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PURPOSE: The COVID-19 pandemic not only exacerbated existing disparities in health care in general but likely worsened disparities in access to primary care. Our objective was to quantify the nationwide decrease in primary care visits and increase in telehealth utilization during the pandemic and explore whether certain groups of patients were disproportionately affected. METHODS: We used a geographically diverse primary care electronic health record data set to examine the following 3 outcomes: (1) change in total visit volume, (2) change in in-person visit volume, and (3) the telehealth conversion ratio defined as the number of pandemic telehealth visits divided by the total number of prepandemic visits. We assessed whether these outcomes were associated with patient characteristics including age, gender, race, ethnicity, comorbidities, rurality, and area-level social deprivation. RESULTS: Our primary sample included 1,652,871 patients from 408 practices. During the pandemic we observed decreases of 7% and 17% in total and in-person visit volume and a 10% telehealth conversion ratio. The greatest decreases in visit volume were observed among pediatric patients (-24%), Asian patients (-11%), and those with more comorbidities (-9%). Telehealth usage was greatest among Hispanic or Latino patients (17%) and those living in urban areas (12%). CONCLUSIONS: Decreases in primary care visit volume were partially offset by increasing telehealth use for all patients during the COVID-19 pandemic, but the magnitude of these changes varied significantly across all patient characteristics. These variations have implications not only for the long-term consequences of the COVID-19 pandemic, but also for planners seeking to ready the primary care delivery system for any future systematic disruptions.
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COVID-19 , Atención Primaria de Salud , SARS-CoV-2 , Telemedicina , Humanos , COVID-19/epidemiología , Telemedicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Adolescente , Anciano , Niño , Preescolar , Adulto Joven , Lactante , Estados Unidos , Pandemias , Disparidades en Atención de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Registros Electrónicos de Salud/estadística & datos numéricos , Recién NacidoRESUMEN
PURPOSE: Numerous studies have documented salary differences between male and female physicians. For many specialties, this wage gap has been explored by controlling for measurable factors that influence pay such as productivity, work-life balance, and practice patterns. In family medicine where practice activities differ widely between physicians, it is important to understand what measurable factors may be contributing to the gender wage gap, so that employers and policymakers and can address unjust disparities. METHODS: We used data from the 2017 to 2020 American Board of Family Medicine (ABFM) National Graduate Survey (NGS) which is administered to family physicians 3 years after residency (n = 8608; response rate = 63.9%, 56.2% female). The survey collects clinical income and practice patterns. Multiple linear regression analysis was performed, which included variables on hours worked, degree type, principal professional activity, rural/urban, and region. RESULTS: Although early-career family physician incomes averaged $225,278, female respondents reported incomes that were $43,566 (17%) lower than those of male respondents (P = .001). Generally, female respondents tended toward lower-earning principal professional activities and US regions; worked fewer hours (2.9 per week); and tended to work more frequently in urban settings. However, in adjusted models, this gap in income only fell to $31,804 (13% lower than male respondents, P = .001). CONCLUSION: Even after controlling for measurable factors such as hours worked, degree type, principal professional activity, population density, and region, a significant wage gap persists. Interventions should be taken to eliminate gender bias in wage determinations for family physicians.
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Medicina Familiar y Comunitaria , Médicos de Familia , Médicos Mujeres , Salarios y Beneficios , Humanos , Salarios y Beneficios/estadística & datos numéricos , Femenino , Masculino , Médicos de Familia/estadística & datos numéricos , Médicos de Familia/economía , Estados Unidos , Medicina Familiar y Comunitaria/economía , Medicina Familiar y Comunitaria/estadística & datos numéricos , Médicos Mujeres/economía , Médicos Mujeres/estadística & datos numéricos , Factores Sexuales , Encuestas y Cuestionarios/estadística & datos numéricos , Adulto , Renta/estadística & datos numéricosRESUMEN
The singular label of "Asian" obscures socioeconomic differences between Asian ethnic groups that affect matriculation into the field of medicine. Using data from American Board of Family Medicine Examination candidates in 2023, we found that compared to the US population, among Asian-American family physicians, Indians were present at higher rates, while Chinese and Filipinos were underrepresented, suggesting the importance of continued disaggregation of Asian ethnicities in medicine.
