Workforce

Publications

Listed by publication date. You can also view these publications alphabetically.

2009

• Workforce Issues Among Sole Community Pharmacies
  Date: 07 / 2009
  Author(s): Donald Klepser, Michelle Lampman, Andrea Radford, Indira Richardson, Stephen Rutledge
  Research centers: North Carolina Rural Health Research and Policy Analysis Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Pharmacy and prescription drugs, Workforce
  Pharmacy services are delivered through a sole community pharmacy in over 1000 small rural communities nationwide. This brief presents the findings from 401 telephone interviews of sole community pharmacist-owners nationwide about their current staffing and future plans. Thirty-three percent of those interviewed have one or fewer pharmacist FTEs on staff. Thirty percent of those interviewed would like to retire in five years or fewer, and most would like to sell their pharmacies upon retirement. This brief explores the shared experiences of sole community pharmacist-owners regarding the challenges facing the pharmacy workforce in their communities and their concerns about their pharmacy's future.
• Aging of the Primary Care Physician Workforce: Are Rural Locations Vulnerable? (Policy Brief)
  Date: 06 / 2009
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Large numbers of primary care physicians are nearing retirement as fewer new U.S. medical graduates are choosing primary care careers. This policy brief describes the rural areas of the U.S. where impending retirement threatens access to primary care, and offers potential solutions to the problem.
• Availability of Family Medicine Residency Training in Rural Locations of the United States (Policy Brief)
  Date: 06 / 2009
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Family physicians constitute the largest proportion of the rural primary care physician workforce, yet declining student interest in rural family medicine may worsen rural primary care shortages.
• Future of Family Medicine and Implications for Rural Primary Care Physicians (Policy Brief)
  Date: 06 / 2009
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  The crisis posed by the persistent shortage of providers in rural areas of the United States is being exacerbated by the precipitous decline in student interest in the field of family medicine. This study examines the rural physician shortage based on an analysis of a cohort of recent medical school graduates, the effect of trends in specialty selection on provider supply, and major trends impacting health care delivery.
• Satisfaction with Practice and Decision to Relocate: An Examination of Rural Physicians
  Date: 05 / 2009
  Author(s): Marc Berk, Jack Feldman, Claudia Schur, Jyoti Gupta
  Research center: Walsh Center for Rural Health Analysis
  Topics: Physicians, Workforce
  The goal of this project was to improve our understanding of the dynamics of physician practice location decision making. The inability of rural areas to attract and retain physicians has been of concern to health services researchers and policymakers for many years. This project tracked practice locations of a cohort of physicians using information on physicians who were identified during the early stages of their medical careers as part of the National Survey of Rural Physicians (NSRP), conducted in 1993-1994 with funding from the Robert Wood Johnson Foundation. These data were supplemented with information on the current practice locations of physicians in the cohort, and with data from a follow-up survey that also asked a battery of satisfaction questions. For the subset of sampled physicians who responded to the NSRP, we identified factors correlated with the decision to maintain a rural practice. Contingency tables were used to test a variety of hypotheses concerning factors affecting the physician's decision to continue practice in a rural community, along with statistical analyses to examine relationships between these factors.
• Crisis in Rural Primary Care (Policy Brief)
  Date: 04 / 2009
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Primary care provides initial and ongoing care for the majority of patient health care needs. Primary care providers are the backbone of rural health care, yet primary care in rural locations is in crisis. The number of students choosing primary care careers has declined precipitously. Low compensation, rising malpractice premiums, professional isolation, limited time off, and scarcity of jobs for spouses discourage the recruitment and retention of rural primary care providers.
• Crisis in Rural General Surgery (Policy Brief)
  Date: 04 / 2009
  Research center: WWAMI Rural Health Research Center
  Topic: Workforce
  The dramatic decline in the number of rural general surgeons in the U.S. since the early 1980s has precipitated a crisis in rural general surgery. General surgeons are vital members of the rural health care system, performing emergency operations, underpinning the trauma care system, backing up primary care providers, reducing drive time for rural residents, and contributing to the financial viability of small hospitals.
• Threats to the Future Supply of Rural Registered Nurses (Policy Brief)
  Date: 04 / 2009
  Research center: WWAMI Rural Health Research Center
  Topics: Nurses, Workforce
  Shortages of registered nurses (RNs) in rural areas of the United States may grow even greater in coming years as the “baby boom” generation retires and as RNs commute to larger towns and urban areas for work.
• Crisis in Rural Dentistry (Policy Brief)
  Date: 04 / 2009
  Research center: WWAMI Rural Health Research Center
  Topics: Dental health, Workforce
  Rural populations have fewer dentists, lower dental care utilization, and higher rates of dental caries and permanent tooth loss than urban populations. Reports from the Surgeon General and the Institute of Medicine call for more dentists in rural locations. Federal and state programs have focused on expanding rural dentist supply to increase dental access and improve oral health, but efforts may need to intensify to meet the needs of rural communities.
• Key Role of Sole Community Pharmacists in Their Local Healthcare Delivery Systems
  Date: 03 / 2009
  Author(s): Andrea Radford, Indira Richardson, Michelle Mason, Stephen Rutledge
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Pharmacy and prescription drugs, Workforce
  This findings brief presents findings from a 2008 survey of 401 community pharmacists that are the only retail provider in their community to document their extended relationships with other health care providers and the additional health care services these pharmacists provide to their patients. Pharmacist-owners in independent pharmacies located at least 10 miles from the next closest retail pharmacy were interviewed to determine the presence in their community of other types of health care organizations that require pharmaceutical support(such as hospitals, long-term care facilities, hospice providers, home health agencies and community health centers), their level of involvement with those facilities, and the types of clinical services (other than dispensing and counseling) the pharmacists offered to their own patients.
• Rural-Urban Comparison of Allied Health Average Hourly Wages
  Date: 01 / 2009
  Author(s): Indira Richardson, Rebecca Slifkin, Randy Randolph, Mark Holmes
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topic: Workforce
  Report Number: Final Report No. 96
  This report uses data from the Bureau of Labor Statistics to describe the extent to which rural-urban differentials exist in wages for eleven allied health professions, focusing on professions that are both likely to be found in rural communities and have adequate data to support hourly wage estimates.

2008

• What Does the Allied Health Clinical Doctorate Mean for Rural Areas (Findings Brief)
  Date: 12 / 2008
  Author(s): Janet Freburger, Jennifer King, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topic: Workforce
  This findings brief examines how the transition to the Doctor of Physical Therapy (DPT) degree has affected the supply and quality of rural physical therapy care.
• U.S. Rural Physician Workforce: Analysis of Medical School Graduates from 1988-1997 (Final Report)
  Date: 10 / 2008
  Author(s): Frederick M. Chen, Meredith A. Fordyce, Steve Andes, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Report Number: 113
  Despite continued federal and state efforts to increase the number of physicians in rural areas, disparities between the supply of rural and urban physicians persist. This paper describes the training of the rural physician workforce in the United States and examines the variations in medical school and residency production of rural physicians.
• U.S. Rural Physician Workforce: Analysis of Medical School Graduates from 1988-1997 (Policy Brief)
  Date: 10 / 2008
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Despite continued federal and state efforts to increase the number of physicians in rural areas, disparities between the supply of rural and urban physicians persist. This paper describes the training of the rural physician workforce in the United States and examines the variations in medical school and residency production of rural physicians.
• Trend Toward the Clinical Doctorate in Allied Health: Implications for Rural Communities (Final Report)
  Date: 08 / 2008
  Author(s): Janet Freburger, Jennifer King, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topic: Workforce
  Report Number: No.94
  This final report examines how the transition to the Doctor of Physical Therapy (DPT) degree has affected the supply and quality of rural physical therapy care.
• Rural-Urban Differences in Characteristics of Local EMS Agencies
  Date: 05 / 2008
  Author(s): Victoria Freeman, DrPH; Rebecca Slifkin, PhD; Daniel Patterson, PhD
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Emergency medical services (EMS), Workforce
  Report Number: Findings Brief 84
  This Findings Brief describes the general characteristics of local rural EMS agencies and important ways that they differ from the characteristics of agencies located in urban areas. The data are from a national survey of 1,425 local EMS directors that was conducted in 2006-2007.
• Challenges for Rural Emergency Medical Services: Medical Oversight
  Date: 05 / 2008
  Author(s): Victoria Freeman, DrPH; Rebecca Slifkin, PhD; Daniel Patterson, PhD
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Emergency medical services (EMS), Workforce
  Report Number: Findings Brief 85
  This Findings Brief examines the challenges faced by local rural EMS agencies in obtaining a medical director and ensuring medical oversight for EMS personnel, and also describes how the challenges faced in rural areas differ from those in urban ones. The data are from a national survey of 1,425 local EMS directors that was conducted in 2006-2007.
• Issues in Staffing Emergency Medical Services: A National Survey of Local Rural and Urban EMS Directors
  Date: 05 / 2008
  Author(s): Victoria Freeman, DrPH; Rebecca Slifkin, PhD; Daniel Patterson, PhD
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Emergency medical services (EMS), Workforce
  Report Number: Final Report No. 93
  This report explores rural-urban differences in medical oversight and the recruitment and retention of emergency medical technicians (EMTs)and paramedics as reported by a survey of 1,425 local EMS directors.

