Mark Doescher, MD, MSPH

Director, WWAMI Rural Health Research Center

Phone: 206.616.9207
Fax: 206.616.4768
E-mail: mdoesche@u.washington.edu

Department of Family Medicine
University of Washington
Box 354982
Seattle, WA 98195-4982

Current Projects (9)

Aging of the Rural Generalist Physician Workforce: Will Some Locations Be More Affected than Others?
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Physicians, Workforce
This study will identify rural locations with high proportions of generalist physicians nearing retirement age.

Dentist Supply, Access to Dental Care, and Oral Health among Rural and Urban Residents: A National Study
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Dental health, Workforce
This study will determine whether shortages of dentists in rural areas of the U.S. are associated with impaired access to dental care and a higher prevalence of dental disease.

General and Specialist Surgeon Supply and Inpatient Procedural Content: A National Rural-Urban Study
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topic: Workforce
This study will examine the degree to which access to inpatient surgical care in rural areas is affected by the diminishing workforce of general surgeons. Using inpatient surgical procedure data, we will examine the availability and content of general surgical procedures in rural and urban hospitals nationally as a function of surgeon supply.

Have Rural Perinatal Health Outcomes Changed Over the Past Two Decades?
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Children, Health disparities, Women
This study will determine whether rural-urban disparities in late prenatal care initiation and post-neonatal mortality found in the mid 1980s have persisted, narrowed, or increased.

Health Information Technology (HIT) Workforce Needs in Rural America
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health information technology, Workforce
Health care increasingly relies on effective health information technology (HIT) to capture and exchange key patient information, and requires a trained workforce to implement this technology. To understand the specific needs and constraints of rural health systems to employ an effective HIT workforce, this study will survey rural primary care clinics across the country to determine their current and projected level of HIT adoption and demand for workers with HIT skills.

Influence of State Policies and Practices on J-1 Visa Waiver Physicians Service in Rural Areas
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: International Medical Graduates (IMGs), J-1 Visa Waiver, Physicians, Workforce
This study will collect information from all states regarding their efforts to track IMG practice after their Conrad 30 program waiver obligations are satisfied, quantify long-term retention for states with available data, and assess how state policies shape IMG practice and long-term retention.

Pre-hospital Emergency Medical Services Workforce in Rural and Urban Areas
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Emergency medical services (EMS), Workforce
This study will describe the distribution of the pre-hospital emergency medical services (EMS) workforce across rural and urban areas using data from a 2008 survey of EMS agencies in nine states. Results will be used to inform policies for ensuring that rural populations have timely access to high quality pre-hospital emergency care.

Rural-Urban Nurse Practitioner Distribution and the Influence of Physician and Physician Assistant Supply
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Nurses, Physicians, Workforce
Issue: While nurse-practitioners (NPs) may play an important role in alleviating persistent workforce shortages in rural areas, little is known about their rural-urban distribution and even less is known about how rural NP distribution is affected by physician and physician assistant (PA) supply in these locations. This study will explore rural-urban differences in NP, physician and PA supply using licensure data from 13 states.

The Current Contribution of Physicians, Advanced Practice Nurses, and Physician Assistants to the Rural Primary Care Workforce
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Mid-level practitioners, Nurses, Physicians, Workforce
This two-year, multi-state study is examining the practices of rural physicians, nurse practitioners (NPs), and physician assistants (PAs) regarding their primary care visit productivity and scope of practice. Through surveys, this study will examine the contributions of physicians, NPs, and PAs by state, degree of practice rurality, practice characteristics, and primary care HPSA status in order to provide information on a range of rural primary care workforce needs.

Completed Projects (5)

Breast, Cervical, Colorectal, and Prostate Cancer Screening in Rural America: Does Proximity to a Metropolitan Area Matter?, Lead researcher
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health disparities, Health promotion and disease prevention, Minority health
The study compared cancer screening rates among various levels of rural versus urban Behavioral Risk Factor Surveillance System respondents and among white respondents versus those from racial/ethnic minority groups.

