WWAMI Rural Health Research Center

Products

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

For a complete list of publications from the Center, which may include older publications and publications funded by other sources, please see the Center's website.

2017

2016

  • Community Factors and Outcomes of Home Health Care for High-Risk Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 10/2016
    Outcomes of care vary by region of the country for rural Medicare beneficiaries receiving home health services for high-risk conditions such as heart failure. Those in the East South Central and West South Central Census Divisions had lower rates of community discharge and higher rates of hospital readmission and emergency department use.
  • Supply and Distribution of the Behavioral Health Workforce in Rural America
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 09/2016
    This brief uses National Provider Identifier (NPI) data to report on the variability of the supply and provider to population ratios of five types of behavioral health workforce providers (psychiatrists, psychologists, social workers, psychiatric nurse practitioners, counselors) in Metropolitan, Micropolitan and Non-core rural areas across the U.S.
  • Graduates of Rural-centric Family Medicine Residencies: Determinants of Rural and Urban Practice
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 07/2016
    This study of graduates of family medicine residencies seeking to produce rural physicians identified influences on rural practice choice, including significant others, residency, and practice communities. Findings point to the need to sustain the preferences of physicians interested in rural practice and encourage this interest in others.
  • Conrad 30 Waivers for Physicians on J-1 Visas: State Policies, Practices, and Perspectives
    Report
    WWAMI Rural Health Research Center
    Date: 03/2016
    States rely on international medical graduates (IMGs) to fill workforce gaps in rural and urban underserved areas. This study collected quantitative and qualitative information from states to assess how state policies and practices shape IMG recruitment and practice in underserved areas.
  • How Could Nurse Practitioners and Physician Assistants Be Deployed to Provide Rural Primary Care?
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 03/2016
    New (2014) rural enrollees in the insurance plans on federal and state exchanges are expected to generate about 1.39 million primary care visits per year. At a national level, it would require 345 full-time equivalent physicians to provide those visits. This study examines how different mixes of physicians, PAs and NPs might meet the increase.
  • Outcomes of Rural-Centric Residency Training to Prepare Family Medicine Physicians for Rural Practice
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 03/2016
    Among those with eight or more weeks of rural training, no single program characteristic or model offered sustained advantages over any other type in producing high yields to rural practice.
  • Access to Rural Home Health Services: Views from the Field
    Report
    WWAMI Rural Health Research Center
    Date: 02/2016
    Access to home health care can be challenging for rural Medicare clients. Key informants for this study detailed obstacles, including financial, regulatory, workforce, and geographic issues. Rural communities will likely benefit from payment reforms that reward quality services while providing incentives to use best practices in home health care.
  • Family Medicine Rural Training Track Residencies: 2008-2015 Graduate Outcomes
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2016
    This policy brief is the latest in a series tracking the rural practice outcomes of family physicians who have completed graduate medical education in Rural Training Track (RTT) residency programs.
  • Which Physician Assistant Training Programs Produce Rural PAs? A National Study
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 02/2016
    The proportion of physician assistant (PA) graduates who enter practice in rural settings has dropped over the last two decades, though PAs still continue to enter rural practice at a higher rate than primary care physicians. This identifies the PA training programs that produced high numbers of rural PAs and the programs associated.

2015

  • Access to Health Information Technology Training Programs at the Community College Level
    WWAMI Rural Health Research Center
    Date: 11/2015
    Successful implementation of health information technology (HIT) in rural areas depends on the availability of a well-trained HIT workforce, and community colleges are key educational resources for producing this workforce. This study examined HIT workforce development programs in community colleges in order to increase understanding of the types of programs offered, describe the characteristics and sources of community college HIT curricula, highlight how these programs may be reaching underserved populations and students with limitations to accessing classroom-based courses, and identify barriers faced by these programs in achieving their HIT education goals. Information about the strengths and needs of the nation’s community college HIT education programs should help inform future HIT skills training programs and contribute to growing and strengthening the HIT workforce.
  • Assessing Rural-Urban Nurse Practitioner Supply and Distribution in 12 States Using Available Data Sources
    WWAMI Rural Health Research Center
    Date: 08/2015

    This study compared estimates of nurse practitioner (NP) supply in 12 states (statewide and rural vs. urban) derived from two sources: state license records and National Provider Identifier (NPI) data. Estimates of state NP supply from license data were found to be higher than NPI-derived estimates for most, but not all states. While data from both license and NPI sources can be useful for health workforce planning, the limitations of each source should be acknowledged and workforce comparisons should be limited to estimates derived from the same types of data.