2007

• 2005 Physician Supply and Distribution in Rural Areas of the United States (Project Summary)
  Date: 11 / 2007
  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
  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 (Full Report)
  Date: 11 / 2007
  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
  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.
• Changes in the Rural Registered Nurse Workforce from 1980 to 2004 (Project Summary)
  Date: 10 / 2007
  Author(s): Skillman SM, Palazzo L, Hart LG, Butterfield P
  Research center: WWAMI Rural Health Research Center
  Topics: Nurses, Workforce
  Report Number: Final Report 115
  Current and projected nationwide shortages of registered nurses (RNs) threaten access to and quality of care in most parts of the country. In rural areas health care is frequently challenged by uneven distribution of health care providers, including nurses. This report shows changes in the rural registered nurse workforce from 1980 to 2004.
• Changes in the Rural Registered Nurse Workforce from 1980 to 2004 (Final Report)
  Date: 10 / 2007
  Author(s): Skillman SM, Palazzo L, Hart LG, Butterfield P
  Research center: WWAMI Rural Health Research Center
  Topics: Nurses, Workforce
  Report Number: Final Report 115
  There are shortages of registered nurses (RNs) in most parts of the country. Rural strategies to address these shortages may differ from urban strategies, and knowledge of how the rural nurse workforce has changed over time is important for rural health policy and planning. With data from 1980-2004 National Sample Surveys of Registered Nurses, and using Rural-Urban Commuting Area definitions, this study describes changes in rural and urban RN demographics, education, and employment characteristics over time.
• Status and Future of Health Care Delivery in Rural Wyoming
  Date: 06 / 2007
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health services, Rural statistics and demographics, Workforce
  Provides findings from an analysis of health care service delivery in rural Wyoming. Includes an overview of Wyoming's population and the health care service delivery system. Covers workforce recruitment and retention, the economic impact of the health care system, and other topics.
• Becoming an Emergency Medical Technician: Urban-Rural Differences in Motivation and Job Satisfaction
  Date: 03 / 2007
  Author(s): P. Daniel Patterson, Victoria A Freeman, Charity G. Moore, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Emergency medical services (EMS), Workforce
  Report Number: Working Paper No. 89
  This study uses cross-sectional data from the 2003 national Longitudinal Emergency Medical Technician Attributes and Demographic Study (LEADS) Project to explore urban-rural differences in why EMTs enter the field, what is important in their jobs, and whether they are satisfied with their profession.
• Health Center Expansion and Recruitment Survey 2004: Results by Health and Human Services Regions and Health Center Geography
  Date: 03 / 2007
  Author(s): C. Holly A. Andrilla, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Federally Qualified Health Centers (FQHCs), Workforce
  Report Number: Technical report
  Reports findings from the national study of health centers staffing, recruitment and retention. Provides information by HHS region, urban and rural geography, and national overall estimates. Includes 118 graphs of selected survey results.
• Washington State Nurse Anesthetist Workforce: A Case Study
  Date: 02 / 2007
  Author(s): Louise Kaplan, Marie-Annette Brown, Holly Andrilla, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Mid-level practitioners, Workforce
  Citation: American Association of Nurse Anesthestists 75:37-42
  The purposes of this study were to describe the Washington State Certified Registered Nurse Anesthetist (CRNA) workforce and analyze selected dimensions of their clinical practice. The authors developed a 31-item CRNA Practice Questionnaire that was mailed to CRNAs licensed in Washington with an address in Washington, Oregon and Idaho. Workforce data may assist CRNAs when negotiating with employers and institutions and in resolving interprofessional conflicts and can have implications for scope of practice, policy and legislative issues.
• North Dakota Health Care Workforce: Planning Together to Meet Future Health Care Needs
  Date: 01 / 2007
  Author(s): Mary Wakefield, Mary Amundson, Patricia Moulton, Brad Gibbens
  Research center: Upper Midwest Rural Health Research Center
  Topic: Workforce
  Report Number: Policy Brief
  Policy brief which details strategies for addressing health workforce needs in North Dakota. Includes examples of state health workforce pipeline strategies used in other states.
• Urban-Rural Flows of Physicians
  Date: 2007
  Author(s): Thomas C. Ricketts, Randy Randolph
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Physicians, Workforce
  Citation: Journal of Rural Health, 23(4), 277–285
  Reports findings from a study to determine whether there was a significant flow of physicians from urban to rural areas in recent years when the overall supply of physicians has been considered in balance with needs.
• Growth and Change in the Physician Assistant Workforce in the United States, 1967-2000
  Date: 2007
  Author(s): Eric H Larson, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Mid-level practitioners, Workforce
  Citation: Journal of Allied Health, Volume 36 Number 3, pp. 121-130
  The physician assistant (PA) profession grew rapidly in the 1970s and 1990s. As acceptance of PAs in the health care system increased, roles for PAs in specialty care took shape and the scope of PA practice became more clearly defined. This report describes key elements of change in the demography and distribution of the PA population between 1967 and 2000, as well as the spread of PA training programs. Individual-level data from the American Academy of Physician Assistants, supplemented with county-level aggregate data from the Area Resource File, were used to describe the emergence of the PA profession between 1967 and 2000. Data on 49,641 PAs who had completed training by 2000 were analyzed. More than half (52.4%) of PAs active in 2000 were women. PA participation in the rural workforce remains high, with more than 18% of PAs practicing in rural settings, compared with about 20% in 1980. Primary care participation appears to have stabilized at about 47% among active PAs for whom specialty is known. By 2000, 51.5% of practicing PAs had been trained in the states where they worked. The profession has grown rapidly; 56% of all PAs were trained between 1991 and 2000. In 2000, more than 42% of accredited PA programs offered a master's degree, compared to master's degree programs in 1986. Although many critical issues of scope of practice and patient and physician acceptance of PAs have been resolved, the PA profession remains young and continues to evolve. Whether the historical contribution of PAs to primary care for rural and underserved populations can be sustained in the face of increasing specialization and higher-level academic credentialing is not clear.