Burden of Asthma Among Rural Residents: A National Study, Lead researcher
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Chronic diseases and conditions, Health disparities, Minority health, Rural statistics and demographics
This study uses data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine the prevalence of and trends in asthma�among rural residents by type of geographic location and by key risk factors.

Policy Analyses of Rural Issues Related to Health Care Reform, Lead researcher
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health policy, Health services
Health care reform provides an array of opportunities to improve health care access and quality for rural Americans. The WWAMI RHRC will support HRSA's efforts to inform this process by summarizing existing evidence characterizing the rural health care workforce and rural health care delivery and will conduct analyses exploring the potential impact on rural populations of proposed and newly- enacted health care reform legislation.

The Rural/Urban Practice Location Patterns of Women Medical School Graduates, Lead researcher
Research center: WWAMI Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Physicians, Women, Workforce
While women are becoming an increasingly large percentage of the graduates of medical schools, they are much less likely to locate their practices in rural towns. This study involved a survey including questions about where the residents preferred to locate and how much they thought they would be practicing in the future.

Unhealthy Lifestyle Behaviors Among Minority Group Members: A National Rural and Urban Study, Lead researcher
Research center: South Carolina Rural Health Research Center
Funder: Office of Rural Health Policy (ORHP)
Topics: Health disparities, Health promotion and disease prevention, Minority health

Publications (16)