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Asiático , Médicos de Familia , Humanos , Asiático/estadística & datos numéricos , Estados Unidos , Médicos de Familia/estadística & datos numéricos , Medicina Familiar y Comunitaria/estadística & datos numéricos , Masculino , FemeninoRESUMEN
BACKGROUND AND OBJECTIVES: The COVID-19 pandemic began interrupting family medicine residency training in spring 2020. While a decline in scores on the American Board of Family Medicine In-Training Examination (ITE) has been observed, whether this decline has translated into the high-stakes Family Medicine Certification Examination (FMCE) is unclear. The goal of this study was to systematically assess the magnitude of COVID-19 impact on medical knowledge acquisition during residency, as measured by the ITE and FMCE. METHODS: A total of 19,101 initial certification candidates from 2017 to 2022 were included in this study. Annual ITE scores and FMCE scores were reported on the same scale (200-800) and served as the outcome measure. We conducted multilevel regression analysis to determine ITE score growth and FMCE scores compared to cohorts prior to COVID-19. RESULTS: During COVID-19, the increase in ITE scores from postgraduate year 2 (PGY-2) to PGY-3 was 25.5 points less, representing a 57.6% relative decrease; and from PGY-3 ITE to FMCE, it was 8.6 points less, a 12.7% relative decrease, compared with cohorts prior to COVID-19. FMCE scores were 6.6 points less during COVID-19, representing a 1.2% relative decline from the average FMCE score prior to COVID-19. CONCLUSIONS: This study found nonsubstantive COVID-19 impact on FMCE scores, but a considerable knowledge acquisition decline during residency, especially during the PGY-2 to PGY-3 period. While COVID-19 impacted learning, our findings indicated that residencies were largely able to remediate knowledge deficits before residents took the FMCE.
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COVID-19 , Internado y Residencia , Humanos , Estados Unidos/epidemiología , Evaluación Educacional , Medicina Familiar y Comunitaria/educación , Pandemias , Competencia Clínica , Medicina Interna/educaciónRESUMEN
INTRODUCTION: Being one of the few existing measures of primary care functions, physician-level continuity of care (Phy-CoC) is measured by the weighted average of patient continuity scores. Compared with the well-researched patient-level continuity, Phy-CoC is a new instrument with limited evidence from Medicare beneficiaries. This study aimed to expand the patient sample to include patients of all ages and all types of insurance and reassess the associations between full panel-based Phy-CoC scores and patient outcomes. METHODS: Cross-sectional analysis at patient-level using Virginia All-Payer Claims Database (VA-APCD). Phy-CoC scores were calculated by averaging patient's Bice-Boxerman Index scores and weighted by the total number of visits. Patient outcomes included total cost and preventable hospitalization. RESULTS: In a sample of 1.6 million Virginians, patients who lived in rural areas or had Medicare as primary insurance were more likely to be attributed to physicians with the highest Phy-CoC scores. Across all adult patient populations, we found that being attributed to physicians with higher Phy-CoC was associated with 7%-11.8% higher total costs, but was not associated with the odds of preventable hospitalization. Results from models with interactions revealed nuanced associations between Phy-CoC and total cost with patient's age and comorbidity, insurance payer, and the specialty of their physician. CONCLUSIONS: In this comprehensive examination of Phy-CoC using all populations from the VA-APCD, we found an overall positive association of higher full panel-based Phy-CoC with total cost, but a non-significant association with the risk of preventable hospitalization. Achieving higher full panel-based Phy-CoC may have unintended cost implications.