2006

• Registered Nurse Vacancies in Federally Funded Health Centers
  Date: 12 / 2006
  Research center: WWAMI Rural Health Research Center
  Topics: Federally Qualified Health Centers (FQHCs), Nurses, Workforce
  Discusses the registered nurse (RN) vacancy rate in federally funded health centers, which varies by degree of rurality.
• Wyoming Physicians Are Significant Providers of Safety Net Care
  Date: 11 / 2006
  Author(s): Sharon A. Dobie, Amy Hagopian, Beth A. Kirlin, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Health services, Physicians, Workforce
  Citation: Journal of the American Board of Family Practice, 18(6), 470-477
  Describes the contributions of family and general practice physicians from Wyoming to the health care safety net.
• Results of the 2004 Health Center Expansion and Recruitment Survey for Health Centers: Analyses for Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI States)
  Date: 11 / 2006
  Author(s): C. Holly A. Andrilla, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Federally Qualified Health Centers (FQHCs), Workforce
  Presents a subset of the findings from the larger national study of Federally Qualified Health Center (FQHC) staffing needs of FQHCs located in Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) overall and by urban and rural geography.
• Evaluation of Alternative Health Professional Shortage Area (HPSA) Definitions in Washington State
  Date: 08 / 2006
  Author(s): C. Holly A. Andrilla, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topic: Workforce
  Technical brief describing the differences in Health Professional Shortage Area (HPSA) designation status of the 124 Health Service Areas (HSAs) in Washington State that result when the current designation system is used and provider counts versus provider full-time equivalencies (FTEs) are used.
• Allied Health Job Vacancy Tracking Report
  Date: 08 / 2006
  Author(s): Samir Thaker, Erin Fraher, and Jennifer King
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Allied health professionals, Workforce
  Quantifies workforce demand for selected allied health professions in North Carolina, tracks job vacancy advertisements in print and online sources, summarizes vacancy advertisements by profession, region, and employer type, and describes the types of sign-on bonuses offered by employers.
• Changing Geography of Americans Graduating from Foreign Medical Schools
  Date: 02 / 2006
  Author(s): Karin Johnson, Amy Hagopian, Catherine Veninga, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: International Medical Graduates (IMGs), Workforce
  Citation: Academic Medicine, 81(2), 179-184
  Reports the results of a study of U.S.-born international medical graduates, analyzing changes in their numbers and countries of training from the 1960s and before until the early 2000s.
• Clearing the Path to Medical School for American Indians and Alaska Natives: New Strategies
  Date: 01 / 2006
  Author(s): Walter B. Hollow, Apanakhi Buckley, Davis G. Patterson, Polly M. Olsen, Joycelyn Dorscher, Rustem Medora, Lori Morin, R. Steven Padilla, Jerry Tahsequah, Laura-Mae Baldwin
  Research center: WWAMI Rural Health Research Center
  Topics: American Indians and Alaska Natives, Physicians, Workforce
  Report Number: Working Paper No. 101
  Two recent studies examining recruitment and retention of American Indians and Alaska Natives (AI/ANs) in medical school identified significant challenges in the pursuit of a medical career by AI/AN students: the academic rigor of medical school, the needs of their communities and families, financial concerns, feelings that their perspectives on healing and spirituality were excluded from medical school, and the paucity of role models and mentors, especially those who shared their culture. Using the results of this research and their experience conducting programs to support AI/ANs pursuing health professions, the authors recommend several strategies for improving recruitment and retention of AI/AN medical students. These strategies include: 1. providing role models, advisors, and mentors; 2. providing early research opportunities by involving AI/AN communities in research on Native health issues; 3. anticipating students' traditional Native spiritual practices; 4. providing professional socialization opportunities for faculty and AI/AN medical students; 5. creating and implementing rigorous curricula that include indigenous perspectives; and 6. developing a pro-diversity institutional mission statement to inform admissions policies. The authors identify governmental and nongovernmental organizations in a position to fund and implement these strategies, as well as a list of resources. Collaboration with AI/AN individuals, organizations, and communities is critical to this effort but not a familiar role for most academic medical centers; suggestions for cross-cultural outreach and collaboration are provided.
• Barriers to Autonomous Practice
  Date: 01 / 2006
  Author(s): Louise Kaplan, Marie-Annette Brown, Holly Andrilla, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Mid-level practitioners, Nurses, Pharmacy and prescription drugs, Workforce
  Citation: Nurse Practitioner, 31(1), 57-63
  Describes a study of the impact of a Washington State law changing nurse practitioners (NPs) prescribing authority. The study examined whether prescribing with indirect physician involvement eliminated barriers to practice, the extent to which the law created barriers to prescribing certain drugs, and compared NPs' experiences prescribing or providing controlled substances before and after implementation of the current law.
• Modeling the Mental Health Workforce in Washington State: Using State Licensing Data to Examine Provider Supply in Rural and Urban Areas
  Date: 2006
  Author(s): Laura-Mae Baldwin, Miriam M. Patanian, Eric H. Larson, Denise M. Lishner, Larry B. Mauksch, Wayne J. Katon, Edward Walker, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Mental health, Workforce
  Citation: Journal of Rural Health, 22(1), 50-8
  The authors sought to identify mental health shortage areas using existing licensing and survey data, and found that notable shortages of mental health providers existed throughout the state, especially in rural areas. Urban areas had 3 times the psychiatrist FTEs per 100,000 and more than 1.5 times the nonpsychiatrist mental health provider FTEs per 100,000 as rural areas. More than 80% of rural health service areas had at least 10% fewer psychiatrist FTEs and nonpsychiatrist mental health provider FTEs than the state ratio. They concluded that states gathering a minimum database at licensure renewal can identify area-specific mental health care shortages for use in program planning.
• Shortages of Medical Personnel At Community Health Centers: Implications for Planned Expansion
  Date: 2006
  Author(s): Roger A. Rosenblatt; C. Holly A. Andrilla; Thomas Curtin; L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Federally Qualified Health Centers (FQHCs), Physicians, Workforce
  Citation: JAMA, 295(9), 1042-1049
  To examine the status of workforce shortages that may limit Community Health Center (CHC) expansion, the authors surveyed all 846 federally funded US CHCs that directly provide clinical services and are within the 50 states and the District of Columbia. Analysis of the results showed that CHCs face substantial challenges in recruitment of clinical staff, particularly in rural areas. The largest numbers of unfilled positions were for family physicians at a time of declining interest in family medicine among graduating US medical students.
• Do International Medical Graduates "Fill the Gap" in Rural Primary Care in the United States?
  Date: 2006
  Author(s): Matthew J. Thompson, Amy Hagopian, Meredith A. Fordyce, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: International Medical Graduates (IMGs), Workforce
  Report Number: Working Paper No. 106
  Compares the practice locations of international medical graduates (IMGs) and U.S. medical graduates (USMGs) in primary care specialties. Report available upon request by contacting rhrc@fammed.washington.edu.
• American Indians and Alaska Natives: How Do They Find Their Path to Medical School?
  Date: 2006
  Author(s): Walter B. Hollow, Davis G. Patterson, Polly M. Olsen, Laura-Mae Baldwin
  Research center: WWAMI Rural Health Research Center
  Topics: American Indians and Alaska Natives, Workforce
  Citation: Academic Medicine, 81(10), S65-S69
  Describes findings of a study to understand the supports and barriers that American Indian and Alaska Native (AI/AN) students encountered on their path to successful medical school entry.
• Will Rural Family Medicine Residency Training Survive?
  Date: 2006
  Author(s): Roger A. Rosenblatt, Amy Hagopian, C. Holly A. Andrilla, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Citation: Family Medicine, 38(10), 706-711
  Reports the results of a study examining the recent performance of rural residencies in the National Resident Matching Program as an indicator of their viability.
• Characteristics of Registered Nurses in Rural Versus Urban Areas: Implications for Strategies to Alleviate Nursing Shortages in the United States
  Date: 2006
  Author(s): Susan M. Skillman, Lorella Palazzo, David Keepnews, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Nurses, Workforce
  Citation: Journal of Rural Health, 22(2), 151-157
  Provides results of a study comparing characteristics of rural and urban registered nurses (RNs) in the United States using data from the 2000 National Sample Survey of Registered Nurses. RNs in 3 types of rural areas are examined using the rural-urban commuting area taxonomy.

