Family Medicine Residencies: How Rural Training Exposure in GME Is Associated With Subsequent Rural Practice.

Background: Rural US populations face a chronic shortage of physicians and an increasing gap in life expectancy compared to urban US populations, creating a need to understand how to increase residency graduates' desire to practice in such areas. Objective: This study quantifies associations between the amount of rural training during family medicine (FM) residencies and subsequent rural work. Methods: American Medical Association (AMA) Masterfile, AMA graduate medical education (GME) supplement, American Board of Family Medicine certification, Accreditation Council for Graduate Medical Education (ACGME), and Centers for Medicare and Medicaid Services hospital costs data were merged and analyzed. Multiple logistic regression measured associations between rural training and rural or urban practice in 2018 by all 12 162 clinically active physicians who completed a US FM residency accredited by the ACGME between 2008 and 2012. Analyses adjusted for key potential confounders (age, sex, program size, region, and medical school location and type) and clustering by resident program. Results: Most (91%, 11 011 of 12 162) residents had no rural training. A minority (14%, 1721 of 12 162) practiced in a rural location in 2018. Residents with no rural training comprised 80% (1373 of 1721) of those in rural practice in 2018. Spending more than half of residency training months in rural areas was associated with substantially increased odds of rural practice (OR 5.3-6.3). Only 4% (424 of 12 162) of residents spent more than half their training in rural locations, and only 5% (26 of 436) of FM training programs had residents training mostly in rural settings or community-based clinics. Conclusions: There is a linear gradient between increasing levels of rural exposure in FM GME and subsequent rural work.

Primary Care's Historic Role in Vaccination and Potential Role in COVID-19 Immunization Programs.

PURPOSE: Coronavirus disease 2019 (COVID-19) pandemic recovery will require a broad and coordinated effort for infection testing, immunity determination, and vaccination. With the advent of several COVID-19 vaccines, the dissemination and delivery of COVID-19 immunization across the nation is of concern. Previous immunization delivery patterns may reveal important components of a comprehensive and sustainable effort to immunize everyone in the nation. METHODS: The delivery of vaccinations were enumerated by provider type using 2017 Medicare Part B Fee-For-Service data and the 2013-2017 Medical Expenditure Panel Survey. The delivery of these services was examined at the service, physician, and visit level. RESULTS: In 2017 Medicare Part B Fee-For-Service, primary care physicians provided the largest share of services for vaccinations (46%), followed closely by mass immunizers (45%), then nurse practitioners/physician assistants (NP/PAs) (5%). The Medical Expenditure Panel Survey showed that primary care physicians provided most clinical visits for vaccination (54% of all visits). CONCLUSIONS: Primary care physicians have played a crucial role in delivery of vaccinations to the US population, including the elderly, between 2012-2017. These findings indicate primary care practices may be a crucial element of vaccine counseling and delivery in the upcoming COVID-19 recovery and immunization efforts in the United States.

Gender Concordance of First and Senior Authors in Family Medicine Journals.

BACKGROUND AND OBJECTIVES: Women have increased in presence within academic family medicine over time yet remain underrepresented among senior faculty. Mentorship is a mechanism by which senior faculty support scholarly achievements, accelerating advancement of junior faculty. METHODS: We analyzed 10 years (2008-2017) of original research articles in three peer-reviewed family medicine journals. We examined first author/last author pairs by gender as a proxy for mentorship of junior faculty by senior faculty. We compiled family medicine faculty data across 9 years to compare trends in scholarly mentorship with faculty advancement. RESULTS: Female last authorship increased from 28.8% (55/191) of original research articles with a first and last author in 2008 to 41.8% (94/225) in 2017. The share of female first authors on articles with a female last author was 56.4% in 2008 and 2017. The share of female first authors on articles with a male last author increased from 41.2% (56/136) to 55.7% (73/131) between 2008 and 2017. From 2009-2017, the proportion of women increased for assistant, associate, and full professor roles, but remained under 50% for the associate professor role and at 35% for professorship in 2017. CONCLUSIONS: Despite disproportionate rates of last authorship and senior faculty positions in family medicine departments, senior female authors have equal if not greater rates of mentorship of female first authors in family medicine literature. The increase in first authorship, last authorship, and faculty position indicates that improvements have occurred in gender advancement over the study period, but gains are still needed to improve gender equity within the field.

Characteristics of Office-Based Buprenorphine Prescribers for Medicare Patients.

INTRODUCTION: Opioid use disorder (OUD) is a major and growing public health concern, and Medicare patients have nearly double the proportion of OUD prevalence compared with those with commercial insurance. This study examines provider-level characteristics to delineate the wide variation behind buprenorphine provision, which is the mainstay of medication-assisted treatment for OUD. METHODS: Using Medicare Part D Public Use Files claims data from 2013 to 2016 in all states, we assessed prescribing patterns of buprenorphine formulations for the specialties of family medicine, internal medicine, psychiatry, and general practice. We incorporated data from 2013 to 2016 American Medical Association Physician Masterfile to model various provider- and area-level characteristics as predictors of buprenorphine prescriber status. RESULTS: Family medicine and internal medicine comprise nearly two-thirds of the outpatient buprenorphine prescriber population for Medicare beneficiaries. Yet, both specialties also have the lowest proportion of active buprenorphine prescribers compared with psychiatrists and general practitioners. Additional characteristics associated with buprenorphine provision include male sex, osteopathic training, Northeast region, US undergraduate medical education, more years in practice, and a higher proportion of dual-eligible patients. CONCLUSIONS: Primary care specialties, such as family medicine and internal medicine, currently comprise a significant majority of the US buprenorphine prescriber population for Medicare beneficiaries. Future policies should target specific demographics to enable greater patient access from physicians who are characteristically less likely to prescribe buprenorphine to increase overall capacity.