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Medicare , Médicos , Adulto , Humanos , Anciano , Estados Unidos , Estudios Transversales , Continuidad de la Atención al Paciente , Comorbilidad , HospitalizaciónRESUMEN
Primary care practices are under pressure to address patients' social determinants of health (SDOH). However, the extent to which these practices have this ability remains unknown. The objective of this study was to examine the association between physician, practice, and community characteristics and the ability of family medicine practices to address patients' SDOH. This cross-sectional study used data from the American Board of Family Medicine Continuing Certification Questionnaire from 2017 to 2019, with a 100% response rate. Respondents rated their practice's ability to address SDOH, which was dichotomized as high or low. Sequential multivariate logistic regression determined the association of the reported ability to address SDOH with physician, practice, and community characteristics. Among 19,300 respondents, 55.6% reported a high ability to address patients' SDOH. Across models controlling for different groups of variables, characteristics persistently positively associated with ability to address SDOH included employment at a federally qualified health center (Odds Ratios [OR] = 2.111-3.012), federally funded clinic (OR = 1.999-2.897), managed care organization (OR = 2.038-2.303), and working collaboratively with a social worker (OR = 2.000-2.523) or care coordinator (OR = 1.482-1.681). Characteristics persistently negatively associated with the ability to address SDOH were practicing at an independently owned (OR = 0.726-0.812) or small practice (OR = 0.512-0.863). While results varied across models, these findings are important for developing evidence-based policies and recommendations for resource sharing and allocation in clinics and communities. Ensuring availability and access to allied health professionals and community resources may be key components in Family Medicine clinics addressing SDOH.
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Medicina Familiar y Comunitaria , Determinantes Sociales de la Salud , Humanos , Estudios Transversales , Instituciones de Atención Ambulatoria , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Understanding how physicians' practice patterns change over a career is important for workforce and medical education planning. This study examined trends in self-reported practice activity among early- and later-career stage family physicians (FPs). METHODS: Data on early career FPs came from the American Board of Family Medicine's National Graduate Survey (NGS) and on later career FPs from its Continuous Certification Questionnaire (CCQ). Both cohorts could complete the Practice Demographic Survey (PDS) 3 years later. Longitudinal cohorts were from 2016 to 2019 and 2017 to 2020, respectively. All surveys included identical items on scope of practice, practice type, organization, and location. We characterized physicians as outpatient continuity only, outpatient and inpatient care (mixed practice), and no outpatient continuity (for example, hospitalist). We conducted repeated cross-sectional and longitudinal analysis of practice type. RESULTS: Our sample included 8,492 NGS and 30,491 CCQ FPs. In both groups, the vast majority provided outpatient continuity of care (77% to 81%). Approximately 25% of NGS had a mixed practice compared with approximately 16% of the CCQ group. The percent of FPs who had a mixed practice declined in both groups (34.21% to 27.10% and 23.88% to 19.33%). In both groups, physicians with higher odds of leaving mixed practice were in metropolitan counties or changed practice types. CONCLUSION: Although early-career FPs more frequently reported providing both inpatient and outpatient care and serving as hospitalists compared with later-career FPs, both groups had a decline in frequency of providing mixed practice. This change after only 3 years in practice has significant implications for patient care and medical education.
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Médicos Hospitalarios , Médicos de Familia , Humanos , Estados Unidos , Estudios Transversales , Encuestas y Cuestionarios , Recursos Humanos , Pautas de la Práctica en MedicinaRESUMEN
OBJECTIVE: To determine the distinct influences of rural background and rural residency training on rural practice choice among family physicians. DATA SOURCES AND STUDY SETTING: We used a subset of The RTT Collaborative rural residency list and longitudinal data on family physicians from the American Board of Family Medicine National Graduate Survey (NGS; three cohorts, 2016-2018) and American Medical College Application Service (AMCAS). STUDY DESIGN: We conducted a logistic regression, computing predictive marginals to assess associations of background and residency location with physician practice location 3 years post-residency. DATA COLLECTION/EXTRACTION METHODS: We merged NGS data with residency type-rural or urban-and practice location with AMCAS data on rural background. PRINCIPAL FINDINGS: Family physicians from a rural background were more likely to choose rural practice (39.2%, 95% CI = 35.8, 42.5) than those from an urban background (13.8%, 95% CI = 12.5, 15.0); 50.9% (95% CI = 43.0, 58.8) of trainees in rural residencies chose rural practice, compared with 18.0% (95% CI = 16.8, 19.2) of urban trainees. CONCLUSIONS: Increasing rural programs for training residents from both rural and urban backgrounds, as well as recruiting more rural students to medical education, could increase the number of rural family physicians.