2005

• State of Rural Hospital Nursing and Allied Health Professional Shortages
  Date: 12 / 2005
  Research center: Southwest Rural Health Research Center
  Topics: Allied health professionals, Hospitals and clinics, Nurses, Workforce
  This study estimated shortages of nurses and allied health personnel among rural hospitals in order to gauge the difficulty experienced by rural hospitals in recruiting such personnel. Additionally, the study examined strategies these hospitals employ in recruitment and retention of nurses, and addressed strategies that might effectively address such shortages. Report available on request.
• Geographic and Demographic Dimensions of the Adoption of a Health Workforce Innovation: Physician Assistants in the United States, 1967-2000
  Date: 12 / 2005
  Author(s): Eric H. Larson, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Mid-level practitioners, Workforce
  Report Number: Working Paper No. 105
  Describes changes in the demography and distribution of the physician assistant (PA) population between 1967 and 2000, as well as the spread of PA training programs.
• Dentist Vacancies in Federally Funded Health Centers
  Date: 12 / 2005
  Research center: WWAMI Rural Health Research Center
  Topics: Dental health, Federally Qualified Health Centers (FQHCs), Workforce
  Presents results for dentists from a study of staffing needs at Federally Qualified Health Centers (FQHCs). Provides information on dentist vacancy rates by rural and urban location. Compares dentist vacancies to other health care provider vacancies at FQHCs.
• Family Physician Vacancies in Federally Funded Health Centers
  Date: 11 / 2005
  Research center: WWAMI Rural Health Research Center
  Topics: Federally Qualified Health Centers (FQHCs), Physicians, Workforce
  Presents results for family physicians from a study of staffing needs at Federally Qualified Health Centers (FQHCs). Provides information on family physician vacancy rates by rural and urban location. Compares family physician vacancies to other physician vacancies at FQHCs.
• Washington State Hospitals: Results of the 2005 Workforce Survey
  Date: 10 / 2005
  Author(s): Susan M. Skillman, C. Holly A. Andrilla, Ed Phippen, Troy Hutson, Elise Bowditch, Tina Praseuth
  Research center: WWAMI Rural Health Research Center
  Topics: Hospitals and clinics, Workforce
  Report Number: Working Paper No. 104
  The University of Washington Center for Health Workforce Studies and the Washington State Hospital Association's Health Work Force Institute collaborated in a staffing survey of Washington's nonfederal acute care hospitals. Eighty-one percent of the 88 hospitals responded to this mailed survey. Growth in Washington's hospital sector appears to be keeping the demand for health care occupations high, even when vacancy rates for some jobs appear to be lower than in past years. This growth, and the shift away from contracting employees, needs to be considered in projections of future workforce supply and demand.
• Pathways to Rural Practice: A Chartbook of Family Medicine Residency Training Locations and Characteristics
  Date: 08 / 2005
  Author(s): L. Gary Hart, Denise M. Lishner, Eric H. Larson, Frederick M. Chen, C. Holly A. Andrilla, Thomas E. Norris, Ronald Schneeweiss, Tim M. Henderson, Roger A. Rosenblatt
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Citation: Seattle, WA: WWAMI Rural Health Research Center, University of Washington.
  Discusses characteristics and geographic locations of family medicine residency programs' rural locations, types of rural family medicine training by location, and rural mission of family medicine residencies.
• WWAMI Physician Workforce 2005
  Date: 05 / 2005
  Author(s): Frederick M. Chen, Meredith A. Fordyce, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Report Number: Working Paper No. 98
  Data on physician supply, demand, and need in the WWAMI region have not been routinely collected or reported. This report responds to a request by the University of Washington School of Medicine (UWSOM) Primary Care Steering Committee to examine the current supply and distribution of physicians in the WWAMI region. These data can help inform and guide the UWSOM in the production of physicians for the WWAMI region. The analysis utilizes the 2005 AMA Masterfile to determine the population-based supply of physicians at the state and county level, analyzed by the discipline of physician, and whether they had graduated from, or trained at the University of Washington, which is the only medical school for the five-state WWAMI region. The emphasis on primary care is important as over one-third of the WWAMI population lives in rural areas and tends to be medically underserved, relying on primary care physicians for the majority of their medical needs.
• Community Health Worker (CHW) Certification and Training: A National Survey of Regionally and State-Based Programs
  Date: 05 / 2005
  Author(s): Marlynn L. May, Bita Kash, Ricardo Contreras
  Research center: Southwest Rural Health Research Center
  Topic: Workforce
  Reports the results of a qualitative study of states provides a national overview of state policy and state involvement in the standardized training and certification of Community Health Workers.
• Changing Geography of Americans Graduating from Foreign Medical Schools
  Date: 03 / 2005
  Author(s): Karin E. Johnson, Amy Hagopian, Catherine Veninga, Meredith A. Fordyce, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: International Medical Graduates (IMGs), Workforce
  Report Number: Working Paper No. 96
  While only 4 percent of U.S. physicians known to have been born in the United States attended medical school in foreign countries, these physicians represent at least 11 percent of the physicians known as international medical graduates (IMGs). Americans continue to pursue medical education abroad. The majority of United States-born IMGs (USIMGs) trained in just a dozen countries and at just two-dozen medical schools. Several foreign medical schools have contributed more graduates to the current practice pool than U.S. medical schools. Currently practicing older USIMGs were most likely to have attended medical school in Europe and Mexico, while more recent USIMGs are most likely to have attended medical school in Mexico and the Caribbean. U.S.-born students comprise a large percentage of the total IMGs from those countries. Offshore medical schools continue to train large numbers of Americans, but in smaller numbers than in the 1980s. Schools in European countries are less prominent and relatively new schools in Caribbean countries have become more popular.
• International Medical Graduate Physicians in the U.S.: Changes Since 1981
  Date: 03 / 2005
  Author(s): L. Gary Hart, Susan M. Skillman, Amy Hagopian, Meredith A. Fordyce, Matthew J. Thompson, Thomas R. Konrad
  Research center: WWAMI Rural Health Research Center
  Topics: International Medical Graduates (IMGs), Workforce
  Report Number: Working Paper No. 102
  The U.S. relies on international medical graduates (IMGs) to provide a significant portion of the country's health care, including generalist care and service to underserved populations. Understanding the trends in IMG migration and practice is important for determining how best to train an adequate supply of physicians with appropriate skills for the U.S. Key findings show that since 1981, India, the Philippines, Mexico and the Republic of Korea have remained leading countries in which IMGs in the U.S. attended medical school, and most IMGs are located in 10 U.S. states. Relatively fewer IMGs are now working in hospitals than 20 years ago. Currently IMGs are only a little more likely to be generalists than U.S. medical school graduates (USMGs).IMGs have remained less likely than USMGs to practice in rural areas, but among rural physicians, a greater proportion of IMGs practice in Health Professional Shortage Areas than of USMGs.
• Characteristics of Registered Nurses in Rural vs. Urban areas: Implications for Strategies to Alleviate Nursing Shortages in the United States
  Date: 01 / 2005
  Author(s): Susan M. Skillman, Lorella Palazzo, David Keepnews, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Nurses, Workforce
  Report Number: Working Paper No. 91
  Compares characteristics of rural and urban registered nurses (RNs) in the United States using national survey data, and examined certain characteristics of rural RNs that should be considered in developing strategies to alleviate nursing shortages. Such strategies require understanding of rural RNs' work, education, and commuting patterns. If higher wages attract and retain nurses, and urban employers are better positioned than rural employers to raise wages, this policy could draw larger numbers of RNs from rural to urban settings. A "one size fits all" approach to resolving nurse shortages may benefit one geographic area type at the expense of others.
• Workforce Issues in Rural Areas: A Focus on Policy Equity
  Date: 01 / 2005
  Author(s): Thomas C. Ricketts
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Health policy, Nurses, Pharmacy and prescription drugs, Physicians, Workforce
  Citation: American Journal of Public Health, 95(1), 42-48
  Reviews the geographic distribution of 6 classes of health professionals: physicians, nurses, dentists, pharmacists, mental health professionals, and public health professionals. Describes the government and private policies and programs intended to affect the geographic distribution of these health professionals.
• Characterizing the General Surgery Workforce in Rural America
  Date: 01 / 2005
  Author(s): Matthew J. Thompson, Dana Christian Lynge, Eric H. Larson, Pantipa Tachawachira, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Citation: Archives of Surgery, 140(1), 74-79
  Describes the rural general surgical workforce. Discusses the potential impact of its demographic characteristics on rural access to surgical services in the future.
• Recruitment and Retention of EMTs: A Qualitative Study
  Date: 2005
  Author(s): P. Daniel Patterson, Janice C. Probst, Katherine H. Leith, Sara J. Corwin, M. Paige Powell
  Research center: South Carolina Rural Health Research Center
  Topics: Emergency medical services (EMS), Workforce
  Citation: Journal of Allied Health, 34(3), 153-62
  Emergency medical technicians (EMTs) are critical to out-of-hospital care, but maintaining staff can be difficult. The study objective was to identify factors that contribute to recruitment and retention of EMTs and paramedics. Analysis of focus group responses showed that for a majority of respondents, emergency medical services was not a primary career path. Most respondents entered the industry as an alternate or replacement for a nursing career or as a second career following military medic service. The majority of respondents believed the job was stressful yet rewarding, and although it negatively affected their personal lives, the occupation gave them a sense of accomplishment and belonging. Respondents expressed a preference for EMT education resulting in college credit or licensure versus professional certification. Job-related stress produced by numerous factors appears to be a likely contributor to low employee retention.
• Impact of U.S. Medical Students' Debt On Their Choice of Primary Care Careers: An Analysis of Data from the 2002 Medical School Graduation Questionnaire
  Date: 2005
  Author(s): Roger A. Rosenblatt, C. Holly A. Andrilla
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Citation: Academic Medicine, 80(9), 815-819
  The authors used results from questions on the Association of American Medical Colleges' 2002 Medical School Graduation Questionnaire that focused on students' debt and career choices to examine the hypothesis that medical students' rising total educational debt is one of the factors that explains the recent decline in students' interest in family medicine and primary care. Students reported that higher levels of debt influenced their future career choices, and there was an inverse relationship between the level of total educational debt and the intention to enter primary care, with the most marked effect noted for students owing more than $150,000 at graduation. Total debt was associated with a lower likelihood of choosing a primary care career, but factors such as gender and race appeared to have more explanatory power. Female students were much more interested in primary care-and especially pediatrics-than were male students; African American students were more interested in inner-city practice than was any other identified racial or ethnic group.

