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.

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.

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.

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.