Robert Bowman

With 2.7 trillion dollars in annual health spending1, America has no excuse for designs that have failed for decades with regard to rural health workforce development. Rural workforce failure can best be understood as the inevitable result of failure by design. Designs for revenue are insufficient to support the rural clinician workforce that would resolve deficits. The designs of health professional training are not specific to rural health needs.

Family practice is the best example of a permanent primary care training form with 29.3 standard primary care years expected over a 35 year career. Other training forms appear to be more flexible. The 2008 pediatric residency graduates can be expected to serve 17.6 years of primary care. Internal medicine resident primary care contributions have been reduced by 50% in the past decade to 5.3 years with international medical graduate internal medicine contributions decreasing to 2.5 years… Show more

Family practice is the best example of a permanent primary care training form with 29.3 standard primary care years expected over a 35 year career. Other training forms appear to be more flexible. The 2008 pediatric residency graduates can be expected to serve 17.6 years of primary care. Internal medicine resident primary care contributions have been reduced by 50% in the past decade to 5.3 years with international medical graduate internal medicine contributions decreasing to 2.5 years. Physician assistant estimates have decreased to 6 years, while nurse practitioner estimates have declined below 3 years per graduate. With decreasing rural and underserved distribution levels in the flexible forms, the numbers of graduates needed to match the family practice rural primary care year and underserved primary care year contributions are even higher. Show less

The purpose of this study was to analyze the relative contributions of the locations of birth, medical education, and residency training in determining a family physician’s eventual practice location. Data were obtained from the American Medical Association Physician Masterfile and the American Academy of Family Physicians files at the Robert Graham Center.3The study sample was limited to family physicians who completed their training from 1997 to 2003. Individuals were included if they were… Show more

The purpose of this study was to analyze the relative contributions of the locations of birth, medical education, and residency training in determining a family physician’s eventual practice location. Data were obtained from the American Medical Association Physician Masterfile and the American Academy of Family Physicians files at the Robert Graham Center.3The study sample was limited to family physicians who completed their training from 1997 to 2003. Individuals were included if they were born, attended medical school, or completed family medicine residency training in Virginia. Individuals were excluded if any of these 3 locations were unknown or the practice location was a military address. The likelihood of practicing in Virginia was calculated for each of seven possible combinations of birth, medical education, and/or residency training in Virginia. Show less

The “Community-Driven Approach” empowers underserved communities so that they can guide the efforts that will best address their needs. This approach has great potential to permanently improve small towns in terms of jobs, leadership and services without extensive state or federal support programs. The Community-Driven approach: a) arises from mutual efforts involving both academic and rural communities; b) selects students from underserved areas; c) trains learners in underserved communities;… Show more

The “Community-Driven Approach” empowers underserved communities so that they can guide the efforts that will best address their needs. This approach has great potential to permanently improve small towns in terms of jobs, leadership and services without extensive state or federal support programs. The Community-Driven approach: a) arises from mutual efforts involving both academic and rural communities; b) selects students from underserved areas; c) trains learners in underserved communities; d) stabilizes and supports underserved practices; e) prepares future generations of physicians for underserved practices; and f) allows towns to preserve and expand health services, a key factor in keeping current jobs and recruiting new jobs and businesses to small towns. Show less

The link allows access to multiple studies including a comprehensive study of accelerated graduates indicating substantial value in distribution and long term continuity - not surprising given the choice to do medical school and residency in the same location.

The result of 90% of FM programs surveyed

The success of rural medical education is a complex matter involving states, institutions, medical training programs, faculty, practitioners and communities. There is not another entity like family medicine that can address the needs of rural health across the multiple dimensions of education, service, location and political influence. The challenge of family medicine in the next decade is to maintain a focus on preparing physicians who have the skills and motivation to make a difference. Armed… Show more

The success of rural medical education is a complex matter involving states, institutions, medical training programs, faculty, practitioners and communities. There is not another entity like family medicine that can address the needs of rural health across the multiple dimensions of education, service, location and political influence. The challenge of family medicine in the next decade is to maintain a focus on preparing physicians who have the skills and motivation to make a difference. Armed with new information and renewed energy, it is time for action regarding rural health.

Recommendation 1: Family medicine should encourage states, medical schools, primary care organizations, rural organizations and primary care training programs to work together to prepare a strategy that will best meet the needs of rural populations. This strategy should include a mission or mandate for rural health; admission of medical students likely to choose rural practice; adequate resources for rural training; coordination of rural training among medical schools, residencies, physicians and communities; recognition of programs that produce rural practitioners; funds to obligate students and residents to practice in a rural area; and programs to improve the organization of rural practices and health systems so that more family practice residency graduates can find out about these locations, choose them and stay in them.

Recommendation 2: Family medicine should urge residency programs to engage residents in longer and better rural rotations and obstetric training.

Recommendation 3: Family medicine should preferentially encourage the creation of residency programs and other training experiences in smaller towns.

Recommendation 4: The various branches of family medicine should coordinate their rural efforts closely, with the assistance of the American Academy of Family Physicians, and report annually on the progress of rural medical education. Show less