Recruitment of Residents to Rural Programs: Early Outcomes From Cohort 1 of the Rural Residency Planning and Development Grants Program.

Background To address rural physician workforce shortages, the Health Resources and Services Administration funded multiple Rural Residency Planning and Development (RRPD) awards, beginning in 2019, to develop rural residency programs in needed specialties. Objective To describe early resident recruitment outcomes of the RRPD grants program. Methods A cross-sectional survey of program directors or administrators of these 25 new rural residency training programs across the United States was administered at RRPD award conclusion in 2022. We performed descriptive analyses of applicant and Match data, including applications and interviews per resident position, positions filled in the main Match vs the Supplemental Offer and Acceptance Program (SOAP), and recruitment of residents from the program's state. Results The 25 Cohort 1 RRPD programs ranged from 2 to 8 residents per year. Most programs (16 of 25, 64.0%) were rural expansion tracks of an urban program. Most programs were sufficiently developed to participate in the 2022 (N=17) or 2023 (N=20) Match; we report on 13 of 17 (76.5%) programs for 2022 and 14 of 20 (70.0%) programs for 2023. Programs completed a median of 14.8 interviews per position. Most positions were filled in the Match (43 of 58, 74.1% in 2022; 45 of 58, 77.6% in 2023); most others were filled in the SOAP. On average, 34.4% of enrolled residents were from the same state as the program (range 0-78.6%). Conclusions The early resident recruitment outcomes of the RRPD model for developing new physician training in rural communities had sufficient recruitment success to support program continuation.

Strategies and Barriers for Diversity, Equity, Inclusion, and Antiracism Work in Family Medicine Departments: A CERA Study.

BACKGROUND AND OBJECTIVES: Medical schools and family medicine organizations have been working on advancing diversity, equity, inclusion, and antiracism (DEIA). Black, Indigenous, and People of Color (BIPOC) faculty members are disproportionately expected to lead DEIA initiatives, negatively affecting academic promotion and well-being. Our study aimed to describe the existing DEIA initiatives, strategies, and barriers to implementing support for DEIA work, as well as the implications of addressing the minority tax in US and Canadian family medicine departments. METHODS: We used data collected as a part of the 2023 Council of Academic Family Medicine Educational Research Alliance (CERA) study. The survey was delivered to 227 department chairs across the United States and Canada. RESULTS: The survey response rate was 50.2% (114/227). Sixty-two percent of the respondents strongly agreed that advancing DEIA was important, and 55.4% reported having a DEIA leader, with 75.4% of those positions reportedly held by BIPOC faculty. Lack of funding was identified as the most significant barrier (26.2%), followed by lack of faculty expertise (18.7%). Department chairs who strongly agreed that DEIA work was important were significantly more likely to report having a DEIA committee, mentorship for BIPOC faculty, and a holistic review for faculty recruitment than those who did not strongly agree. CONCLUSIONS: Though most department chairs perceived advancing DEIA work as important, appropriate compensation and institutional support are often lacking. Further study is needed to explore ways in which departments can enhance their institutional support for DEIA initiatives.

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.

Eligible Applicants and Diversity Across Settings in a Regional Family Medicine Residency Network.

OBJECTIVES: Residency programs must gather and track data on the diversity of their applicants, interviewees, and matched residents as part of the process of checking for bias in the interview and rank process. As such, the aims of this study were (1) to provide data from a large, regional network of family medicine residencies on who is applying, interviewing, and matching into our programs as a baseline for the family medicine residency community; and (2) to assess potential differences in the gender and racial diversity of the eligible applicants to programs across settings, including in rural and underserved communities. METHODS: Survey of programs in Alaska, Idaho, Montana, Washington and Wyoming about their applicant pool in the 2020-2021 interview season. RESULTS: Programs received a median of 100 applications per position, 57 of which were considered eligible. Programs offered 17 interviews per position and 15 of these were completed. Programs in rural and underserved communities did not have fewer eligible applicants per position, nor was there less diversity within that pool of applicants. Most programs are working to increase their program's diversity. CONCLUSION: On average, the racial and gender diversity of eligible applicants to programs in rural and underserved settings is no different than other programs. What is important in terms of diversity varies across programs, based on community needs and program mission, but having a mechanism to extract and review data and to then be able to assess progress is a place to start.