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Internado y Residencia , Servicios de Salud Rural , Humanos , Estados Unidos , Médicos de Familia , Ubicación de la Práctica Profesional , Recursos HumanosRESUMEN
PURPOSE: Family medicine incomes are often cited as a key reason for shortages of family physicians. The purpose of this study was to identify family physician income trends and to test how income varies among early-career family physicians. METHODS: We used data from the 2016 to 2020 American Board of Family Medicine National Graduate Survey (NGS) collected from early-career family physicians (n = 9566; response rate = 63.9%). The NGS asked practice income, practice activities, practice site, and setting. We performed an income trend analysis and conducted multivariate regression to test for associations of personal and workplace characteristics with income. RESULTS: Average income across the full sample of early-career family physicians (after inflation adjustments) was $224,292. Overall, income growth outpaced inflation from 2016 to 2020. There are significant differences in income based on personal and work characteristics, and income growth varied dramatically. Notably, women respondents reported earnings of $33,522 below those of men respondents in adjusted models. In addition, the incomes of several groups lagged behind inflation, including those practicing geriatrics (-0.67%), employed by the Indian Health Service (-1.72%), and respondents who identified as Black or African American (-0.85%). Greatest increases in inflation-adjusted incomes were observed among those in palliative care (4.61%) and at nonfederal government clinics (4.46%). CONCLUSIONS: Though income is only one factor physicians consider in deciding where and how to work, it is concerning to see lower incomes among groups that traditionally experience shortages (eg, geriatrics and government-associated practice sites). Differences in expected income among family physicians choosing different work may exacerbate workforce challenges.
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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.
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Medicina Familiar y Comunitaria , Médicos de Familia , Humanos , Creación de Capacidad , Teoría Fundamentada , ConocimientoRESUMEN
PURPOSE: As the average level of medical education indebtedness rises, physicians look to programs such as Public Service Loan Forgiveness (PSLF) and National Health Service Corps (NHSC) to manage debt burden. Both represent service-dependent loan repayment programs, but the requirements and program outcomes diverge, and assessing the relative uptake of each program may help to inform health workforce policy decisions. We sought to describe variation in the composition of repayment program participant groups and measure relative impact on patient access to care. METHODS: In this bivariate analysis, we analyzed data from 10,677 respondents to the American Board of Family Medicine's National Graduate Survey to study differences in loan repayment program uptake as well as the unique participant demographics, scope of practice, and likelihood of practicing with a medically underserved or rural population in each program cohort. RESULTS: The rate of PSLF uptake tripled between 2016 and 2020, from 7% to 22% of early career family physicians, while NHSC uptake remained static at 4% to 5%. Family physicians reporting NHSC assistance were more likely than those reporting PSLF assistance to come from underrepresented groups, demonstrated a broader scope of practice, and were more likely to practice in rural areas (23.3% vs 10.8%) or whole-county Health Professional Shortage Areas (12.5% vs 3.7%) and with medically underserved populations (82.2% vs 24.2%). CONCLUSIONS: Although PSLF supports family physicians intending to work in public service, their peers who choose NHSC are much more likely to work in underserved settings. Our findings may prompt a review of the goals of service loan forgiveness programs with potential to better serve health workforce needs.