2004

• Retail Pharmacies in Washington State: Results of the 2003 Workforce Survey
  Date: 12 / 2004
  Author(s): Susan M. Skillman, L. Gary Hart, Elise Bowditch, Beth A. Kirlin
  Research center: WWAMI Rural Health Research Center
  Topics: Pharmacy and prescription drugs, Workforce
  Report Number: Working Paper No. 100
  Researchers surveyed retail pharmacies in Washington to estimate the demand for pharmacists, as well as pharmacy technicians and administrative/clerical staff, and to describe the impact of implementation of the Health Insurance Portability and Accountability Act (HIPAA) on retail pharmacies. Combining the results of this survey with the estimates from a survey of pharmacist vacancies in the state's hospitals, 403 pharmacists were needed statewide for retail and hospital pharmacies in 2003-2004. Pharmacy schools in Washington graduated 180 pharmacists in 2003, which was not enough to fill all of the vacancies across the state.
• Community Health Workers: Status of Certification and Training
  Date: 11 / 2004
  Research center: Southwest Rural Health Research Center
  Topic: Workforce
  Report Number: Policy Brief
  Provides a national overview of state policy and state involvement in the standardized training and certification of Community Health Workers.
• Mujer y Corazon: Community Health Workers and their Organizations in Colonias on the U.S.-Mexico Border
  Date: 10 / 2004
  Author(s): Marlynn L. May, Ricardo B. Contreras, Linda Callejas, Elvia Ladezma
  Research center: Southwest Rural Health Research Center
  Topics: Border and international health, Hispanics, Minority health, Workforce
  Report Number: Policy Brief
  Reports the results of a study that analyzed the Community Health Worker (CHW) organizations and practices to learn how they work and why they are key resources in colonias for improving the health of the communities. The study also examined the relationships of the CHW with and their impact on the communities they serve, finding variation programmatically, structurally, and geographically. A full report is also available.
• Mujer Y Corazon: Community Health Workers and Their Organizations in Colonias on the US-Mexico Border: An Exploratory Study
  Date: 08 / 2004
  Author(s): Marlynn L. May, Ricardo B. Contreras, Linda Callejas, Elvia Ledezma
  Research center: Southwest Rural Health Research Center
  Topics: Border and international health, Hispanics, Minority health, Workforce
  Reports the results of a study that analyzed the Community Health Worker (CHW) organizations and practices to learn how they work and why they are key resources in colonias for improving the health of the communities. The study also examined the relationships of the CHW with and their impact on the communities they serve, finding variation programmatically, structurally, and geographically. A policy brief is also available.
• Characterizing the General Surgery Workforce in Rural America
  Date: 05 / 2004
  Author(s): Matthew J. Thompson, Dana Christian Lynge, Eric H. Larson, Pantipa Tachawachira, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Report Number: Working Paper No. 77
  General surgeons form a crucial component of the medical workforce in rural areas of the United States. Analysis of the data suggests that the general surgical workforce has not kept pace with the rising population, and that the number of general surgeons in most rural areas of the U.S. will decline further. Report available upon request by contacting rhrc@fammed.washington.edu.
• Are Advanced Practice Nurses A Solution To Rural Mental Health Workforce Shortages?
  Date: 04 / 2004
  Author(s): David Hartley, Valerie Hart, Nancy Hanrahan, Stephenie Loux
  Research center: Maine Rural Health Research Center
  Topics: Mental health, Nurses, Workforce
  Report Number: Working Paper No. 31
  Summarizes the clinical skills and prescriptive authority of Advanced Practice Psychiatric Nurses (APPNs), and investigates current trends in their geographic distribution to determine what their future role may be in addressing rural mental health needs. Includes information on prescription authority and collaboration requirements for each state, as well as state distribution of APPNs.
• American Indians and Alaska Natives: How Do They Find Their Path to Medical School?
  Date: 01 / 2004
  Author(s): Walter B. Hollow, Davis G. Patterson, Polly M. Olsen, Laura-Mae Baldwin
  Research center: WWAMI Rural Health Research Center
  Topics: American Indians and Alaska Natives, Physicians, Workforce
  Report Number: Working Paper No. 86
  Describes the findings of a study to understand the paths of American Indian and Alaska Native (AI/AN) students who successfully entered medical school.
• Role of International Medical Graduates in America's Small Rural Critical Access Hospitals
  Date: 2004
  Author(s): Amy Hagopian, Matthew J. Thompson, Emily Kaltenbach, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, International Medical Graduates (IMGs), Workforce
  Citation: Journal of Rural Health, 20(1), 52-58
  Descriptive report presenting the roles and characteristics of foreign-born international medical graduates (IMGs) in Critical Access Hospital (CAH) facilities and the opinions of the CEOs about these practitioners.

2003

• International Medical Graduates in the United States: A Review of the Literature 1995 to 2003
  Date: 10 / 2003
  Author(s): Amy Hagopian, Matthew J. Thompson, Karin E. Johnson, Denise M. Lishner
  Research center: WWAMI Rural Health Research Center
  Topics: International Medical Graduates (IMGs), Workforce
  Report Number: Working Paper No. 83
  Synthesizes the literature addressing International Medical Graduates (IMGs) from 1995 to 2003, with sections addressing the overall U.S. supply of physicians, IMG demographics and characteristics, the IMG pipeline, Graduate medical education, the role of IMGs in the U.S. health care safety net, IMG quality, and legal issues.
• Contribution of Nurse Practitioners and Physician Assistants to Generalist Care in Underserved Areas of Washington State
  Date: 08 / 2003
  Author(s): Eric H Larson, Lorella Palazzo, Bobbi Berkowitz, Michael J Pirani, L Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Mid-level practitioners, Nurses, Workforce
  Citation: Health Services Research, 38(4), 1033-1050
  Uses productivity data from the non-physician clinician (NPC) and physician populations in Washington State to assess the contribution to generalist care made by NPCs, giving special attention to the role of NPCs in rural and underserved areas and the role of women NPCs in the female provider population. Overall, generalist NPCs make up 23.4 percent of the generalist provider population and perform about 21 percent of the generalist outpatient visits in Washington State. NPC contribution is higher in rural areas of the state and a bit lower in urban areas. In rural areas, female physicians provided only 49.3 percent of the visits by female providers; female NPCs provided the remaining 50.3 percent. In urban areas, female physicians provided about 63.5 percent; female NPCs provided 46.5 percent. NPCs made similar contributions to total care in rural HPSAs compared to rural non-shortage areas, though physician assistants appear to contribute somewhat more care in HPSAs with severe shortages of providers. The results suggest that accurate and meaningful estimates of available generalist care must take into account the contribution of NPCs.
• State of the Health Workforce in Rural America: Profiles and Comparisons
  Date: 08 / 2003
  Author(s): Eric H. Larson, Karin E. Johnson, Thomas E. Norris, Denis M. Lishner, Roger A. Rosenblatt, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topic: Workforce
  Overview of rural health care workforce issues. National and state-by-state data on the health care workforce, with rural-urban comparisons and interstate comparisons. Also includes data on rural health care facilities. To request a copy, call (206) 685-0402 or email: rowe@u.washington.edu
• Health Departments' Use of International Medical Graduates in Physician Shortage Areas
  Date: 2003
  Author(s): Amy Hagopian, Matthew J. Thompson, Emily Kaltenbach, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: International Medical Graduates (IMGs), J-1 Visa Waiver, Workforce
  Citation: Health Affairs, 22(5), 241-249
  Describes results of a survey of program administrators of the Conrad State 20 Program, which places international medical graduates (IMGs) on J-1 visas in health professional shortage areas (HPSAs). Problems reported include unfair working conditions and compensation for physicians. Federal immigration agencies were reported to be unresponsive and difficult. Employers seem to be more satisfied than physicians with the program.
• How International Medical Graduates Enter U.S. Graduate Medical Education or Employment
  Date: 2003
  Author(s): Karin E. Johnson, Emily Kaltenbach, Kenneth Hoogstra, Matthew J. Thompson, Amy Hagopian, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: International Medical Graduates (IMGs), J-1 Visa Waiver, Workforce
  Report Number: Working Paper No. 76
  Provides an overview of the steps that must occur for an international medical graduate (IMG) to come to the United States to practice medicine. Describes how long and by what means IMGs holding temporary visas can remain in the United States, with detailed coverage of the State 30/Conrad J-1 visa waiver program.
• Effects of the 1997 Balanced Budget Act on Family Practice Residency Training Programs
  Date: 2003
  Author(s): Ronald Schneeweiss, Roger A. Rosenblatt, Susan Dovey, L. Gary Hart, Frederick M. Chen, Susan Casey, George E. Fryer Jr
  Research center: WWAMI Rural Health Research Center
  Topics: International Medical Graduates (IMGs), Physicians, Workforce
  Citation: Fam Med 2003;35(2):93-9
  Background and Objectives: This study assessed the impact of the Balanced Budget Act (BBA) of 1997 on family practice residency training programs in the United States.
  Methods: We surveyed 453 active family practice residency programs, asking about program closures and new program starts (including rural training tracks), changes in the number of residents and faculty, and curriculum changes. Programs were classified according to their urban or rural location, university or community hospital setting, and rural and/or urban underserved mission emphasis.
  Results: A total of 435 (96%) of the programs responded. Overall, the impact of the BBA was relatively small. In 1998 and 1999, nationwide, there were 11 program closures, a net decrease of only 82 residents, and a net increase of 52 faculty across program settings and mission emphasis. The rate of family practice residency program closures increased from an average of 3.0 per year between 1988–1997 to 4.8 per year in the 4 years following passage of the BBA.
  Conclusions: The 1997 BBA did not have an immediate significant negative impact on family practice residency programs. However, there is a worrisome increase in the rate of family practice residency closures since 1997. A mechanism needs to be established to monitor all primary care program closures to give an early warning should this trend continue.

