Ranked by Rural Percentage by RUCA coding as per Hart method noted at Bowman FP Grad Studies
Important Notation: In the medical literature in this area, there are errors. Rural training has been associated with 3 times higher rural distribution. Better studies controlling for origins, medical school, and age indicate that family practice is the tripling multiplier. Choice of family medicine doubles all urban distribution to serve 60% of the population left behind and triples (or greater) rural distributions when compared to other choices. IM or PD primary care might get a 1.1 multiplier so essentially FM is the only career multiplier of distribution. The same is seen for PA and NP graduates. Only the family practice component (25% and falling of PA and 25% of NP total grads) have the required distribution to be able to improve health access. And this lasts only as long as family practice sources stay in family practice.
Robert C. Bowman, M.D. email@example.com
City listed and more details given for cities with more programs. So far the data is a mix of first practice location after leaving residency zip code but includes 1997 - 2003 graduates. Hopefully future efforts will allow some updating.
Family medicine is unique in that locations away from Major Medical Centers are maintained, with all other physicians, primary care physicians, and primary care types including NP and PA folding back into major medical centers over time. FM distributions of first time graduates often are similar to mid career and later graduates.
The standard for workforce should remain multiple class years in equilibrium conditions. 11% rural and 7% underserved are standards for all physicians across the nation and FP is a steady 24% rural and 12 - 14% underserved across class years and distance from graduation.
I was looking at the RME website as to best FM residency programs wrt grads doing rural practice. I am familiar with most of the residency programs that are listed including several UW network residency programs. As you know I have helped many of these programs develop their rural GME. I was surprised to see that Family Medicine and our RTTs were not included among “best programs”. Through 2006, FMS has had 208 grads of whom 105 (50%) practice in rural communities which is about twice the National average. The RTT has had 30 grads of whom 24 (80%) are practicing rurally. 97% of the RTT grads practice in WA, OR, AK and ID. If you could include the Spokane programs with your list that would be appreciated as I believe them to be among the better programs with rural practice preparation and placing/maintaining grads in rural areas. I am in the process of analyzing the information returned to me as part of our 2006 Graduate Follow-up Survey and it is very interesting e.g. 51% of FMS grads do OB and 29% do CS, while 67% of RTT grads do OB and 61% do C/Sections. Reflective of where they practice I am sure. Bob Maudlin
Bob truly has been instrumental in all these areas and in the training of the
Minifellows and myself. I
have revised to reflect these and will continue to accept submissions based on
current data on a number of class years, a workforce in equilibrium. I have
added two columns also as Bob has reported. Data on all tracks
is appreciated since these often cannot be tracked using secondary data.
Programs with a common sponsor as in Arkansas or Mayo programs are also hard to
track. Maine residency programs also have rural graduates in top percentages and
|City||State||1992 - 95 rural % (Director Survey)||1997-2003 rural FP % (Masterfile + Graham Center||total grads||% in state||% in state and adjacent||OB and C section|
|Omaha UNMC RTT||NE||88.5%||26|
|Some programs in Maine have levels of rural distribution at this level|
|Omaha UNMC Accel||NE||73.9%||23|
|Toledo MCO Accel||OH||64.3%||14|
|Memphis Accel U TN||TN||55.0%||20|
|Mobile Accel USA||AL||50.0%||10|
|Omaha Accel Creighton||NE|| ||50.0%||6|| || || |
Accel is Accelerated family medicine programs, 3 - 3 programs except for U of NE see Accelerated Family Medicine Training Programs
This data includes ACGME Family Medicine residency programs only. The AMA Masterfile is weak in coding for Osteopathic Family Medicine Programs. Also many GPs in the Masterfile are actually family physicians and FPGP numbers are more reflective of actual family medicine contributions. Residency programs expecting higher numbers may be disappointed in some states. This can be because they have graduates who have located in rural towns with 30% of the population or more commuting to urban areas. These have a 0.1 code in the RUCA coding scheme and are considered urban-focused and part of the urban workforce.
The 1992 - 1995 data involves program director surveys which were the basis of the authors previous publication Fam Med Residency Programs and the Graduation of Rural Family Physicians
Major Medical Centers
Distribution: Index Concentrations of Physician Distribution
Physician Workforce Studies