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Medicina Estatal , Apoyo a la Formación Profesional , Humanos , Estados Unidos , Médicos de Familia , Recursos Humanos , Área sin Atención Médica , Atención Primaria de Salud , Selección de ProfesiónRESUMEN
INTRODUCTION: As an increasing number of rural hospitals close their maternity care units, many of the approximately 28 million reproductive-age women living in rural America do not have local access to obstetric services. We sought to describe the characteristics and distribution of cesarean section-providing family physicians who may provide critical services in maintaining obstetric access in rural hospitals. METHODS: Using a cross-sectional study design, we linked data from the 2017 to 2022 American Board of Family Medicine's Continuting Certification Questionnaire on provision of cesarean sections as primary surgeon and practice characteristics to geographic data. Logistic regression determined associations with provision of cesarean sections. RESULTS: Of 28,526 family physicians, 589 (2.1%) provided cesarean sections as primary surgeon. Those who provided cesarean sections were more likely to be male (odds ratio (OR) = 1.573, 95% confidence limits (CL) 1.246-1.986), and work in rural health clinics (OR = 2.157, CL 1.397-3.330), small rural counties (OR = 4.038, CL 1.887-8.642), and in counties without obstetrician/gynecologists (OR = 2.163, CL 1.440-3.250). DISCUSSION: Although few in number, family physicians who provide cesarean sections as primary surgeon disproportionately serve rural communities and counties without obstetrician/gynecologists, suggesting that they provide access to obstetric services in these communities. Policies that support family physician training in cesarean sections and facilitate credentialing of trained family physicians could reverse the trend of closing obstetric units in rural communities and reduce disparities in maternal and infant health outcomes.
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Servicios de Salud Materna , Obstetricia , Femenino , Estados Unidos , Embarazo , Masculino , Humanos , Médicos de Familia/educación , Cesárea , Población Rural , Estudios Transversales , Obstetricia/educaciónRESUMEN
PURPOSE: The Medicare Access and CHIP Reauthorization Act (MACRA) incentivized primary care practices to improve colorectal cancer screening rates. This study examined if colorectal screening rates improved among rural and urban primary care practices amid implementation of MACRA. METHODS: Colorectal cancer screening data are from a national registry of 139 primary care practices. Repeated measures regression tested for rural/urban differences and changes in screening rates between 2016 and 2020, adjusting for county demographic factors and social deprivation. RESULTS: Screening rates were 64% in both rural and urban practices in the first quarter of 2016 and increased to 80% and 83% in rural and urban practices, respectively, in the last quarter of 2020. In adjusted analyses, screening rates increased by 4% per year and there were no rural/urban differences. Lower screening rates were associated with higher county proportions of persons who were 45 to 74 years of age and Hispanic. Higher screening rates were associated with higher county proportions of persons who were White, Black, and Asian and higher social deprivation. CONCLUSIONS: Colorectal screening rates improved among rural and urban primary care practices during implementation of MACRA, but disparities persist among practices serving county populations that are relatively older, more Hispanic, and have higher social deprivation.
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Neoplasias Colorrectales , Detección Precoz del Cáncer , Anciano , Humanos , Neoplasias Colorrectales/diagnóstico , Hispánicos o Latinos , Medicare , Atención Primaria de Salud , Población Rural , Estados Unidos , Población Urbana , Persona de Mediana EdadRESUMEN
Opioid use disorder (OUD) is a leading cause of death in the United States placing a tremendous burden on patients, their families, and health care systems. Artificial intelligence (AI) can be harnessed with available healthcare data to produce automated OUD prediction tools. In this retrospective study, we developed AI based models for OUD prediction and showed that AI can predict OUD more effectively than existing clinical tools including the unweighted opioid risk tool (ORT). Data include 474,208 patients' data over 10 years; 269,748 were females with an average age of 56.78 years. Cases are prescription opioid users with at least one diagnosis of OUD or at least one prescription for buprenorphine or methadone. Controls are prescription opioid users with no OUD diagnoses or buprenorphine or methadone prescriptions. On 100 randomly selected test sets including 47,396 patients, our proposed transformer-based AI model can predict OUD more efficiently (AUC = 0.742 ± 0.021) compared to logistic regression (AUC = 0.651 ± 0.025), random forest (AUC = 0.679 ± 0.026), xgboost (AUC = 0.690 ± 0.027), long short-term memory model (AUC = 0.706 ± 0.026), transformer (AUC = 0.725 ± 0.024), and unweighted ORT model (AUC = 0.559 ± 0.025). Our results show that embedding AI algorithms into clinical care may assist clinicians in risk stratification and management of patients receiving opioid therapy.
