Susan M. Skillman, MS

WWAMI Rural Health Research Center

Phone: 206.543.3557
Email: skillman@uw.edu

University of Washington
4311 Eleventh Ave. NE, Suite 210
Seattle, WA 98105


Current Projects - (1)


Completed Projects - (13)

  • Access to Home Care Services in the Rural United States
    This study will identify and describe the scope of home health services required to meet current and future needs in rural areas of the U.S., identify current and anticipated barriers to accessing those needs, and describe ways that may help overcome these barriers.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Home health
  • Assessing Rural-Urban Nurse Practitioner Supply and Distribution in 12 States Using Available Data Sources
    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.
    Research center: WWAMI Rural Health Research Center
    Topics: Nurses, Physicians, Workforce
  • Community College's Contributions to the Education of Allied Health Professionals in Rural Areas of the U.S.
    This study will identify rural-serving community colleges across the U.S. and their 5-year graduation trends for specific allied health professions, examine the spectrum of how rural allied health professions education currently is being allocated and delivered, and explore how community economic status and estimated regional allied health workforce demand is associated with the availability of rural community college allied health education programs.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Workforce
  • Current Contribution of Physicians, Advanced Practice Nurses, and Physician Assistants to the Rural Primary Care Workforce
    This two-year, multi-state study is examining the practices of rural physicians, nurse practitioners (NPs), and physician assistants (PAs) regarding their primary care visit productivity and scope of practice. Through surveys, this study will examine the contributions of physicians, NPs, and PAs by state, degree of practice rurality, practice characteristics, and primary care HPSA status in order to provide information on a range of rural primary care workforce needs.
    Research center: WWAMI Rural Health Research Center
    Topics: Nurse practitioners, Nurses, Physician assistants, Physicians, Workforce
  • Factors Associated with Rural-Residing Registered Nurses' Choices to Work in Urban Locations and Larger Rural Cities
    While larger numbers of registered nurses (RNs) are living in rural areas, research from the WWAMI RHRC shows that since 1980, a growing percentage are commuting from rural residences to work within urban and larger rural cities. This study will explore factors that may be associated with RNs' decisions to commute away from their rural areas of residence to work in less rural areas.
    Research center: WWAMI Rural Health Research Center
    Topics: Nurse practitioners, Nurses, Physician assistants, Workforce
  • Health Information Technology (HIT) Workforce Needs in Rural America
    Health care increasingly relies on effective health information technology (HIT) to capture and exchange key patient information, and requires a trained workforce to implement this technology. To understand the specific needs and constraints of rural health systems to employ an effective HIT workforce, this study will survey rural primary care clinics across the country to determine their current and projected level of HIT adoption and demand for workers with HIT skills.
    Research center: WWAMI Rural Health Research Center
    Topics: Health information technology, Workforce
  • HIT Workforce Development in Rural-Serving Community Colleges
    This study will describe trends in the number of students completing Health Information Technology (HIT) programs in community colleges located near rural populations in the U.S.; assess the extent to which these programs have incorporated, or plan to incorporate, components of the recently released community college curriculum by the Office of the National Coordinator for HIT (ONC) into their programs; and identify factors that affect the ability of programs to reach rural student populations.
    Research center: WWAMI Rural Health Research Center
    Topics: Health information technology, Technology, Workforce
  • Long Term Trends in Characteristics of the Rural Nurse Workforce: A National Health Workforce Study
    This national study characterizes changes in the demographic, education and practice characteristics of registered nurses (RNs) in rural and urban areas from 1980 to 2004. This study provides important information for projecting future trends in rural RN supply.
    Research center: WWAMI Rural Health Research Center
    Topics: Nurse practitioners, Nurses, Physician assistants, Workforce
  • Practice Characteristics of Rural Nurse Practitioners in the United States
    This study will use data from HRSA’s first National Sample Survey of Nurse Practitioners (NSSNP) to expand on the agency’s basic descriptive analyses of rural and urban nurse practitioners (NPs).
    Research center: WWAMI Rural Health Research Center
    Topics: Nurses, Workforce
  • The Rural/Urban Practice Location Patterns of Women Medical School Graduates
    While women are becoming an increasingly large percentage of the graduates of medical schools, they are much less likely to locate their practices in rural towns. This study involved a survey including questions about where the residents preferred to locate and how much they thought they would be practicing in the future.
    Research center: WWAMI Rural Health Research Center
    Topics: Physicians, Women, Workforce
  • Use of Home Health Services among High Risk Rural Medicare Patients: Patient, Service, and Community Factors Associated with Hospital Readmission
    This study will examine the 60-day post-acute care outcomes of rural Medicare patients who were discharged from hospitals and admitted to home health care services. Key predictors include home health services provided, type of Medicare home health reimbursement, and available community health care resources.
    Research center: WWAMI Rural Health Research Center
    Topics: Home health, Hospitals and clinics, Medicare
  • Use of Recommended Radiation Therapy in the Rural U.S.
    This study will use cancer registry data from 10 U.S. states to examine which rural cancer patients are receiving recommended radiation therapy, and what factors influence receipt of recommended treatment. Identifying gaps in radiation therapy will inform cancer centers, rural program planners, and policy makers in rural cancer service locations and cancer support program development.
    Research center: WWAMI Rural Health Research Center
    Topics: Chronic diseases and conditions, Health services
  • What Strategies Are Nurse Practitioner Educational Programs Using to Encourage Rural Practice?
    This study will quantify and describe nurse practitioner (NP) education programs that encourage NPs to practice in rural areas, and identify data sources that could be used in future studies of the effectiveness of these programs.
    Research center: WWAMI Rural Health Research Center
    Topics: Nurse practitioners, Nurses, Physician assistants, Workforce