  • Prehospital Emergency Medical Services Personnel in Rural Areas: Results from a Survey in Nine States
    WWAMI Rural Health Research Center
    Date: 08/2015
    This study uses a survey of all ground-based prehospital emergency medical services (EMS) agencies in nine states (AR, FL, KS, MA, MT, NM, OR, SC, WI) to examine supply and demand for emergency response personnel, the involvement of medical directors, and the availability of medical consultation, in rural and urban agencies. Compared with urban EMS agencies, rural agencies had lower staff skill levels, higher reliance on volunteers, higher vacancy ratios, and less access to oversight and skill maintenance through regular interaction with a medical director and online medical consultation during emergency calls. Agencies in isolated small rural areas were the most distinct from other rural and urban agencies, having the most volunteers (both EMS providers and medical directors) and paid staff vacancies.
  • Recruitment of Non-U.S. Citizen Physicians to Rural and Underserved Areas through Conrad State 30 J-1 Visa Waiver Programs
    WWAMI Rural Health Research Center
    Date: 07/2015
    Conrad State 30 J-1 visa waiver programs (commonly called Conrad 30 programs) allow international medical graduates (IMGs) training in the U.S. on J-1 visas to remain in the U.S. after completing residency to provide healthcare for rural and urban medically underserved populations. This study collected information from state health department personnel, using both quantitative and qualitative methods, to characterize national trends in waivers and factors related to states’ successful recruitment of IMGs for the years 2000-01 through 2009-10. States varied greatly in the number of waivers used and in the resources devoted to operating the Conrad 30 program. Over the decade there was a shift away from rural primary care placements of IMGs toward non-rural specialist placements. States with larger populations gained an increasing share of J-1 visa waiver physicians during the decade of the 2000s. States devoting more staff to the Conrad 30 program recruited more physicians seeking waivers. Whether or not states charged applicant fees had no association with the number of waivers used.
  • Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents
    WWAMI Rural Health Research Center
    Date: 05/2015
    Do adults in rural locations report lower dental care utilization or higher prevalence of dental disease or both compared with their urban counterparts? This analysis of data from the Behavioral Risk Factor Surveillance System (BRFSS) shows that residents of non-metropolitan counties were significantly less likely than residents of metropolitan counties to report having a dental visit or teeth cleaning in the past year and significantly more likely to report undergoing tooth extraction. These findings persisted even when controlling for demographic factors, income, insurance and health and smoking status. Policies aimed at increasing the supply of generalist dentists who will choose to work in rural areas may reduce these substantial rural/urban disparities in access to oral health care and dental outcomes.
  • Graduate Medical Education Financing: Sustaining Medical Education in Rural Places
    WWAMI Rural Health Research Center
    Date: 05/2015
    Rural Training Track (RTT) graduate medical education (GME) programs have shown success at preparing family physicians for rural practice, but financial difficulties have contributed to program closures. This policy brief reports on a survey of RTT directors and administrators across the U.S. to understand their finances.
  • Variability in General Surgical Procedures in Rural and Urban U.S. Hospital Inpatient Settings
    WWAMI Rural Health Research Center
    Date: 03/2015
    This report addresses rural/urban differences in surgical practices in commonly performed inpatient surgical procedures that are typically handled by general surgeons. National Inpatient Sample data from rural and urban hospitals in 24 states were used to examine the frequency of general surgical procedures, complications during hospitalizations and predicted resource demand. Findings indicate that rural hospitals concentrated on relatively common, low complexity procedures that can be handled by general surgeons, especially if they have received additional training in obstetrics/gynecology and orthopedics. Resource demand, length of stay, complication rates and mortality were lower for patients undergoing common procedures in rural hospitals. Rural training tracks for general surgery that provide a high case load for common general surgery, obstetrics/gynecology and orthopedics procedures may help sustain the general surgery workforce in rural areas.

