Recruitment of Residents to Rural Programs: Early Outcomes of RRPD Cohort 1.

Context: Rural America has fewer physicians leading to poorer health outcomes. In an attempt to bolster the rural physician workforce, the Health Resources and Services Administration (HRSA) funded a series of Rural Residency Planning and Development (RRPD) awards to develop rural residency programs in needed specialties. These 3-year program start-up grants were awarded to the initial cohort of RRPD grantees in 2019. Objective: Explore early workforce outcomes of the RRPD grants program, using resident recruitment data Study Design & Analysis: cross-sectional, descriptive analysis of qualitative and quantitative evaluation data Setting: new rural residency training programs across the U.S. Intervention/instrument: grantee exit survey, administered at the conclusion of their RRPD award Population studied: Cohort 1 RRPD grantees: 25 newly developing residency programs in Family Medicine (n=20), Psychiatry (n=4) and Internal Medicine (n=1) across the US Outcome measures: Median total and eligible applications per available position; median interviews offered and completed per position; positions filled in the main residency Match vs the Supplemental Offer and Acceptance Program (SOAP); residents from the state where program is located Results: The 25 Cohort 1 RRPD programs range in size from 2 to 8 residents per year. Most programs (16 or 64%) were considered rural training tracks and anticipate that residents will spend on average 73% of their time at rural training sites (50% min to 100% max). Of the 25 sites, 17 (68%) were far enough along in development to participate in the 2022 Match. These programs received a median of 152 (range 25-349) total applications per position, 22 (range 5-122) of which were considered eligible. They offered a median of 15 (range 5-45) interviews per position and completed 15 (range 5-33) of these. Most of the 68 total positions were filled in the main NRMP Match (79% average) though some (19% average) were filled in the SOAP. Approximately 1 in 3 (34%) of residents currently enrolled in Cohort 1 RRPD programs are from the state in which the program is located, though this ranged from 0 to 79% by program. Conclusions: Early resident recruitment outcomes suggest the RRPD model is successful in creating and supporting new physician workforce training in rural communities. A strong main Match fill rate (79%) may indicate student interest in rural training, including those who are local to the area.

Research interests of family physicians applying for research training.

BACKGROUND: There is an ongoing need for research to support the practice of high quality family medicine. The Family Medicine Discovers Rapid Cycle Scientific Discovery and Innovation (FMD RapSDI) program is designed to build capacity for family medicine scientific discovery and innovation in the United States. Our objective was to describe the applicants and research questions submitted to the RapSDI program in 2019 and 2020. METHODS: Descriptive analysis for applicant characteristics and rapid qualitative analysis using principles of grounded theory and content analysis to examine the research questions and associated themes. We examined differences by year of application submission and the applicant's career stage. RESULTS: Sixty-five family physicians submitted 70 applications to the RapSDI program; 45 in 2019 and 25 in 2020. 41% of applicants were in practice for five years or less (n = 27), 18% (n = 12) were in in practice 6-10 years, and 40% (n = 26) were ≥ 11 years in practice. With significant diversity in questions, the most common themes were studies of new innovations (n = 20, 28%), interventions to reduce cost (n = 20, 28%), improving screening or diagnosis (n = 19, 27%), ways to address mental or behavioral health (n = 18, 26%), and improving care for vulnerable populations (n = 18, 26%). CONCLUSION: Applicants proposed a range of research questions and described why family medicine is optimally suited to address the questions. Applicants had a desire to develop knowledge to help other family physicians, their patients, and their communities. Findings from this study can help inform other family medicine research capacity building initiatives.

Support for rural practice: female physicians and the life-career interface.

INTRODUCTION: The need for family physicians in rural areas across the USA and Canada is a longstanding issue that has been well documented. Since family physicians constitute the largest population of rural practitioners, the problem has been exacerbated by a sharp decline in medical students' interest in the field of family medicine and the aging of the current rural workforce. Previous research has shown that female physicians in rural areas need strong support networks to maintain a healthy work-life balance. The purpose of this study was to better understand the types of support they need and how they find it, as well as how their needs change over time. METHODS: Twenty physicians from the same rurally focused family medicine residency were interviewed over a 3-month period using a semi-structured format. Physicians ranged in experience from 1 year out of residency to 25 years out of residency. Using a phenomenological approach, interviews were transcribed and then coded and analyzed by three members of the research team, one of them an experienced qualitative researcher, who met periodically to reflect on the process of coding. Emergent subthemes and themes were discussed by the multidisciplinary team. RESULTS: The participants discussed in detail the types of support they relied on and the continuing challenges of maintaining a healthy work-life interface. Main themes included the need to select carefully one's life partner and practice partners and the difficulties in setting up practice in an area without family, friends or professional mentors nearby. Although forming boundaries was important, so was developing close relationships with patients and their families. The one thing that sustained all of the physicians was a meaningful relationship with their patients. The doctor-patient connection is what brings joy and helps every one of them cope with the harder aspects of life in rural areas. CONCLUSION: The general consensus of respondents was that the career-life interface varies across individuals, changes over time and is always a work in progress. Rural female physicians think of their work in relational terms, and it involves a great deal of emotional labor. Support systems mitigate the psychological effects of this labor and help physicians develop resilience in managing both career and life. Educators can better prepare female physicians by discussing the costs and benefits of emotional labor and the necessity of support networks, as well as how to negotiate a contract that is consistent with one's values, practice style and family life.

