships as well as talking with rural physicians and faculty about their choice of practice. Finally many rural communities and those who recruit for them attend the meeting and have booths. Drop by and visit and find out about the various types of rural practices.
In a later paragraph I would list:
The STFM Group on Rural Health. This group of the Society of Teachers of Family Medicine surveys program directors of family practice, collects information about rural training, and distributes this information to students, residents, and faculty. The Group also has a rural newsletter that can assist you with information about rural health and rural medical education. For information about this group contact STFM at
Regional meetings of the STFM often have information about preparing for rural family practice. Be sure to examine these opportunities as well.
Rec 2 - I have to agree that the information is a bit much on the web site with lots of links. Perhaps less links in member driven categories would send webbers in better directions. Also agree with a rural category to click on the member page. This would then have nice subheads with various information. Right now some STFM Group info is listed under the Rural Committee under an Index, but the data is not inputted yet. Shannon Merritt is working on the input. He thought he could get the input done, but has not had a chance as of 5 days ago. We'll check in a week or so and get back to you.
Sorry about the length, hope this helps you and the Board.