2002

• Accounting for Graduate Medical Education Funding in Family Practice Training
  Date: 10 / 2002
  Author(s): Frederick M Chen, RL Phillips Jr, R Schneeweiss, C Holly A Andrilla, L Gary Hart, GE Fryer Jr, S Casey, Roger A Rosenblatt
  Research center: WWAMI Rural Health Research Center
  Topics: Medicare, Physicians, Workforce
  Citation: Fam Med 2002;34(9):663-8
  Background and Objectives: Medicare provides the majority of funding to support graduate medical education (GME). Following the flow of these funds from hospitals to training programs is an important step in accounting for GME funding.
  Methods: Using a national survey of 453 family practice residency programs and Medicare hospital cost reports, we assessed residency programs’ knowledge of their federal GME funding and compared their responses with the actual amounts paid to the sponsoring hospitals by Medicare. Results: A total of 328 (72%) programs responded; 168 programs (51%) reported that they did not know how much federal GME funding they received. Programs that were the only residency in the hospital (61% versus 36%) and those that were community hospital-based programs (53% versus 22%) were more likely to know their GME allocation. Programs in hospitals with other residencies received less of their designated direct medical education payment than programs that were the only residency in the sponsoring hospital (-45% versus +19%).
  Conclusions: More than half of family practice training programs do not know how much GME they receive. These findings call for improved accountability in the use of Medicare payments that are designated for medical education.
• Rural Populations and Health Care Providers: A Map Book
  Date: 09 / 2002
  Author(s): Randy Randolph, Katherine Gaul, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Rural statistics and demographics, Workforce
  Uses 2000 Census data to reassess and provide a visual picture of where rural people live, how the racial and ethnic nature of rural populations is changing, and whether the distribution of health care providers matches the population distribution.
• Family Medicine Training in Rural Areas
  Date: 09 / 2002
  Author(s): Roger A. Rosenblatt, Ronald Schneeweiss, L. Gary Hart, Susan Casey, C. Holly A. Andrilla, Frederick M. Chen
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Citation: JAMA. 2002;288:1063-1064
  Letter to the Editor: The discipline of family medicine was created in the 1970s, in part, as a way to address the chronic shortage of US rural physicians. It was predicted that the new discipline would augment the supply of rural clinicians because family physicians are much more likely than other physicians to settle in rural areas.
  There is also empirical evidence that training family physicians in rural areas increases the likelihood that residency graduates will choose to settle in rural places. However, the exact proportion of family medicine residency programs located in truly rural parts of the United States remains unknown, as does the extent to which training rural physicians is a priority of existing family medicine residency programs.
• Gender-Related Factors in the Recruitment of Generalist Physicians to the Rural Northwest
  Date: 09 / 2002
  Author(s): Ellsbury KE, Baldwin LM, Johnson KE, Runyan SJ, Hart LG
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Women, Workforce
  Citation: Journal of the American Board of Family Practice, 15(5), 391-400
  Background: This study examines differences in the factors female and male physicians considered influential in their rural practice location choice and describes the practice arrangements that successfully recruited female physicians to rural areas.
  Methods: This cross-sectional study was based on a mailed survey of physicians successfully recruited between 1992 and 1999 to towns of 10,000 or less in six states in the Pacific Northwest.
  Results: Responses from 77 men and 37 women (response rate 61%) indicated that women were more likely than men to have been influenced in making their practice choice by issues related to spouse or personal partner, flexible scheduling, family leave, availability of childcare, and the interpersonal aspects of recruitment. Commonly reported themes reflected the respondents' desire for flexibility regarding family issues and the value they placed on honesty during recruitment.
  Conclusions: It is very important in recruitment of both men and women to highlight the positive aspects of the community and to involve and assist the physician's spouse or partner. If they want to achieve a gender-balanced physician workforce, rural communities and practices recruiting physicians should place high priority on practice scheduling, spouse-partner, and interpersonal issues in the recruitment process.
• Rural-Urban Differences in the Public Health Workforce: Findings From Local Health Departments in three Rural Western States
  Date: 07 / 2002
  Author(s): Rosenblatt RA, Casey S, Richardson M
  Research center: WWAMI Rural Health Research Center
  Topics: Public health, Workforce
  Citation: American Journal of Public Health, 92(7):1102-1105
  Most local health departments or districts are small and rural; two thirds of the nation's 2832 local health departments serve populations smaller than 50,000 people. Rural local health departments have small staffs and slender budgets, yet they are expected to provide a wide array of services during a period when the health care system of which they are a part is undergoing change.

  This study provided quantitative, population-based data on the supply and composition of the rural public health workforce in 3 extremely rural states: Alaska, Montana, and Wyoming. The study focused on the relative supply of personnel in the principal public health occupational categories, differences across states in staffing levels, and difficulties experienced in recruiting and retaining personnel.

