Interest in Family Medicine Among US Medical Students and Its Association With a Community College Academic Pathway.

BACKGROUND AND OBJECTIVES: One-third of all medical students attend a community college (CC) on their path to medical school. The objective of this study was to examine the association between CC participation and initial specialty of interest among US allopathic medical students. METHODS: We performed a national cross-sectional study of allopathic medical students who completed the 2012 Association of American Medical Colleges' Matriculating Student Questionnaire. Bivariate and logistic regression analyses were conducted. RESULTS: A total of 9,885 medical student respondents were included in the study sample, consisting of 7,035 (71%) non-CC pathway, and 2,850 (29%) CC pathway participants. CC pathway participants were more likely to express intent to specialize in family medicine (272/2,850 [10%] vs 463/7,035 [7%], P<.001), compared to those on the non-CC path. CC pathway participants had higher odds of intent to specialize in family medicine (adjusted odds ratio [AOR]=1.32; 95% CI 1.13-1.56, P<0.001), compared to those on the non-CC path. Women, independent of college pathway, were nearly two times more likely to express an intention to specialize in family medicine, and three times more likely to express an intention to specialize in pediatrics than men. CONCLUSIONS: Medical students who used a CC pathway are more likely to have intentions to specialize in family medicine, compared to those on the non-CC path.

Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review.

PURPOSE: The authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States. METHOD: In November 2015, the authors searched databases (MEDLINE, ERIC, SCOPUS) and Google Scholar to identify published peer-reviewed studies that focused on PCPs and reported practice location outcomes that included U.S. underserved urban or rural areas. Studies focusing on practice intentions, nonphysicians, patient panel composition, or retention/turnover were excluded. They screened 4,130 titles and reviewed 284 full-text articles. RESULTS: Seventy-two observational or case-control studies met inclusion criteria. These were categorized into four broad themes aligned with prior literature: 19 studies focused on physician characteristics, 13 on financial factors, 20 on medical school curricula/programs, and 20 on graduate medical education (GME) programs. Studies found significant relationships between physician race/ethnicity and language and practice in underserved areas. Multiple studies demonstrated significant associations between financial factors (e.g., debt or incentives) and underserved or rural practice, independent of preexisting trainee characteristics. There was also evidence that medical school and GME programs were effective in training PCPs who locate in underserved areas. CONCLUSIONS: Both financial incentives and special training programs could be used to support trainees with the personal characteristics associated with practicing in underserved or rural areas. Expanding and replicating medical school curricula and programs proven to produce clinicians who practice in underserved urban or rural areas should be a strategic investment for medical education and future research.

What physicians from diverse specialties know and support in health care reform.

BACKGROUND AND OBJECTIVES: The United States is in an unprecedented era of health care reform that is pushing medical professionals and medical educators to evaluate the future of their patients, careers, and the field of medicine. Our objectives were to describe physician familiarity and knowledge with the Patient Protection and Affordable Care Act (ACA) and to determine if knowledge is associated with support and endorsement of the ACA. METHODS: We used a cross-sectional Internet-based survey of 559 physicians practicing in California. Primary outcomes were physician support and endorsement of ACA: (1) overall impact on the country (one item) and (2) perceived impact on physician's medical practice (one item). The primary predictor was knowledge of the ACA as measured with 10 questions. Other measures included age, gender, race-ethnicity, specialty, political views, provision of direct care, satisfaction with the practice of medicine, and compensation type. Descriptive statistics and multiple variable regression models were calculated. RESULTS: Respondents were 65% females, and the mean age was 54 years (+/- 9.7). Seventy-seven percent of physicians understood the ACA somewhat well/very well, and 59% endorsed the ACA, but 36% of physicians believed that health care reform will most likely hurt their practice. Primary care physicians were more likely to perceive that the new law will help their practice, compared to procedural specialties. Satisfaction with the practice of medicine, political affiliation, compensation type, and more knowledge of the health care law were independently associated with endorsement of the ACA. CONCLUSIONS: Endorsement of the ACA varied by specialty, knowledge, and satisfaction with the practice of medicine.

Utilizing international medical graduates in health care delivery: brain drain, brain gain, or brain waste? A win-win approach at University of California, Los Angeles.

After identifying many unlicensed Hispanic international medical graduates (IMGs) legally residing in southern California, University of California, Los Angeles developed an innovative program to prepare these sidelined physicians to enter family medicine residency programs and become licensed physicians. On completion of a 3-year family medicine residency-training program, these IMGs have an obligation to practice in a federally designated underserved community in the state for 2 to 3 years. As the US health care system moves from physician-centered practices to patient-focused teams, with primary care serving as the foundation for building patient-centered medical homes, attention to educating IMGs in these concepts is crucial.

Double-blind placebo-controlled evaluation of the PROMETA™ protocol for methamphetamine dependence.

AIMS: To evaluate the efficacy and safety of the PROMETA™ Protocol for treating methamphetamine dependence. DESIGN: A double-blind, placebo-controlled 108-day study with random assignment to one of two study conditions: active medication with flumazenil (2 mg infusions on days 1, 2, 3, 22, 23), gabapentin (1200 mg to day 40) and hydroxazine (50 mg to day 10) versus placebo medication (with active hydroxazine only). SETTING: Three substance abuse treatment clinics: two in-patient, one out-patient. PARTICIPANTS: Treatment-seeking, methamphetamine-dependent adults (n = 120). MEASUREMENTS: Primary outcome was percentage of urine samples testing negative for methamphetamine during the trial. FINDINGS: No statistically significant between-group differences were detected in urine drug test results, craving, treatment retention or adverse events. CONCLUSIONS: The PROMETA protocol, consisting of flumazenil, gabapentin and hydroxyzine, appears to be no more effective than placebo in reducing methamphetamine use, retaining patients in treatment or reducing methamphetamine craving.

Eight years of building community partnerships and trust: the UCLA family medicine community-based participatory research experience.

Acknowledging the growing disparities in health and health care that exist among immigrant families and minority populations in large urban communities, the UCLA Department of Family Medicine (DFM) sought a leadership role in the development of family medicine training and community-based participatory research (CBPR). Performing CBPR requires that academic medicine departments build sustainable and long-term community partnerships. The authors describe the eight-year (2000-2008) process of building sustainable community partnerships and trust between the UCLA DFM and the Sun Valley community, located in Los Angeles County.The authors used case studies of three research areas of concentration (asthma, diabetes prevention, and establishing access to primary care) to describe how they established community trust and sustained long-term community research partnerships. In preparing each case study, they used an iterative process to review qualitative data.Many lessons were common across their research concentration areas. They included the importance of (1) having clear and concrete community benefits, (2) supporting an academic-community champion, (3) political advocacy, (4) partnering with diverse organizations, (5) long-term academic commitment, and (6) medical student involvement. The authors found that establishing a long-term relationship and trust was a prerequisite to successfully initiate CBPR activities that included an asthma school-based screening program, community walking groups, and one of the largest school-based primary care clinics in the United States.Their eight-year experience in the Sun Valley community underscores how academic-community research partnerships can result in benefits of high value to communities and academic departments.