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.

Infrastructure Features Associated With Increased Department Research Capacity.

PURPOSE: Although researchers have identified factors associated with research capacity in academic medicine departments, less is known about how a department builds research capacity over time. The Association of Departments of Family Medicine's Research Capacity Scale (RCS) can be used by departments to self-categorize into five capacity levels. Our current study aimed to describe the distribution of infrastructure features and to evaluate how the addition of infrastructure features influences movement of a department along the RCS. METHOD: An online survey was sent to US family medicine department chairs in August 2021. Survey questions asked chairs to categorize their department's research capacity in 2018 and 2021 and also about the presence of infrastructure resources and changes in these features across 6 years. RESULTS: The response rate was 54.2%. Departments identified substantial variation in research capacity. Most departments classified into the middle three levels. Departments in higher levels were more likely than those at lower levels to have any of the infrastructure resources in 2021. Department size, as measured by full time faculty, was highly associated with department level. From 2018 and 2021, 43% of responding departments climbed at least one level. Of these, more than half added three or more infrastructure features. Adding a PhD researcher was the feature most associated with increasing research capacity (P<.001). CONCLUSIONS: Most departments that increased their research capacity added multiple additional infrastructure features. For chairs of departments without a PhD researcher, this additional resource may be the most impactful investment to increase research capacity.

Postgraduate education to expand access to dental care: A roadmap to community dental program development.

Evidence indicates an increasing shortage of dentists in communities across the United States with potentially significant implications for oral health, as well as overall health and well-being. One strategy to increase access to dental care in rural and underserved communities is community-based postgraduate dental training. However, developing new dental programs requires navigating complex accreditation, financial and community governance, among other, barriers. The Roadmap for Teaching Health Center Dental Program Development presents a framework that guides institutions through the successive steps of developing new postgraduate training programs from identification of need to ultimate maintenance and sustainability. The tool assists programs in anticipating and understanding requirements, reducing time, expense, and uncertainty. While the framework was developed for community-based programs, the steps are applicable to postgraduate programs sponsored by academic institutions as well.

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.

How to Sponsor, Coach, and Mentor: A Qualitative Study With Family Medicine Department Chairs.

BACKGROUND AND OBJECTIVES: The goal of this study was to explore how to use sponsoring, coaching, and mentoring (SCM) for faculty development by clarifying the functions embedded in SCM. The study aims to ensure that department chairs can be intentional in providing those functions and/or playing those roles for the benefit of all their faculty. METHODS: We used qualitative, semistructured interviews in this study. We followed a purposeful sampling strategy to recruit a diverse sample of family medicine department chairs across the United States. Participants were asked about their experiences receiving and providing sponsoring, coaching, and mentoring. We iteratively coded audio recorded and transcribed interviews for content and themes. RESULTS: We interviewed 20 participants between December 2020 and May 2021 to identify actions associated with sponsoring, coaching, and mentoring. Participants identified six main actions sponsors perform. These actions are identifying opportunities, recognizing an individual's strengths, encouraging opportunity-seeking, offering tangible support, optimizing candidacy, nominating as a candidate, and promising support. In contrast, they identified seven main actions a coach performs. These are clarifying, advising, giving resources, performing critical appraisals, giving feedback, reflecting, and scaffolding (ie, providing support while learning). Finally, participants identified six main actions the mentors perform. The list includes checking in, listening, sharing wisdom, directing, supporting, and collaborating. CONCLUSIONS: We present SCM as an identifiable series of actions that need to be thought of and performed intentionally. Our clarification will help leaders purposefully select their actions and allows opportunity for evaluating their effectiveness. Future research will explore developing and evaluating programs that support learning how to provide SCM in order to enhance the process of faculty development and provide it equitably.