2005 Physician Supply and Distribution in Rural Areas of the United States (Full Report)
Author(s): Meredith A. Fordyce, Frederick M. Chen, Mark P. Doescher, L. Gary Hart
Research center: WWAMI Rural Health Research Center
Topics: International Medical Graduates (IMGs), Physicians, Workforce
Date: 11 / 2007
This study describes the 2005 supply and distribution of physicians (including osteopathic physicians and international medical graduates) with particular emphasis on generalists in rural areas. Results indicate variability in the rural-urban distribution of physicians, with generalist physicians playing prominent roles in rural areas.
2005 Physician Supply and Distribution in Rural Areas of the United States (Project Summary)
Author(s): Meredith A. Fordyce, Frederick M. Chen, Mark P. Doescher, L. Gary Hart
Research center: WWAMI Rural Health Research Center
Topics: International Medical Graduates (IMGs), Physicians, Workforce
Date: 11 / 2007
This study describes the 2005 supply and distribution of physicians (including osteopathic physicians and international medical graduates) with particular emphasis on generalists in rural areas. Results indicate variability in the rural-urban distribution of physicians, with generalist physicians playing prominent roles in rural areas.
Family Medicine Residency Training in Rural Locations (Final Report)
Author(s): Frederick M. Chen, C. Holly A. Andrilla, Mark P. Doescher, Carl Morris
Research center: WWAMI Rural Health Research Center
Topics: Physicians, Workforce
Report Number: #126
Date: 07 / 2010
Rural physician supply has remained relatively stable over the past decade, but its future is threatened by reduced medical student interest in family medicine careers and a declining residency match rate. This 2007 survey of all U.S. family medicine residency programs found that 33 rural programs accounted for over 80% of family medicine training occurring in rural sites, although some urban programs offer rural training tracks. Expansion of rural family medicine training is limited by Medicare graduate medical education funding caps on residency slots, financial hardships facing rural hospitals, and the challenges of creating residency training programs.
Future of Family Medicine and Implications for Rural Primary Care Physician Supply (Final Report)
Author(s): Roger A. Rosenblatt, Frederick M. Chen, Denise M. Lishner, Mark P. Doescher
Research center: WWAMI Rural Health Research Center
Topics: Physicians, Workforce
Report Number: #125
Date: 08 / 2010
Examines the rural physician shortage, the effect of recent trends in specialty choice on provider supply, and major trends that are changing the dynamics that shape the delivery of health care.
Heavy And Binge Drinking In Rural America: A Comparison Of Rural And Urban Counties From 1995/1997 Through 1999/2001
Author(s): J. Elizabeth Jackson, Mark P. Doescher, L. Gary Hart
Research center: WWAMI Rural Health Research Center
Topics: Health promotion and disease prevention, Substance abuse
Report Number: Working Paper No. 95
Date: 02 / 2005
Assesses the prevalence of, and recent trends in, alcohol use among adults 18 years and older in rural areas of the United States. It uses a random digit telephone survey method to gather information on alcohol use among adults in 49 states and the District of Columbia that participated in the Behavioral Risk Factor Surveillance System. The paper finds that heavy drinking was highest and increasing in urban areas, but that binge drinking was greater in rural areas. It recommends tailoring interventions specifically to meet the needs of rural residents. Report available upon request by contacting rhrc@fammed.washington.edu.
National Study of Lifetime Asthma Prevalence and Trends in Metro and Non-Metro Counties, 2000-2003 (Full Report)
Author(s): J. Elizabeth Jackson, Mark P. Doescher, L. Gary Hart
Research center: WWAMI Rural Health Research Center
Topic: Chronic diseases and conditions
Report Number: Working Paper No. 108
Date: 01 / 2007
Reports the findings of a study of the prevalence of and recent trends in asthma among adults residing in metropolitan and non-metropolitan counties in the United States. In 2003, the adjusted prevalence of lifetime asthma diagnosis was 12.0 percent for metropolitan counties and 11.0 percent for non-metropolitan counties (p < 0.001). Prevalence of lifetime asthma diagnosis trended upwards across the rural-urban spectrum between 2000 and 2003, and states with the highest 2003 prevalence and the greatest increase in prevalence among non-metropolitan residents were concentrated in the West Census region (e.g., Arizona, California, Oregon and Washington). Asthma prevalence in non-metropolitan counties was highest for those aged 18 to 34 (15.9%), the unemployed (13.5%), American Indians (12.7%) and women (12.4%).
National Study of Obesity Prevalence and Trends by Type of Rural County
Author(s): J. Elizabeth Jackson, Mark P. Doescher, Anthony F. Jerant, L. Gary Hart
Research center: WWAMI Rural Health Research Center
Topics: Health promotion and disease prevention, Obesity
Citation: Journal of Rural Health, 21(2), 140-148
Date: 2005
To estimate the prevalence of and recent trends in obesity among US adults residing in rural locations, the authors analyzed data from the Behavioral Risk Factor Surveillance System for 1994-1996 and 2000-2001and found that in 2000-2001 the prevalence of obesity was 23.0% for rural adults and 20.5% for their urban counterparts, representing increases of 4.8% and 5.5%, respectively, since 1994-1996. The highest obesity prevalence occurred in rural counties in Louisiana, Mississippi, and Texas; obesity prevalence increased for rural residents in all states but Florida over the study period. African Americans had the highest obesity prevalence of any group, up to 31.4% in rural counties adjacent to urban counties.