Publications - (30)

  • Access to Health Information Technology Training Programs at the Community College Level
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 11/2015
    Successful implementation of health information technology (HIT) in rural areas depends on a well-trained HIT workforce, and community colleges are key in producing this workforce. This study examined HIT workforce development programs in community colleges to find their strengths and needs.
  • 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.
  • The Aging of the Rural Primary Care Physician Workforce: Will Some Locations Be More Affected than Others?
    WWAMI Rural Health Research Center
    Date: 09/2013
    This report shows that as the aging primary care physician population retires, rural provider shortages will be further exacerbated.
  • Assessing Rural-Urban Nurse Practitioner Supply and Distribution in 12 States Using Available Data Sources
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 08/2015
    This study compared estimates of nurse practitioner supply in 12 states (statewide and rural vs. urban) derived from two sources: state license records and National Provider Identifier data.
  • Availability of Anesthesia Personnel in Rural Washington and Montana
    WWAMI Rural Health Research Center
    Date: 03/1998
    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.
  • Changes in the Rural Registered Nurse Workforce from 1980 to 2004 (Final Report)
    WWAMI Rural Health Research Center
    Date: 10/2007
    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 registered nurse 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, healthcare is frequently challenged by uneven distribution of healthcare providers, including nurses. This report shows changes in the rural RN workforce from 1980 to 2004.
  • Characteristics of Rural RNs Who Live and Work in Different Communities
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 09/2012
    This policy brief explores why many registered nurses living in rural areas of the United States leave their communities to work in other rural and urban communities.
  • Characteristics of Rural RNs Who Live and Work in Different Communities (Final Report)
    WWAMI Rural Health Research Center
    Date: 09/2012
    This study explores factors associated with registered nurses' decisions to commute away from their rural areas of residence for work.
  • 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.
  • 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.
  • The Contribution of Physicians, Physician Assistants, and Nurse Practitioners Toward Rural Primary Care: Findings from a 13-state Survey
    WWAMI Rural Health Research Center
    Date: 06/2014

    This study quantifies the average weekly number of outpatient primary care visits and the types of services provided within and beyond the outpatient setting by physicians, physician assistants (PAs), and nurse practitioners (NPs) in rural areas. Findings suggest that although a greater reliance on PAs and NPs in rural primary care settings would have a minor impact on outpatient practice volume, this shift might reduce the availability of services that have more often been traditionally provided by rural primary care physicians beyond the outpatient clinic setting.