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.

Negotiating a new chair package: context and considerations.

Negotiating a resource package as a potential new department chair is common practice in academic medicine. The foundations for this negotiation include the historical presence of the department in relation to the broader institution, projections for future growth, accounting for mission/vision, resource needs (space, personnel, finances, etc), faculty and staff development, and external partnerships within and outside the institution. Despite similarities in this process across departments, many nuances influence the development of a specific new chair package, such as, department size; desires, perspectives and talents of the incoming chair, the department faculty, the medical school and dean; prevailing agendas and mission imperatives; and the overall priorities of the institution. With strategy and forethought, a new chair package can promote a successful chair tenure and departmental growth. Assembled through the Association of Departments of Family Medicine with input from several dozen department chairs and senior leaders, this is intended to serve as a practical guide to new chair packages for chair candidates.

Patient concerns about accessing sexual and reproductive health services outside of primary care: A survey in rural and urban settings in the Pacific Northwest.

OBJECTIVES: While primary care providers are a major source of sexual and reproductive health (SRH) services in the United States, particularly in rural areas, not all primary care settings offer a full range of SRH services. We aimed to understand primary care patient concerns regarding accessing SRH services, including abortion care, outside of their primary care clinic and if those concerns differed by urban or rural setting. STUDY DESIGN: An anonymous survey was distributed over a 2-week period between December 2019 to March 2020 to all adult patients in four primary care clinics in Idaho, Washington, and Wyoming. The survey assessed patient concerns regarding accessing SRH services outside of their primary care clinic and their willingness to travel to access SRH services. RESULTS: The overall response rate was 69% (745/1086). Over 85% of respondents identified at least one concern to seeking SRH services outside of a primary care setting, with cost, insurance coverage, length of wait time, and lack of an established relationship being the most frequently reported concerns. A majority of respondents were willing to travel a maximum of 1 hour for most SRH services. Respondents from rural-serving clinics were significantly more likely to be willing to travel longer amounts of time for medication abortion, aspiration abortion, and intrauterine device placement. CONCLUSION: Our findings highlight that a majority of both urban and rural primary care patients have concerns regarding accessing SRH services outside of their primary care clinic and are unwilling to travel more than 1 hour to access most SRH services. IMPLICATIONS: A majority of primary care patients have concerns regarding accessing SRH services outside of primary care settings. Health care policy changes should aim to strengthen the SRH services available in primary care settings to alleviate the burdens primary care patients face in accessing SRH services outside of their primary care clinic, particularly for rural populations.

What's Worth Doing in Virtual Recruitment? A Regional Survey of Program Directors and Incoming Interns.

BACKGROUND AND OBJECTIVES: In 2020-2021, the Family Medicine Residency Network (FMRN) programs participated in virtual recruitment. We conducted a study to describe the recruitment activities utilized by programs and to identify which of these activities were most and least helpful to both students and the programs. METHODS: In May 2021, we sent an electronic survey to the incoming interns (n=242) asking which recruitment activities they participated in, which were most and least helpful in deciding their rank list, and which most positively impacted their perception of the program. Simultaneously, we surveyed the 43 FMRN program directors (PDs), asking them which virtual recruitment activities they offered, which were most and least helpful in creating their rank list, and which they thought most positively impacted students' perception. RESULTS: The 167 intern survey responses (69% response) indicated that virtual interviews and virtual get-togethers with residents were most helpful to deciding rank list order while receiving gifts and meals were least helpful. Websites, bios, and social media positively impacted perception of a program. PDs (79% response) overestimated the importance of the recruitment video and a prerecorded hospital/clinic tour and underestimated the importance of resident-only social interactions to the applicants. CONCLUSIONS: Programs may improve the effectiveness of their virtual recruitment process by maximizing interactions with current residents and creating opportunities for interviews with individuals in different positions across the program. Reducing spending on gifts and meals frees up funds better spent on activities with greater impact such as website improvement and more events for student interaction with current residents.