Obesity Prevalence In Rural Counties: A National Study
Author(s): J. Elizabeth Jackson, Mark P. Doescher, Anthony F. Jerant, L. Gary Hart
Research center: WWAMI Rural Health Research Center
Topics: Health promotion and disease prevention, Obesity, Rural statistics and demographics
Report Number: Working Paper No. 87
Date: 01 / 2004
Using a random-digit telephone survey of adults aged 18 and older residing in states participating in the Behavioral Risk Factor Surveillance System in 1994-96 and 2000-2001, researchers found that the prevalence of obesity was 23 percent for rural adults and 20.5 percent for urban adults. This finding represents increases of 4.8 percent and 5.5 percent, respectively. The highest obesity prevalence occurred in rural counties of Mississippi, Texas, and Louisiana. Only Rhode Island and Colorado had rural counties that met the Healthy People 2010 goal of a maximum of 15 percent obese for adults. Report available on request.
Persistent Primary Care Health Professional Shortage Areas (HPSAs) and Health Care Access in Rural America (Policy Brief)
Author(s): Mark P. Doescher, Meredith A. Fordyce, Susan M. Skillman, J. Elizabeth Jackson, Roger A. Rosenblatt
Research center: WWAMI Rural Health Research Center
Topics: Health policy, Health services
Date: 09 / 2009
Resources are needed to increase and sustain the number of primary care providers and reduce financial barriers to care in all rural primary care HPSAs.
Prevalence And Trends In Smoking: A National Rural Study
Author(s): Mark P. Doescher, J. Elizabeth Jackson, Anthony F. Jerant, L. Gary Hart
Research center: WWAMI Rural Health Research Center
Topics: Health promotion and disease prevention, Substance abuse
Report Number: Working Paper No. 85
Date: 12 / 2003
Using data from the Behavioral Risk Factor Surveillance System, the research showed that the prevalence of smoking between 1994-1996 and 2000-2001 did not change substantially for the United States as a whole. The prevalence of smoking for rural residents decreased by more than 2 percent in six states (CA, CT, MD, NC, TN, UT). However, it increased by 2 percent or more in ten states. Report available on request.
Prevalence and Trends in Smoking: A National Rural Study
Author(s): Mark P. Doescher, J. Elizabeth Jackson, Anthony Jerant, L. Gary Hart
Research center: WWAMI Rural Health Research Center
Topics: Health promotion and disease prevention, Minority health, Substance abuse
Citation: Journal of Rural Health, 22(2), 112-118
Date: 2006
Reports the results of a study to estimate the prevalence of and recent trends in smoking among adults by type of rural location and by state.
Problem Drinking: Rural and Urban Trends in America 1995/97 to 2003
Author(s): J. Elizabeth Jackson, Mark P. Doescher, L. Gary Hart
Research center: WWAMI Rural Health Research Center
Topic: Substance abuse
Citation: Preventive Medicine, 43(2), 122-124
Date: 2006
Examines recent trends in heavy and binge drinking in urban counties and three types of rural counties.
Production of Rural Female Generalists by U.S. Medical Schools
Author(s): Katherine E Ellsbury, Mark P Doescher, L Gary Hart
Research center: WWAMI Rural Health Research Center
Topics: Physicians, Women, Workforce
Date: 05 / 1999
Compares the production of rural female generalists among medical schools. Data from the 1996 AMA Physician Masterfile for the 1988-96 graduate cohort were analyzed to compare the production of rural female generalists by medical school. Outcome measures included total number and percentage of rural female generalist graduates of each school. Only a few schools contribute most of ht erural female generalists. These schools' admissions policies, curricula, extracurricular programs, and career advising efforts may serve as models of schools who make it a priority to encourage more of their female graduates to enter rural practice.
Trends in Cervical and Breast Cancer Screening Practices Among Women in Rural and Urban Areas of the United States (Final Report)
Author(s): Mark P. Doescher, J. Elizabeth Jackson
Research center: WWAMI Rural Health Research Center
Topics: Health promotion and disease prevention, Women
Report Number: 121
Date: 08 / 2008
Reports on trends in breast cancer screening practices. Participation in mammography improved nationally, but women living in rural locations remained less likely to receive this test than those living in urban settings.
Trends in Cervical and Breast Cancer Screening Practices Among Women in Rural and Urban Areas of the United States (Policy Brief)
Author(s): Mark P. Doescher, J. Elizabeth Jackson
Research center: WWAMI Rural Health Research Center
Topics: Health promotion and disease prevention, Women
Date: 08 / 2008
Documents the receipt of timely breast and cervical cancer screening using a rural-urban classification system and nationally representative data.
Trends in Professional Advice to Lose Weight Among Obese Adults, 1994-2000
Author(s): J. Elizabeth Jackson, Mark P. Doescher, Barry G. Saver, L. Gary Hart
Research center: WWAMI Rural Health Research Center
Topics: Health promotion and disease prevention, Obesity
Citation: Journal of General Internal Medicine, 20(9), 814-8
Date: 2005
The authors studied whether rising obesity prevalence in the U.S. was accompanied by an increasing trend in professional advice to lose weight among obese adults, and found that disparities in professional advice to lose weight associated with income and educational attainment increased from 1994 to 2000. They concluded that there is a need for mechanisms that allow health care professionals to devote sufficient attention to weight control and to link with evidence-based weight loss interventions, especially those that target groups most at risk for obesity