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Buprenorfina , Trastornos Relacionados con Opioides , Femenino , Humanos , Estados Unidos , Persona de Mediana Edad , Masculino , Analgésicos Opioides/efectos adversos , Tratamiento de Sustitución de Opiáceos , Estudios Retrospectivos , Inteligencia Artificial , Trastornos Relacionados con Opioides/diagnóstico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Metadona/uso terapéutico , Buprenorfina/uso terapéuticoRESUMEN
Integrating behavioral health into primary care can improve access to behavioral health and patient health outcomes. We used 2017-2021 American Board of Family Medicine continuing certificate examination registration questionnaire responses to determine the characteristics of family physicians who work collaboratively with behavioral health professionals. With a 100% response rate, 38.8% of 25,222 family physicians reported working collaboratively with behavioral health professionals, with those working in independently owned practices and in the South having substantially lower rates. Future research exploring these differences could help develop strategies to support family physicians implement integrated behavioral health to improve care for patients in these communities.
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Médicos de Familia , Psiquiatría , Humanos , Estados Unidos , Medicina Familiar y ComunitariaRESUMEN
INTRODUCTION: Comprehensiveness is a defining principle of primary care and Family Medicine but is declining in some settings. This study explores the relationship between practice setting and comprehensiveness among family physicians (FPs). METHODS: Using 2014 to 2016 American Board of Family Medicine survey data to generate scope of practice (SOP) scores (0 to 30) for FPs. We ran univariate and bivariate analyses for services by practice organization type. Our principal independent variable was practice organization type and dependent variable, the SOP score. RESULTS: Among 25,117 total respondents, FPs at rural health centers (RHC) had the widest scope of practice (SOP score of 17.7) whereas FPs in federal, urgent care and other safety net clinics had the narrowest with mean SOP score of 14.0 or less. Higher rates of FPs practicing in Federally Qualified Health Centers and academic health centers were providing a women's health service, except for deliveries, whereas FPs in rural health centers were providing obstetric services (24%). The proportion of FPs providing newborn care was highest in RHCs and lowest in the urgent care setting (85%, vs 26%). A higher proportion of FPs in RHCs provided joint injections and skin procedures than FPs in other practice organizations. CONCLUSIONS: Significant variation in FP comprehensiveness exists across different practice types. FPs in practice types commonly associated with large health systems had narrower breadth of practice, concerning amid increasing practice consolidation. Given associations between comprehensiveness and desirable health care outcomes, policy makers should encourage payment/accountability models that incentivize broader SOP.
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Médicos de Familia , Servicios de Salud Rural , Embarazo , Recién Nacido , Humanos , Femenino , Estados Unidos , Medicina Familiar y Comunitaria , Encuestas y Cuestionarios , Pautas de la Práctica en MedicinaRESUMEN
We found the intended scope of practice remained unchanged in graduating family medicine residents between pre-pandemic and pandemic period. Tracking these trends with later cohorts will fully assess the pandemics' impact on training so that residencies can adjust their education accordingly.
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Internado y Residencia , Humanos , Pandemias , Alcance de la Práctica , Medicina Familiar y Comunitaria/educación , Selección de ProfesiónRESUMEN
Background: Since 2011, the Teaching Health Center Graduate Medical Education (THC GME) program has sought to expand access to care by training residents in safety net settings. Objective: To examine impact on physician scope, location, and patient population served using a unique data set. Methods: Using 2017-2020 data from the American Board of Family Medicine National Graduate Survey, we compared demographics, practice location, populations served, and scope of practice between graduates of THC GME programs and graduates of other family medicine programs. Results: Our sample comprised 8608 (out of 13â465) eligible family medicine graduates 3 years after completion of residency training, for a response rate of 63.9%. THC graduates were significantly more likely than other graduates to practice in a rural location (17.9% to 11.8%), within 5 miles of their residency program (18.9% to 12.9%), and to care for medically underserved populations (35.2% to 18.6%). Their scope of practice was wider than other graduates and more likely to comprise services like buprenorphine prescribing, behavioral health care, and outpatient gynecological procedures. Regression results suggest that THC training is independently correlated with a broader scope of practice. Conclusions: Graduates of THC programs were significantly more likely than graduates of other programs to practice close to their training sites and in rural areas, and to care for underserved patients while maintaining a broader scope of practice than other graduates.