2014

2013

2012

2011

2010

  • The Future of Family Medicine and Implications for Rural Primary Care Physician Supply (Final Report)
    WWAMI Rural Health Research Center
    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.
  • Family Medicine Residency Training in Rural Locations (Final Report)
    WWAMI Rural Health Research Center
    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.
  • Quality of Care for Acute Myocardial Infarction: Are the Gaps Between Rural and Urban Hospitals Closing?
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 03/2010

    Many simple, evidence-based guidelines that improve acute myocardial infarction outcomes are inadequately implemented in both rural and urban hospitals. Overall, there has been improvement in acute myocardial infarction quality measures, and persistent rural-urban disparities in only a few. Particularly in small and remote small rural locations, developing strategies to increase use of beneficial discharge medications is important.

2009

  • Persistent Primary Care Health Professional Shortage Areas (HPSAs) and Health Care Access in Rural America
    Policy Brief
    WWAMI Rural Health Research Center
    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.

  • The Aging of the Primary Care Physician Workforce: Are Rural Locations Vulnerable?
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 06/2009

    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.

  • The Availability of Family Medicine Residency Training in Rural Locations of the United States
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 06/2009

    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.

  • The Future of Family Medicine and Implications for Rural Primary Care Physicians
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 06/2009

    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.

  • The Crisis in Rural Dentistry
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 04/2009

    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.

  • The Crisis in Rural General Surgery
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 04/2009

    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.

  • The Crisis in Rural Primary Care
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 04/2009

    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.

  • Threats to the Future Supply of Rural Registered Nurses
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 04/2009

    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.

2008

2007

  • 2005 Physician Supply and Distribution in Rural Areas of the United States (Full Report)
    WWAMI Rural Health Research Center
    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)
    WWAMI Rural Health Research Center
    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.
  • Access to Cancer Services for Rural Colorectal Cancer Patients (Project Summary)
    WWAMI Rural Health Research Center
    Date: 10/2007
    Brief overview of findings from a study to determine how far rural and urban colorectal cancer (CRC) patients travel to three types of specialty cancer care services: surgery, medical oncology consultation, and radiation oncology consultation.
  • Changes in the Rural Registered Nurse Workforce from 1980 to 2004 (Final Report)
    WWAMI Rural Health Research Center
    Date: 10/2007
    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.
  • Changes in the Rural Registered Nurse Workforce from 1980 to 2004 (Project Summary)
    WWAMI Rural Health Research Center
    Date: 10/2007
    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.
  • Health Center Expansion and Recruitment Survey 2004: Results by Health and Human Services Regions and Health Center Geography
    WWAMI Rural Health Research Center
    Date: 03/2007
    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.
  • The Washington State Nurse Anesthetist Workforce: A Case Study
    WWAMI Rural Health Research Center
    Date: 02/2007
    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.
  • A National Study of Lifetime Asthma Prevalence and Trends in Metro and Non-Metro Counties, 2000-2003 (Full Report)
    WWAMI Rural Health Research Center
    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%).
  • A National Study of Lifetime Asthma Prevalence and Trends in Metro and Non-Metro Counties, 2000-2003 (Project Summary)
    WWAMI Rural Health Research Center
    Date: 01/2007
    Brief overview of 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. A full report is also available.