Topics Centers Researchers Other Resources Search		Mark Doescher, MD, MSPH Director, WWAMI Rural Health Research Center Phone: 206.616.9207 Fax: 206.616.4768 E-mail: mdoesche@u.washington.edu Department of Family Medicine University of Washington Box 354982 Seattle, WA 98195-4982 Current Projects (9) Aging of the Rural Generalist Physician Workforce: Will Some Locations Be More Affected than Others? Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Physicians, Workforce This study will identify rural locations with high proportions of generalist physicians nearing retirement age. Dentist Supply, Access to Dental Care, and Oral Health among Rural and Urban Residents: A National Study Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Dental health, Workforce This study will determine whether shortages of dentists in rural areas of the U.S. are associated with impaired access to dental care and a higher prevalence of dental disease. General and Specialist Surgeon Supply and Inpatient Procedural Content: A National Rural-Urban Study Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topic: Workforce This study will examine the degree to which access to inpatient surgical care in rural areas is affected by the diminishing workforce of general surgeons. Using inpatient surgical procedure data, we will examine the availability and content of general surgical procedures in rural and urban hospitals nationally as a function of surgeon supply. Have Rural Perinatal Health Outcomes Changed Over the Past Two Decades? Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Children, Health disparities, Women This study will determine whether rural-urban disparities in late prenatal care initiation and post-neonatal mortality found in the mid 1980s have persisted, narrowed, or increased. Health Information Technology (HIT) Workforce Needs in Rural America Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Health information technology, Workforce Health care increasingly relies on effective health information technology (HIT) to capture and exchange key patient information, and requires a trained workforce to implement this technology. To understand the specific needs and constraints of rural health systems to employ an effective HIT workforce, this study will survey rural primary care clinics across the country to determine their current and projected level of HIT adoption and demand for workers with HIT skills. Influence of State Policies and Practices on J-1 Visa Waiver Physicians Service in Rural Areas Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: International Medical Graduates (IMGs), J-1 Visa Waiver, Physicians, Workforce This study will collect information from all states regarding their efforts to track IMG practice after their Conrad 30 program waiver obligations are satisfied, quantify long-term retention for states with available data, and assess how state policies shape IMG practice and long-term retention. Pre-hospital Emergency Medical Services Workforce in Rural and Urban Areas Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Emergency medical services (EMS), Workforce This study will describe the distribution of the pre-hospital emergency medical services (EMS) workforce across rural and urban areas using data from a 2008 survey of EMS agencies in nine states. Results will be used to inform policies for ensuring that rural populations have timely access to high quality pre-hospital emergency care. Rural-Urban Nurse Practitioner Distribution and the Influence of Physician and Physician Assistant Supply Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Nurses, Physicians, Workforce Issue: While nurse-practitioners (NPs) may play an important role in alleviating persistent workforce shortages in rural areas, little is known about their rural-urban distribution and even less is known about how rural NP distribution is affected by physician and physician assistant (PA) supply in these locations. This study will explore rural-urban differences in NP, physician and PA supply using licensure data from 13 states. The Current Contribution of Physicians, Advanced Practice Nurses, and Physician Assistants to the Rural Primary Care Workforce Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Mid-level practitioners, Nurses, Physicians, Workforce This two-year, multi-state study is examining the practices of rural physicians, nurse practitioners (NPs), and physician assistants (PAs) regarding their primary care visit productivity and scope of practice. Through surveys, this study will examine the contributions of physicians, NPs, and PAs by state, degree of practice rurality, practice characteristics, and primary care HPSA