  • The Contribution of Physicians, Physician Assistants, and Nurse Practitioners Toward Rural Primary Care: Findings from a 13-State Survey
    WWAMI Rural Health Research Center
    Date: 06/2014
    Evaluates a questionnaire that measures weekly outpatient visits and services provided in a rural setting.
  • The Contributions of Community Colleges to the Education of Allied Health Professionals in Rural Areas of the United States
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 10/2012
    This policy brief describes where community college allied health education programs (of those most relevant to rural healthcare delivery) are located in relation to rural populations and small rural hospitals.
  • The Contributions of Community Colleges to the Education of Allied Health Professionals in Rural Areas of the United States (Final Report)
    WWAMI Rural Health Research Center
    Date: 10/2012
    Community colleges educate a significant portion of the nation's allied health workforce, and because they have a history of educating residents of their communities for local jobs, they are important to the economies of many rural communities.
  • The Effects of the 1997 Balanced Budget Act on Family Practice Residency Training Programs
    WWAMI Rural Health Research Center
    Date: 2003
    This study assessed the impact of the Balanced Budget Act (BBA) of 1997 on family practice residency training programs in the United States.
  • Family Medicine Training in Rural Areas
    WWAMI Rural Health Research Center
    Date: 09/2002

    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.

  • Graduate Medical Education Financing: Sustaining Medical Education in Rural Places
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 05/2015
    Rural Training Track (RTT) graduate medical education 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.
  • Health Information Technology Workforce Needs of Rural Primary Care Practices
    WWAMI Rural Health Research Center
    Date: 07/2014
    Assesses electronic health records and heath information technology workforce resources that are needed by rural primary care practices to manage the increasing patient populations.
  • The Migration of Physicians From Sub-Saharan Africa to the United States of America: Measures of the African Brain Drain
    WWAMI Rural Health Research Center
    Date: 2004
    The objective of this paper is to describe the numbers, characteristics, and trends in the migration to the United States of physicians trained in sub-Saharan Africa.
    Methods: We used the American Medical Association 2002 Masterfile to identify and describe physicians who received their medical training in sub-Saharan Africa and are currently practicing in the USA.
    Results: More than 23% of America's 771 491 physicians received their medical training outside the USA, the majority (64%) in low-income or lower middle-income countries. A total of 5334 physicians from sub-Saharan Africa are in that group, a number that represents more than 6% of the physicians practicing in sub-Saharan Africa now. Nearly 86% of these Africans practicing in the USA originate from only three countries: Nigeria, South Africa and Ghana. Furthermore, 79% were trained at only 10 medical schools.
    Conclusions: Physician migration from poor countries to rich ones contributes to worldwide health workforce imbalances that may be detrimental to the health systems of source countries. The migration of over 5000 doctors from sub-Saharan Africa to the USA has had a significantly negative effect on the doctor-to-population ratio of Africa. The finding that the bulk of migration occurs from only a few countries and medical schools suggests policy interventions in only a few locations could be effective in stemming the brain drain.
  • Nurse Practitioner Autonomy and Satisfaction in Rural Settings
    WWAMI Rural Health Research Center
    Date: 01/2016
    Compares urban and rural primary care nurse practitioners (NPs) by practice location in urban, large rural, small rural, or isolated small rural areas by using analysis of the 2012 National Sample Survey of NPs.
  • 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
    This policy brief finds that resources are needed to increase and sustain the number of primary care providers and reduce financial barriers to care in all rural primary care health professional shortage areas.
  • Prehospital Emergency Medical Services Personnel in Rural Areas: Results from a Survey in Nine States
    Report
    WWAMI Rural Health Research Center
    Date: 08/2015
    This study examines supply and demand for emergency response personnel, the involvement of medical directors, and the availability of medical consultation in rural and urban emergency service personnel (EMS) agencies in nine states.