• State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
  Date: 05 / 2002
  Author(s): David Hartley, Erika C. Ziller, David Lambert, Stephenie L. Loux, Donna C. Bird
  Research center: Maine Rural Health Research Center
  Topics: Legislation and regulation, Mental health, Workforce
  Report Number: Working Paper No. 29
  Investigates whether and the extent to which licensure laws that determine the permissible scope of practice for each of these professions may affect the availability of mental health services, particularly in rural communities. Findings: Licensure laws authorize non-physician mental health providers to practice assessment, treatment planning, and individual and group counseling independently in most of the 40 states studied. Many states do not explicitly grant the authority to all of these professions for diagnosis or psychotherapy, but none explicitly deny it. Despite this finding, Medicare and some other payers do not directly reimburse Marriage and Family Therapists or Licensed Professional Counselors. Laws that require clinical supervision of newly trained practitioners to be performed exclusively by a member of the profession in a face-to face setting may make it difficult for a new graduate seeking rural practice to log the number of required hours within the specified time limit to qualify for independent practice. Some states' laws allow supervision that is not face-to-face, a rural-friendly policy. Also discussed are the nature and effects of guild behavior in the mental health professions. Based on the findings, report recommends that states simplify licensure and clarify clinical roles by combining regulatory functions for several professions into a single office or agency; that Medicare reconsider its position on reimbursing Marriage and Family Therapists or Licensed Professional Counselors; that professional competition over the right to practice and be reimbursed be addressed; and that supervision requirements be modified to allow new mental health professional graduates to address rural needs soon after graduation.
• Rural Research Focus: Rural Physician Shortages
  Date: 05 / 2002
  Author(s): George E. Wright, C. Holly A. Andrilla, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Discusses a model for understanding how many physicians a rural community can support, based on research at the WWAMI Rural Health Research Center.
• Immediate and Future Role of the J-1 Visa Waiver Program for Physicians: The Consequences of Change for Rural Health Care Service Delivery
  Date: 04 / 2002
  Author(s): Keith J. Mueller
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: J-1 Visa Waiver, Physicians, Workforce
  Report Number: Policy Brief 2002-3
  Examines the consequences for the delivery of health care services in rural underserved areas if current policies governing the granting of J-1 visa waivers are changed and increases or decreases the numbers of physicians affected. Among its findings: J-1 visa waiver doctors provide care to more than 4 million people living in underserved areas of rural America. If all primary care doctors in the program were to leave, the number of rural counties with no primary care physicians would go from 161 to 212. Makes several recommendations: 1) The Department of Health and Human Services--which currently only requests waivers for physicians involved in research-should consider requesting waivers for doctors to practice in underserved areas. 2) Physicians recommended for waivers should be allowed to begin practicing in underserved areas as soon as the request is made. If, in subsequent screening, a problem turns up the waiver would be revoked. 3) The Conrad State 20 Program, which allows the 44 states that participate in it to sponsor waivers, should be expanded from 20 waivers per year to 40.
• Family Medicine Residency Training in Rural Areas: How Much is Taking Place, and Is It Enough to Prepare a Future Generation of Rural Family Physicians?
  Date: 03 / 2002
  Author(s): Roger A Rosenblatt, R Schneeweiss, L Gary Hart, S Casey, C Holly Andrilla, Fredercik M Chen
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Report Number: No. 69
  Determines how much rural family practice training is taking place in the United States. Among the results are that only 33 family medicine residency programs (7.4 percent) are located in rural areas and most of the training sponsored by these programs occurs in rural areas. On the other hand, while more than one-third of the urban programs listed rural training as an important part of their mission, only 2.3 percent of the training they supported took place in rural areas. For the nation as a whole, only 7.5 percent of family medicine residency training occurred in rural areas despite the fact that 22.3 percent of the U.S. population lives in rural places. The report concludes that to the extent that there is a link between the place of training and future practice, the lack of rural training contributes to the shortage of rural physicians. Furthermore, unless significant efforts are made to increase rural residency training, rural physician shortages are likely to persist.

2001

• Addressing Mental Health Workforce Needs in Underserved Rural Areas: Accomplishments and Challenges
  Date: 10 / 2001
  Author(s): Donna C. Bird, Patricia Dempsey, David Hartley
  Research center: Maine Rural Health Research Center
  Topics: Mental health, Workforce
  Report Number: Working Paper No. 23
  Reviews efforts to address mental health workforce needs in underserved rural areas and addresses three questions: 1) How is health and mental health workforce adequacy currently measured? 2) How do unique characteristics of rural communities and the mental health service delivery system challenge current methods for determining workforce adequacy? 3) What role has the federal government played in addressing health and mental health workforce needs in underserved rural areas? Finds that current workforce adequacy measurements all focus on physicians and are limited by the lack of a commonly accepted way to obtain needed data and by widely varying estimates of adequate population-to-provider ratios. In addition, the pluralistic and minimally coordinated nature of the mental health services system makes it difficult to translate methods for estimating workforce adequacy from health to mental health. Finally, there are several federal efforts to address workforce needs that foster training, provide scholarships, fund demonstration programs, and allow foreign medical graduates to serve in underserved areas. Makes several recommendations pertaining to the collection of data, field-testing of estimation models, and increasing the supply of mental health service providers.
• Access to Rural Pharmacy Services in Minnesota, North Dakota, and South Dakota
  Date: 07 / 2001
  Author(s): Michelle M. Casey, Jill Klingner, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Health services, Legislation and regulation, Medicare Part D, Pharmacy and prescription drugs, Workforce
  Report Number: Working Paper No. 36
  Describes the current status of rural retail pharmacies in the three states; examines the availability of pharmacy services in rural areas of the states; and analyzes regulatory and policy issues that affect the delivery of pharmacy services in rural areas. Among the findings are that pharmacy access problems in the states are not primarily due to closure of rural pharmacies in recent years; relief coverage is a major concern for many rural pharmacies; financial access to pharmacy services is a major concern in rural areas of the states; the financial viability of rural pharmacies is a key policy issue; and the addition of a Medicare prescription benefit may have a substantial negative impact on the financial status of rural pharmacies. Makes several recommendations pertaining to the capacity of colleges of pharmacy to produce an adequate supply of rural pharmacists; options for providing affordable relief coverage for rural pharmacists; financial access to prescription drug coverage for the elderly and other vulnerable populations; and the potential financial impact of a Medicare prescription benefit on rural pharmacies.
• If Fewer International Medical Graduates are Allowed in the U.S., Who Might Replace Them in Rural Underserved Areas?
  Date: 05 / 2001
  Author(s): Leonard D. Baer, Thomas R. Konrad, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: International Medical Graduates (IMGs), Workforce
  Report Number: Findings Brief
  Describes a study to identify rural communities that would be most affected by a decrease in availability of international medical graduates (IMGs) and perceptions of recruiters on who might replace IMGs in these areas. Includes maps. A full report is also available.
• How Many Physicians Can a Rural Community Support? A Practice Income Potential Model for Washington State
  Date: 04 / 2001
  Author(s): George E Wright, C Holly Andrilla, L Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Report Number: No. 45
  Addresses the ability of smaller and underserved rural communities to financially support needed physicians. Reports on an experimental simulation model that projects potential practice income for primary care physicians in rural communities of Washington State. Finds that the distribution of physicians follows predicted economic potential. Surprisingly, the types of rural communities most likely to have fewer physicians are not small isolated towns, but larger communities with above average population growth, closer proximity to metro areas and somewhat lower average family incomes. Towns in HPSAs were predominantly constrained by demand deficits. To overcome demand barriers, continuous subsidies such as enhanced Medicare payments for certified Rural Health Clinics or 10 percent Medicare supplemental payments for care provided in a HPSA could be offered. Signing-bonus approaches may help overcome initial reluctance to practice in rural areas where demand is sufficient to support long-term retention.
• If Fewer International Medical Graduates Were Allowed in the U.S., Who Might Replace Them in Rural Areas?
  Date: 02 / 2001
  Author(s): Leonard D. Baer, Thomas R. Konrad, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: International Medical Graduates (IMGs), Workforce
  Report Number: Working Paper No. 71
  Identifies rural communities that would be most affected should restrictions on IMG entry into the United States be tightened, and reports on the perceptions of physician recruiters and health planners about who might replace IMGs currently working in such areas. Findings indicate that given the difficulty of expanding ongoing recruitment and retention efforts, many underserved rural areas would likely remain underserved in the event of a cutback in IMGs, and many rural areas that are currently adequately served could face serious problems as well. A single national solution to replace IMGs would be difficult. Recruiters and planners within states and local areas will need to expand creative and innovative approaches, and even then, many rural communities might have to make do with less.
• National Estimates of Physician Assistant Productivity
  Date: 2001
  Author(s): Eric H Larson, L. Gary Hart, Ruth Ballweg
  Research center: WWAMI Rural Health Research Center
  Topics: Mid-level practitioners, Workforce
  Citation: Journal of Allied Health, Volume 30, Number 3, pp. 146-152(7)
  Analysis of productivity data from a nationally representative sample of physician assistants (PAs) showed that PAs performed 61.4 outpatient visits per week compared with 74.2 visits performed by physicians, for an overall physician full-time equivalent (FTE) estimate of 0.83. However, productivity of PAs varies strongly across practice specialty and location, with generalist PAs performing more visits than their specialist counterparts. Rural PA productivity is higher than urban productivity because of the concentration of generalist PAs in rural settings. A generalist PA physician FTE estimate of 0.75 appears to be more accurate than the 0.5 currently under consideration in proposed modifications to Health Personnel Shortage Area designation regulations.
• Local Health Districts and the Public Health Workforce: A Case Study of Wyoming and Idaho
  Date: 2001
  Author(s): Richardson M, Casey S, Rosenblatt RA
  Research center: WWAMI Rural Health Research Center
  Topics: Public health, Workforce
  Citation: Journal of Public Health Management Practice, 7(1):37-48
  This study of personnel in local health departments (LHDs) focused on two predominantly rural states: Idaho and Wyoming. Although in the same region of the country, the structure of local public health is different in each state. Idaho's regionalized LHDs are relatively autonomous, whereas Wyoming's are county based, with many public health functions retained at the state level. The majority of professionals are nurses followed by environmental health workers and sanitarians, similar to data reported nationally. With increased emphasis on core public health functions of policy, assurance, and assessment, rural LHDs will be challenged to redirect the functions of their workforce.