2006

  • Registered Nurse Vacancies in Federally Funded Health Centers
    WWAMI Rural Health Research Center
    Date: 12/2006
    Discusses the registered nurse (RN) vacancy rate in federally funded health centers, which varies by degree of rurality.
  • Results of the 2004 Health Center Expansion and Recruitment Survey for Health Centers: Analyses for Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI States)
    WWAMI Rural Health Research Center
    Date: 11/2006
    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.
  • Rural Dental Practice: A Tale of Four States (Full Report)
    WWAMI Rural Health Research Center
    Date: 03/2006
    Reports the findings of a study investigating rural dentist issues, such as demography, training, practice characteristics, staff, and job satisfaction, in Alabama, California, Maine, and Missouri. Generally, dentists and their work patterns were similar across the four states. Dentist practices varied dramatically across states regarding staffing patterns. Vacancy rates for dental hygienists varied greatly from state to state, ranging from 35 percent to 6 percent, while dental assistant vacancy rates varied from 12 percent to 4 percent. Dentist Medicaid participation and volume differed widely across the states. The majority of dentists in the four states were satisfied with their professional life, but the percentage who felt they were too busy or not busy enough varied widely among the states.
  • Rural Dental Practice: A Tale of Four States (Project Summary)
    WWAMI Rural Health Research Center
    Date: 03/2006
    Overview results of a survey of rural dentists in Alabama, California, Maine, and Missouri. Provides charts and statistics on dentist demographics, dental hygienist and dental assistant vacancy rates, and dentist participation in Medicaid. A full report is also available.
  • The Changing Geography of Americans Graduating from Foreign Medical Schools
    WWAMI Rural Health Research Center
    Date: 02/2006
    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.
  • Do International Medical Graduates "Fill the Gap" in Rural Primary Care in the United States?
    WWAMI Rural Health Research Center
    Date: 2006
    Compares the practice locations of international medical graduates (IMGs) and U.S. medical graduates (USMGs) in primary care specialties. Report available by contacting the Center.
  • Problem Drinking: Rural and Urban Trends in America 1995/97 to 2003
    WWAMI Rural Health Research Center
    Date: 2006
    Examines recent trends in heavy and binge drinking in urban counties and three types of rural counties.
  • Shortages of Medical Personnel At Community Health Centers: Implications for Planned Expansion
    WWAMI Rural Health Research Center
    Date: 2006
    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.
  • Will Rural Family Medicine Residency Training Survive?
    WWAMI Rural Health Research Center
    Date: 2006
    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.

2005

  • Dentist Vacancies in Federally Funded Health Centers
    WWAMI Rural Health Research Center
    Date: 12/2005
    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
    WWAMI Rural Health Research Center
    Date: 11/2005
    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
    WWAMI Rural Health Research Center
    Date: 10/2005
    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
    WWAMI Rural Health Research Center
    Date: 08/2005
    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
    WWAMI Rural Health Research Center
    Date: 05/2005
    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.
  • Geographic Access to Health Care for Rural Medicare Beneficiaries
    WWAMI Rural Health Research Center
    Date: 04/2005
    This study looked at where Medicare beneficiaries of five states obtain their care, how far they travel for that care, and the mix of physician specialties from whom they obtain their ambulatory care. Findings from this study suggest that rural residents do not rely on urban areas for the majority of their care. Those living in small and isolated rural areas have decreased geographic access to healthcare providers, particularly specialists, and rely heavily on generalists for the majority of their care. Additionally, results of the study suggest that these individuals have few visits overall and must travel longer distances to access certain types of care. These findings have policy implications for geographic reimbursement differentials, telehealth networks, and graduate medical education. Report available upon request by contacting the Center.
  • Heavy And Binge Drinking In Rural America: A Comparison Of Rural And Urban Counties From 1995/1997 Through 1999/2001
    WWAMI Rural Health Research Center
    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 the Center.
  • The Flight of Physicians From West Africa: Views of African Physicians and Implications for Policy
    WWAMI Rural Health Research Center
    Date: 2005
    West African-trained physicians have been migrating from the sub-continent to rich countries, primarily the US and the UK, since medical education began in Nigeria and Ghana in the 1960s. In 2003, we visited six medical schools in West Africa to investigate the magnitude, causes and consequences of the migration. We conducted interviews and focus groups with faculty, administrators (deans and provosts), students and post-graduate residents in six medical schools in Ghana and Nigeria. In addition to the migration push and pull factors documented in previous literature, we learned that there is now a well-developed culture of medical migration. This culture is firmly rooted, and does not simply fail to discourage medical migration but actually encourages it. Medical school faculty are role models for the benefits of migration (and subsequent return), and they are proud of their students who successfully emigrate.
  • The 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
    WWAMI Rural Health Research Center
    Date: 2005
    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