  • The Productivity of Washington State's Obstetrician-Gynecologist Workforce: Does Gender Make a Difference?
    WWAMI Rural Health Research Center
    Date: 2004
    Objective: To compare the practice productivity of female and male obstetrician-gynecologists in Washington State.
    Methods: The primary data collection tool was a practice survey that accompanied each licensed practitioner's license renewal in 1998-1999. Washington State birth certificate data were linked with the licensure data to obtain objective information regarding obstetric births.
    Results: Of the 541 obstetrician-gynecologists identified, two thirds were men and one third were women. Women were significantly younger than men (mean age 43.3 years versus 51.7 years). Ten practice variables were evaluated: total weeks worked per year, total professional hours per week, direct patient care hours per week, nondirect patient care hours per week, outpatient visits per week, inpatient visits per week, percent practicing obstetrics, number of obstetrical deliveries per year, percentage working less than 32 hours per week, and percentage working 60 or more hours per week. Of these, only 2 variables showed significant differences: inpatient visits per week (women 10.1 per week, men 12.8 per week, P <= .01) and working 60 or more hours per week (women 22.1% versus men 31.5%, P <= .05). After controlling for age, analysis of covariance and multiple logistic regression confirmed these findings and in addition showed that women worked 4.1 fewer hours per week than men (P < .01). When examining the ratio of female-to-male practice productivity in 10-year age increments from the 30-39 through the 50-59 age groups, a pattern emerged suggesting lower productivity in many variables in the women in the 40-49 age group.
    Conclusion: Only small differences in practice productivity between men and women were demonstrated in a survey of nearly all obstetrician-gynecologists in Washington State. Changing demographics and behaviors of the obstetrician-gynecologist workforce will require ongoing longitudinal studies to confirm these findings and determine whether they are generalizable to the rest of the United States.
  • Recruitment of Non-U.S. Citizen Physicians to Rural and Underserved Areas through Conrad State 30 J-1 Visa Waiver Programs
    Report
    WWAMI Rural Health Research Center
    Date: 07/2015
    Conrad 30 programs allow international medical graduates (IMGs) on J-1 visas to remain in the U.S. after their residencies to provide healthcare for medically underserved populations. Information from state health department personnel was used to characterize national trends in waivers and factors related to states’ successful recruitment of IMGs.
  • Rural Residency Training for Family Medicine Physicians: Graduate Early-Career Outcomes
    WWAMI Rural Health Research Center
    Date: 01/2012
    This policy brief describes the characteristics of family physicians who have completed graduate medical education in Rural Training Track residency programs and their outcomes in terms of practice in rural communities, health professional shortage areas, and safety net facilities.
  • Rural Residency Training for Family Medicine Physicians: Graduate Early-Career Outcomes, 2008-2012
    WWAMI Rural Health Research Center
    Date: 01/2013
    This policy brief provides an update on the rural and shortage area practice outcomes of family physicians who have completed graduate medical education in Rural Training Track (RTT) residency programs.
  • Support for Rural Recruitment and Practice among U.S. Nurse Practitioner Education Programs
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 05/2014
    This brief details nurse practitioner (NP) education programs across the United States to identify those actively promoting NP practice in rural areas. It also describes the use of education methods that may promote rural practice and identifies barriers to recruiting rural students and providing rural NP clinical training.
  • Training Physicians for Rural Practice: Capitalizing on Local Expertise to Strengthen Rural Primary Care
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 01/2011
    This policy brief explains the challenges of ensuring sufficient numbers of well-prepared family physicians for rural communities and describes the Rural Training Track (RTT) Technical Assistance Program, a strategy to utilize local expertise in sustaining the “1-2” RTT as a national model for training physicians for rural practice.
  • 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.