2000

• U.S. Medical Schools and the Rural Family Physician Gender Gap
  Date: 05 / 2000
  Author(s): Kathleen E. Ellsbury, Mark P. Doescher, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Women, Workforce
  Citation: Fam Med. May 2000;32(5):331-337
  Background: Women comprise increasing proportions of medical school graduates. They tend to choose primary care but are less likely than men to choose rural practice.
  Methods: This study used American Medical Association masterfile data on 1988–1996 medical school graduates to identify the US medical schools most successful at producing rural family physicians and general practitioners of both genders.
  Results: The number of listed rural female family physician or general practitioner graduates among schools ranged from 0–27 (0% to 4.4% of each school’s 1988–1996 graduates). There were approximately twice as many male as female rural family physicians and general practitioners. Publicly funded schools produced more rural female family physicians and general practitioners than their privately funded counterparts.
  Conclusions: Our findings suggest that a few schools, most of them public, may serve as models for schools that aim to train women who later enter rural practice.
• Educating Generalist Physicians for Rural Practice: How Are We Doing?
  Date: 2000
  Author(s): John P Geyman, Gary L Hart, Tom E Norris, John B Coombs, Denise Lishner
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Citation: Journal of Rural Health, 16(1), 56-80
  Although about 20 percent of Americans live in rural areas, only 9 percent of physicians practice there. Physicians consistently and preferentially settle in metropolitan, suburban and other nonrural areas. The last 20 years have seen a variety of strategies by medical education programs and by federal and state governments to promote the choice of rural practice among physicians. This comprehensive literature review was based on MEDLINE and Health STAR searches, content review of more than 125 relevant articles and review of other materials provided by members of the Society of Teachers of Family Medicine Working Group on Rural Health. To the extent possible, a particular focus was directed to "small rural" communities of less than 10,000 people. Significant progress has been made in arresting the downward trend in the number of physicians in these communities but 22 million people still live in health professions shortage areas. This report summarizes the successes and failures of medical education and government programs and initiatives that are intended to prepare and place more generalist physicians in rural practice. It remains clear that the educational pipeline to rural medical practice is long and complex, with many places for attrition along the way. Much is now known about how to select, train and place physicians in rural practice, but effective strategies must be as multifaceted as the barriers themselves.
• Distribution of Rural Female Generalist Physicians in the United States
  Date: 2000
  Author(s): Mark P Doescher, Kathrine E Ellsbury, Gary L Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Women, Workforce
  Citation: Journal of Rural Health, 16(2), 111-118
  Female physicians are underrepresented in rural areas. What impact might the increasing proportion of women in medicine have on the rural physician shortage? To begin addressing this question, we present data describing the geographic distribution of female physicians in the United States. We examine the geographic distribution of all active U.S. allopathic physicians recorded in the October 1996 update of the American Medical Association Physician Masterfile. Percentages and numbers of female physicians by professional activity, specialty type, and geographic location are reported. Findings reveal there were fewer than 7,000 female allopathic physicians practicing in rural America in 1996. The proportion of generalist female physicians who practice in rural settings was significantly lower than the proportion who practice in urban locations. Although members of the most recent 10-year medical school graduation cohort of female generalist physicians were slightly more likely to practice in rural areas than members of earlier cohorts, female physicians remained significantly underrepresented in rural areas. States varied dramatically in rural female generalist underrepresentation. Should female generalists continue to be underrepresented in rural locations, the rural physician shortage will not be resolved quickly. Effective strategies to improve rural female physician placement and retention need to be identified and implemented to improve rural access to physician care.

1999

• Production of Rural Female Generalists by U.S. Medical Schools
  Date: 05 / 1999
  Author(s): Katherine E Ellsbury, Mark P Doescher, L Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Women, Workforce
  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.
• Dimensions of Retention: A National Study of the Locational Histories of Physician Assistants
  Date: 1999
  Author(s): Eric H Larson, Gary L Hart, Goodwin MK, John Geller, C Holly Andrilla
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Citation: Journal of Rural Health, 15(4), 391-402
  This study describes the locational histories of a representative national sample of physician assistants and considers the implications of observed locational behavior for recruitment and retention of physician assistants in rural practice. Through a survey, physician assistants listed all the places they had practiced since completing their physician assistant training, making it possible to classify the career histories of physician assistants as "all rural," "all urban," "urban to rural" or "rural to urban." The study examined the retention of physician assistants in rural practice at several levels: in the first practice, in rural practice overall and in states. Physician assistants who started their careers in rural locations were more likely to leave them during the first four years of practice than urban physician assistants, and female rural physician assistants were slightly more likely to leave than men. Those starting in rural practice had high attrition to urban areas (41 percent); however, a significant proportion of the physician assistants who started in urban practice settings left for rural settings (10 percent). This kept the total proportion of physician assistants in rural practice at a steady 20 percent. While 21 percent of the earliest graduates of physician assistant training programs have had exclusively rural careers, only 9 percent of physician assistants with four to seven years of experience have worked exclusively in rural settings. At the state level, generalist physician assistants were significantly more likely to leave states with practice environments unfavorable to physician assistant practice in terms of prescriptive authority, reimbursement and insurance.

1998

• Availability of Anesthesia Personnel in Rural Washington and Montana
  Date: 03 / 1998
  Author(s): Peter J Dunbar, Jonathan D Mayer, Meredith Fordyce, Denise M Lishner, Amy Hagopian, Ken Spanton, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Mid-level practitioners, Workforce
  Citation: The Journal of the American Society of Anesthesiologists 88(3):800-808
  Anesthesia has historically been an undersupplied specialty. Health personnel issues used to be dominated by the findings of the 1980 Graduate Medical Education National Advisory Committee study, which suggested that anesthesia would be a balanced specialty for the rest of the century. Recent studies, however, have demonstrated that there is an oversupply of all specialists, including anesthesiology. These studies take a "top down" view of health personnel through analysis of national statistics and exploration of subsets of the data by hospital size and rurality. This approach assumes that the databases of the American Hospital Association and the American Medical Association are accurate and do not take into account the presence of certified registered nurse anesthetists (CRNAs), who are the predominant providers of anesthesia care in the smallest and most remote hospitals in the United States. We compared the 1994 master file of the American Medical Association with our local knowledge of the practitioners in the rural areas of Washington state and found numerous small errors. These errors of one or two practitioners made no difference to the analysis of practitioner groups with more than approximately five people, but in the most rural communities the erroneous presence or absence of a single practitioner made a significant difference.

1997

• National Health Service Corps: Rural Physician Service and Retention
  Date: 1997
  Author(s): Cullen TJ, L Gary Hart, Whitcomb ME, Roger A Rosenblatt
  Research center: WWAMI Rural Health Research Center
  Topics: Physicians, Workforce
  Citation: Journal of the American Board Family Practice, 10(4):272-9
  BACKGROUND: The National Health Service Corps (NHSC) scholarship program is the most ambitious program in the United States designed to supply physicians to medically underserved areas. In addition to providing medical service to underserved populations, the NHSC promotes long-term retention of physicians in the areas to which they were initially assigned. This study uses existing secondary data to explore some of the issues involved in retention in rural areas.
  METHODS: The December 1991 American Medical Association (AMA) Masterfile was used to determine the practice location and specialty of the 2903 NHSC scholarship recipients who graduated from US medical schools from 1975 through 1983 and were initially assigned to nonmetropolitan counties. We used the AMA Masterfile to determine what percentage of the original cohort was still practicing in their initial county of assignment and the relation of original practice specialty and assignment period to long-term retention.
  RESULTS: Twenty percent of the physicians assigned to rural areas were still located in the county of their initial assignment, and an additional 20 percent were in some other rural location in 1991. Retention was highest for family physicians and lowest for scholarship recipients who had not completed residency training when they were first assigned. Retention rates were also higher for those with longer periods of obligated service. Substantial medical care service was provided to rural underserved communities through obligated and postobligation service. Nearly 20 percent of all students graduating from medical schools between 1975 and 1983 who are currently practicing in rural counties with small urbanized populations were initially NHSC assignees.
  CONCLUSIONS: Although most NHSC physicians did not remain in their initial rural practice locations, a substantial minority are still rural practitioners; those remaining account for a considerable proportion of all physicians in the most rural US counties. This study suggests that rural retention can be enhanced by selecting more assignees who were committed to and then completed family medicine residencies before assignment.

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