Changes in Preparation and Practice Patterns Among New Family Physicians.

Family physicians' scope of practice is declining despite being well prepared to provide a range of clinical services. To evaluate whether this is a new phenomenon, we compared the proportions of regional family medicine residency graduates who report practicing and those who report feeling more than adequately prepared to practice various procedures and clinical services from 2 points in time-a survey in 2000 of graduates from 1996-1999 (n = 293) and a survey in 2012 or 2014 of graduates from 2010-2013 (n = 408). The recent graduates felt better prepared, but reported a narrower scope of practice than those who graduated more than a decade earlier. These findings suggest that family medicine residency training has improved over time but the declining scope of practice is a concerning trend.

Burnout and Scope of Practice in New Family Physicians.

PURPOSE: Family physicians report some of the highest levels of burnout, but no published work has considered whether burnout is correlated with the broad scope of care that family physicians may provide. We examined the associations between family physician scope of practice and self-reported burnout. METHODS: Secondary analysis of the 2016 National Family Medicine Graduate Survey respondents who provided outpatient continuity care (N = 1,617). We used bivariate analyses and logistic regression to compare self-report of burnout and measures of scope of practice including: inpatient medicine, obstetrics, pediatric ambulatory care, number of procedures and/or clinical content areas, and providing care outside the principal practice site. RESULTS: Forty-two percent of respondents reported feeling burned out from their work once a week or more. In bivariate analysis, elements of scope of practice associated with lower burnout rates included providing more procedures/clinical content areas (mean procedures/clinical areas: 7.49 vs 7.02; P = .02) and working in more settings than the principal practice site (1+ additional settings: 57.6% vs 48.4%: P = .001); specifically in the hospital (31.4% vs 24.2%; P = .002) and patient homes (3.3% vs 1.5%; P = .02). In adjusted analysis, practice characteristics significantly associated with lower odds of burnout were practicing inpatient medicine (OR = 0.70; 95% CI, 0.56-0.87; P = .0017) and obstetrics (OR = 0.64; 95% CI, 0.47-0.88; P = .0058). CONCLUSIONS: Early career family physicians who provide a broader scope of practice, specifically, inpatient medicine, obstetrics, or home visits, reported significantly lower rates of burnout. Our findings suggest that comprehensiveness is associated with less burnout, which is critical in the context of improving access to good quality, affordable care while maintaining physician wellness.

Never Felt at Home: A Qualitative Study of the Experiences of Faculty From Underrepresented Groups in Family Medicine and Strategies for Empowerment.

BACKGROUND AND OBJECTIVES: Increasing diversity among medical educators is a vital step toward diversifying the physician workforce. This study examined how gender, race, and other attributes affect family medicine department chairs' experiences with sponsoring, mentoring, and coaching (SMC). We identified strategies at multiple levels to enhance SMC for faculty from underrepresented groups (URGs). METHODS: Our qualitative study employed semistructured interviews with the chairs of departments of family medicine in the United States. We used inductive and deductive thematic analysis approaches to describe the experience and name usable strategies organized along the social-ecological model. RESULTS: We interviewed 20 family medicine department chairs between December 2020 and May 2021. Many participants continued to be alarmed that leaders and role models from URGs have been rare. Participants described incidents of aggression in White- and male-dominated atmospheres. Such experiences left some feeling not at home. Some White male leaders appeared oblivious to the experiences of URG faculty, many of whom were burdened with a minority tax. For some URGs, surviving meant moving to a more supportive institution. Building spaces for resiliency and connecting with others to combat discrimination gave meaning to some participants. Participant responses helped identify multilevel strategies for empowerment and support for URG faculty. CONCLUSIONS: Understanding the experiences of URG faculty is paramount to improving the environment in academic medicine-paving the way to enhancing diversity in the health care sector. Institutions and individuals need to develop multilevel strategies for empowerment and support to actively make diverse faculty feel at home.