status in order to provide information on a range of rural primary care workforce needs. Completed Projects (5) Breast, Cervical, Colorectal, and Prostate Cancer Screening in Rural America: Does Proximity to a Metropolitan Area Matter?, Lead researcher Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Health disparities, Health promotion and disease prevention, Minority health The study compared cancer screening rates among various levels of rural versus urban Behavioral Risk Factor Surveillance System respondents and among white respondents versus those from racial/ethnic minority groups. Burden of Asthma Among Rural Residents: A National Study, Lead researcher Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Chronic diseases and conditions, Health disparities, Minority health, Rural statistics and demographics This study uses data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine the prevalence of and trends in asthma�among rural residents by type of geographic location and by key risk factors. Policy Analyses of Rural Issues Related to Health Care Reform, Lead researcher Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Health policy, Health services Health care reform provides an array of opportunities to improve health care access and quality for rural Americans. The WWAMI RHRC will support HRSA's efforts to inform this process by summarizing existing evidence characterizing the rural health care workforce and rural health care delivery and will conduct analyses exploring the potential impact on rural populations of proposed and newly- enacted health care reform legislation. The Rural/Urban Practice Location Patterns of Women Medical School Graduates, Lead researcher Research center: WWAMI Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Physicians, Women, Workforce While women are becoming an increasingly large percentage of the graduates of medical schools, they are much less likely to locate their practices in rural towns. This study involved a survey including questions about where the residents preferred to locate and how much they thought they would be practicing in the future. Unhealthy Lifestyle Behaviors Among Minority Group Members: A National Rural and Urban Study, Lead researcher Research center: South Carolina Rural Health Research Center Funder: Office of Rural Health Policy (ORHP) Topics: Health disparities, Health promotion and disease prevention, Minority health Publications (16) 2005 Physician Supply and Distribution in Rural Areas of the United States (Full Report) Author(s): Meredith A. Fordyce, Frederick M. Chen, Mark P. Doescher, L. Gary Hart Research center: WWAMI Rural Health Research Center Topics: International Medical Graduates (IMGs), Physicians, Workforce Date: 11 / 2007 This study describes the 2005 supply and distribution of physicians (including osteopathic physicians and international medical graduates) with particular emphasis on generalists in rural areas. Results indicate variability in the rural-urban distribution of physicians, with generalist physicians playing prominent roles in rural areas. 2005 Physician Supply and Distribution in Rural Areas of the United States (Project Summary) Author(s): Meredith A. Fordyce, Frederick M. Chen, Mark P. Doescher, L. Gary Hart Research center: WWAMI Rural Health Research Center Topics: International Medical Graduates (IMGs), Physicians, Workforce Date: 11 / 2007 This study describes the 2005 supply and distribution of physicians (including osteopathic physicians and international medical graduates) with particular emphasis on generalists in rural areas. Results indicate variability in the rural-urban distribution of physicians, with generalist physicians playing prominent roles in rural areas. Family Medicine Residency Training in Rural Locations (Final Report) Author(s): Frederick M. Chen, C. Holly A. Andrilla, Mark P. Doescher, Carl Morris Research center: WWAMI Rural Health Research Center Topics: Physicians, Workforce Report Number: #126 Date: 07 / 2010 Rural physician supply has remained relatively stable over the past decade, but its future is threatened by reduced medical student interest in family medicine careers and a declining residency match rate. This 2007 survey of all U.S. family medicine residency programs found that 33 rural programs accounted for over 80% of family medicine training occurring in rural sites, although some urban programs offer rural training tracks. Expansion of rural family medicine training is limited by Medicare graduate medical education funding caps on residency slots, financial hardships facing rural hospitals, and the challenges of creating residency training programs. Future of Family