  • Access to Specialty Health Care for Rural American Indians: Provider Perceptions in Two States
    WWAMI Rural Health Research Center
    Date: 10/2004
    Examines access to specialty services among rural Indian populations in Montana and New Mexico, based on a survey sent to primary care providers addressing access to specialty physicians, perceived barriers to access, and access to nonphysician clinical services. Report available by contacting the Center.
  • Characterizing the General Surgery Workforce in Rural America
    WWAMI Rural Health Research Center
    Date: 05/2004
    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 by contacting the Center.
  • American Indians and Alaska Natives: How Do They Find Their Path to Medical School?
    WWAMI Rural Health Research Center
    Date: 01/2004
    Describes the findings of a study to understand the paths of American Indian and Alaska Native (AI/AN) students who successfully entered medical school.
  • Obesity Prevalence In Rural Counties: A National Study
    WWAMI Rural Health Research Center
    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 by contacting the Center.

2003

  • Prevalence And Trends In Smoking: A National Rural Study
    WWAMI Rural Health Research Center
    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 by contacting the Center.
  • The Contribution of Nurse Practitioners and Physician Assistants to Generalist Care in Underserved Areas of Washington State
    WWAMI Rural Health Research Center
    Date: 08/2003
    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
    WWAMI Rural Health Research Center
    Date: 08/2003
    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
  • Who is Caring for the Underserved? A Comparison of Primary Care Physicians and Nonphysician Clinicians in California and Washington
    WWAMI Rural Health Research Center
    Date: 07/2003
    Compares the geographic distribution and patient populations of physician and nonphysician primary care clinicians. Includes the proportion of clinicians within each discipline practicing in rural areas, Health Professional Shortage Areas (HPSAs), and areas with vulnerable populations.
  • The Effects of the 1997 Balanced Budget Act on Family Practice Residency Training Programs
    WWAMI Rural Health Research Center
    Date: 2003
    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
    WWAMI Rural Health Research Center
    Date: 10/2002
    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 Research Focus: Rural Physician Shortages
    WWAMI Rural Health Research Center
    Date: 05/2002
    Discusses a model for understanding how many physicians a rural community can support, based on research at the WWAMI Rural Health Research Center.
  • 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?
    WWAMI Rural Health Research Center
    Date: 03/2002
    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. Report available by contacting the Center.

2001

  • How Many Physicians Can a Rural Community Support? A Practice Income Potential Model for Washington State
    WWAMI Rural Health Research Center
    Date: 04/2001
    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.
  • Gender-Related Factors in the Recruitment of Generalist Physicians to the Rural Northwest
    WWAMI Rural Health Research Center
    Date: 02/2001
    Examines differences in the factors female and male generalist physicians considered influential in their rural practice location choice and identifies the practice arrangements that attracted female generalist physicians to rural areas. Findings include: women were more likely than men to have been influenced in practice choice by issues related to spouse/personal partner, flexible scheduling, family leave, and availability of childcare; women were more highly influenced by the interpersonal aspects of recruitment; and men and women were equally likely to consider community factors, practice content, practice partner compatibility, and financial issues. Findings indicate that rural communities and practices recruiting physicians should place high priority on practice scheduling, spouse/partner, and interpersonal issues in the recruiting process if they want to achieve a gender-balanced physician workforce. Report available by contacting the Center.

2000

  • U.S. Medical Schools and the Rural Family Physician Gender Gap
    WWAMI Rural Health Research Center
    Date: 05/2000
    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.

1999

  • The Production of Rural Female Generalists by U.S. Medical Schools
    WWAMI Rural Health Research Center
    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 the rural 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. Report available by contacting the Center.
  • Metropolitan, Urban and Rural Commuting Areas: Toward a Better Depiction of the U.S. Settlement System
    WWAMI Rural Health Research Center
    Date: 1999
    Discontent with the current definition of metropolitan areas and the lack of differentiation within nonmetropolitan territory provided the incentive for the research presented here. Census tracts rather than counties were used as the building blocks for assignment of tracts, not just to metropolitan areas, but also to larger towns (10,000 to 49,999) and to smaller urban places (2,500 to 9,999). The analysis used 1990 census-defined urbanized areas and tract-to-tract commuter flows. Results include a modest shift of population from metropolitan to nonmetropolitan, as well as a significant reduction in the areal size of metropolitan areas, disaggregation of many areas, and frequent reconfiguration to a more realistic settlement form.