Prevalence and Predictors of Burnout Among Resident Family Physicians.

BACKGROUND AND OBJECTIVES: Resident burnout may affect career choices and empathy. We examined predictors of burnout among family medicine residents. METHODS: We used data from the 2019-2021 American Board of Family Medicine Initial Certification Questionnaire, which is required of graduating residents. Burnout was a binary variable defined as reporting callousness or emotional exhaustion once a week or more. We evaluated associations using bivariate and multilevel multivariable regression analyses. RESULTS: Among 11,570 residents, 36.4% (n=4,211) reported burnout. This prevalence did not significantly vary from 2019 to 2021 and was not significantly attributable to the residency program (ICC=0.07). Residents identifying as female reported higher rates of burnout (39.0% vs 33.4%, AOR=1.29 [95% CI 1.19-1.40]). Residents reporting Asian race (30.5%, AOR=0.78 [95% CI 0.70-0.86]) and Black race (32.3%, AOR=0.71 [95% CI 0.60-0.86]) reported lower odds of burnout than residents reporting White race (39.2%). We observed lower rates among international medical graduates (26.7% vs 40.3%, AOR=0.54 [95% CI 0.48-0.60]), those planning to provide outpatient continuity care (36.0% vs 38.7%, AOR=0.77 [95% CI 0.68-0.86]), and those at smaller programs (31.7% for <6 residents per class vs 36.3% for 6-10 per class vs 40.2% for >10 per class). Educational debt greater than $250,000 was associated with higher odds of burnout than no debt (AOR=1.29 [95% CI 1.15-1.45]). CONCLUSIONS: More than one-third of recent family medicine residents reported burnout. Odds of burnout varied significantly with resident and program characteristics.

Supplemental Offer and Acceptance Program Outcomes in a Family Medicine Residency Network.

BACKGROUND AND OBJECTIVE: The National Resident Matching Program's (NRMP) Supplemental Offer and Acceptance Program (SOAP) places unmatched applicants in residency programs. We examined the outcomes and experience of family medicine residency programs that matched with residents through SOAP. METHODS: In 2020, all program directors in a regional family medicine residency network whose programs had participated in SOAP (n=23) completed a survey on their experience with SOAP and characteristics of residents who were matched via SOAP (n=52) anytime between 2012 and 2020. Resident outcome measures included graduation, remediation, leadership, fit, and comparisons of Milestones areas. Experiences with the SOAP process included factors that may have led the program to SOAP and advice for other programs participating. RESULTS: Eighty-seven percent of residents matched via the SOAP graduated, and the majority compared favorably to other residents. Two-thirds of program directors were very likely to hire their residents matched via the SOAP. Rural programs had similar outcomes, although rural-track positions represented 30% of all residents matched via the SOAP in the study. More than half of all responding program directors reported being underprepared for the SOAP process. Program directors recommend getting familiar with the NRMP resources and setting aside time for key personnel in case a program needs to participate in SOAP. CONCLUSIONS: The vast majority of residents matched via the SOAP are well prepared for training, contribute to their programs, and perform as well as other residents. Rural programs are more likely to place residents via SOAP than nonrural programs.

To What Extent Are Programs Recruiting Their Own Graduates as Faculty? A CERA Study.

BACKGROUND AND OBJECTIVES: Most family medicine (FM) residency programs continuously recruit faculty, though little is known about their recruitment practices. In this study, we sought to define to what extent FM residency programs are relying on recruitment of program graduates, regional programs, or programs outside their region for filling faculty roles and to compare these data across program characteristics. METHODS: As part of a large 2022 omnibus survey of FM residency program directors, we asked specific questions regarding the percentage of FM faculty who were graduates of that program, a program in the region, or a distant program. We aimed to determine to what extent respondents attempted to recruit their own residents to faculty positions and to identify additional program offerings and characteristics. RESULTS: The response rate was 41.4% (298/719). Programs reported hiring more of their own graduates compared to regional or distant graduates, and 40% prioritized recruiting their own graduates for open positions. Those who prioritized recruiting their own graduates were significantly more likely to have a higher percentage of their graduates on faculty as were larger, older, more urban programs and those offering clinical fellowships. The existence of a faculty development fellowship was significantly associated with having more faculty from regional programs. CONCLUSIONS: Programs that aim to improve faculty recruitment from their own graduates should consider prioritizing internal recruitment. They also may consider the development of both clinical and faculty development fellowships for local and regional hires.