Medicine and Implications for Rural Primary Care Physician Supply (Final Report) Author(s): Roger A. Rosenblatt, Frederick M. Chen, Denise M. Lishner, Mark P. Doescher Research center: WWAMI Rural Health Research Center Topics: Physicians, Workforce Report Number: #125 Date: 08 / 2010 Examines the rural physician shortage, the effect of recent trends in specialty choice on provider supply, and major trends that are changing the dynamics that shape the delivery of health care. Heavy And Binge Drinking In Rural America: A Comparison Of Rural And Urban Counties From 1995/1997 Through 1999/2001 Author(s): J. Elizabeth Jackson, Mark P. Doescher, L. Gary Hart Research center: WWAMI Rural Health Research Center Topics: Health promotion and disease prevention, Substance abuse Report Number: Working Paper No. 95 Date: 02 / 2005 Assesses the prevalence of, and recent trends in, alcohol use among adults 18 years and older in rural areas of the United States. It uses a random digit telephone survey method to gather information on alcohol use among adults in 49 states and the District of Columbia that participated in the Behavioral Risk Factor Surveillance System. The paper finds that heavy drinking was highest and increasing in urban areas, but that binge drinking was greater in rural areas. It recommends tailoring interventions specifically to meet the needs of rural residents. Report available upon request by contacting rhrc@fammed.washington.edu. National Study of Lifetime Asthma Prevalence and Trends in Metro and Non-Metro Counties, 2000-2003 (Full Report) Author(s): J. Elizabeth Jackson, Mark P. Doescher, L. Gary Hart Research center: WWAMI Rural Health Research Center Topic: Chronic diseases and conditions Report Number: Working Paper No. 108 Date: 01 / 2007 Reports the findings of a study of the prevalence of and recent trends in asthma among adults residing in metropolitan and non-metropolitan counties in the United States. In 2003, the adjusted prevalence of lifetime asthma diagnosis was 12.0 percent for metropolitan counties and 11.0 percent for non-metropolitan counties (p < 0.001). Prevalence of lifetime asthma diagnosis trended upwards across the rural-urban spectrum between 2000 and 2003, and states with the highest 2003 prevalence and the greatest increase in prevalence among non-metropolitan residents were concentrated in the West Census region (e.g., Arizona, California, Oregon and Washington). Asthma prevalence in non-metropolitan counties was highest for those aged 18 to 34 (15.9%), the unemployed (13.5%), American Indians (12.7%) and women (12.4%). National Study of Obesity Prevalence and Trends by Type of Rural County Author(s): J. Elizabeth Jackson, Mark P. Doescher, Anthony F. Jerant, L. Gary Hart Research center: WWAMI Rural Health Research Center Topics: Health promotion and disease prevention, Obesity Citation: Journal of Rural Health, 21(2), 140-148 Date: 2005 To estimate the prevalence of and recent trends in obesity among US adults residing in rural locations, the authors analyzed data from the Behavioral Risk Factor Surveillance System for 1994-1996 and 2000-2001and found that in 2000-2001 the prevalence of obesity was 23.0% for rural adults and 20.5% for their urban counterparts, representing increases of 4.8% and 5.5%, respectively, since 1994-1996. The highest obesity prevalence occurred in rural counties in Louisiana, Mississippi, and Texas; obesity prevalence increased for rural residents in all states but Florida over the study period. African Americans had the highest obesity prevalence of any group, up to 31.4% in rural counties adjacent to urban counties. Obesity Prevalence In Rural Counties: A National Study Author(s): J. Elizabeth Jackson, Mark P. Doescher, Anthony F. Jerant, L. Gary Hart Research center: WWAMI Rural Health Research Center Topics: Health promotion and disease prevention, Obesity, Rural statistics and demographics Report Number: Working Paper No. 87 Date: 01 / 2004 Using a random-digit telephone survey of adults aged 18 and older residing in states participating in the Behavioral Risk Factor Surveillance System in 1994-96 and 2000-2001, researchers found that the prevalence of obesity was 23 percent for rural adults and 20.5 percent for urban adults. This finding represents increases of 4.8 percent and 5.5 percent, respectively. The highest obesity prevalence occurred in rural counties of Mississippi, Texas, and Louisiana. Only Rhode Island and Colorado had rural counties that met the Healthy People 2010 goal of a maximum of 15 percent obese for adults. Report available on request. Persistent Primary Care Health Professional Shortage Areas (HPSAs) and Health Care Access in Rural America (Policy Brief) Author(s): Mark P. Doescher, Meredith A. Fordyce, Susan M. Skillman, J. Elizabeth Jackson, Roger A. Rosenblatt Research center: WWAMI Rural Health Research Center Topics: Health policy, Health services Date: 09 / 2009 Resources are needed to increase and sustain the number of primary care providers and reduce financial barriers to care in all rural primary care HPSAs. Prevalence And Trends In Smoking: A National Rural Study Author(s): Mark P. Doescher, J. Elizabeth Jackson, Anthony F. Jerant, L. Gary Hart Research center: WWAMI Rural Health Research Center Topics: Health promotion and disease prevention, Substance abuse Report Number: Working Paper No. 85 Date: 12 / 2003 Using data from the Behavioral Risk Factor Surveillance System, the research showed that the prevalence of smoking between 1994-1996 and 2000-2001 did not change substantially for the United States as a whole. The prevalence of smoking for rural residents decreased by more than 2 percent in six states (CA, CT, MD, NC, TN, UT). However, it increased by 2 percent or more in ten states. Report available on request. Prevalence and Trends in Smoking: A National Rural Study Author(s): Mark P. Doescher, J. Elizabeth Jackson, Anthony Jerant, L. Gary Hart Research center: WWAMI Rural Health Research Center Topics: Health promotion and disease prevention, Minority health, Substance abuse Citation: Journal of Rural Health, 22(2), 112-118 Date: 2006 Reports the results of a study to estimate the prevalence of and recent trends in smoking among adults by type of rural location and by state. Problem Drinking: Rural and Urban Trends in America 1995/97 to 2003 Author(s): J. Elizabeth Jackson, Mark P. Doescher, L. Gary Hart Research center: WWAMI Rural Health Research Center Topic: Substance abuse Citation: Preventive Medicine, 43(2), 122-124 Date: 2006 Examines recent trends in heavy and binge drinking in urban counties and three types of rural counties. Production of Rural Female Generalists by U.S. Medical Schools Author(s): Katherine E Ellsbury, Mark P Doescher, L Gary Hart Research center: WWAMI Rural Health Research Center Topics: Physicians, Women, Workforce Date: 05 / 1999 Compares the production of rural female generalists among medical schools. Data from the 1996 AMA Physician Masterfile for the 1988-96 graduate cohort were analyzed to compare the production of rural female generalists by medical school. Outcome measures included total number and percentage of rural female generalist graduates of each school. Only a few schools contribute most of ht erural female generalists. These schools' admissions policies, curricula, extracurricular programs, and career advising efforts may serve as models of schools who make it a priority to encourage more of their female graduates to enter rural practice. Trends in Cervical and Breast Cancer Screening Practices Among Women in Rural and Urban Areas of the United States (Final Report) Author(s): Mark P. Doescher, J. Elizabeth Jackson Research center: WWAMI Rural Health Research Center Topics: Health promotion and disease prevention, Women Report Number: 121 Date: 08 / 2008 Reports on trends in breast cancer screening practices. Participation in mammography improved nationally, but women living in rural locations remained less likely to receive this test than those living in urban settings. Trends in Cervical and Breast Cancer Screening Practices Among Women in Rural and Urban Areas of the United States (Policy Brief) Author(s): Mark P. Doescher, J. Elizabeth Jackson Research center: WWAMI Rural Health Research Center Topics: Health promotion and disease prevention, Women Date: 08 / 2008 Documents the receipt of timely breast and cervical cancer screening using a rural-urban classification system and nationally representative data. Trends in Professional Advice to Lose Weight Among Obese Adults, 1994-2000 Author(s): J. Elizabeth Jackson, Mark P. Doescher, Barry G. Saver, L. Gary Hart Research center: WWAMI Rural Health Research Center Topics: Health promotion and disease prevention, Obesity Citation: Journal of General Internal Medicine, 20(9), 814-8 Date: 2005 The authors studied whether rising obesity prevalence in the U.S. was accompanied by an increasing trend in professional advice to lose weight among obese adults, and found that disparities in professional advice to lose weight associated with income and educational attainment increased from 1994 to 2000. They concluded that there is a need for mechanisms that allow health care professionals to devote sufficient attention to weight control and to link with evidence-based weight loss interventions, especially those that target groups most at risk for obesity