Rural Health
Research Gateway

Physicians

Research Products & Journal Articles

Browse the full list of research publications on this topic completed by the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

  • 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.
  • 2005 Physician Supply and Distribution in Rural Areas of the United States (Project Summary)
    WWAMI Rural Health Research Center
    Date: 11/2007
    This summary describes the 2005 supply and distribution of physicians (including osteopathic physicians and international medical graduates), with particular emphasis on generalists in rural areas.
  • Access to Specialty Health Care for Rural American Indians in Two States
    Journal Article
    WWAMI Rural Health Research Center
    Date: 06/2008
    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.
  • Accounting for Graduate Medical Education Funding in Family Practice Training
    Journal Article
    WWAMI Rural Health Research Center
    Date: 10/2002
    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.
  • Addressing Social Determinants of Health in Family Medicine Practices
    Journal Article
    Rural and Underserved Health Research Center
    Date: 10/2023
    This study evaluated physician, practice, and community characteristics as health care system elements to determine the ability of a primary care practice to address social determinants of health.
  • 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 retirements threaten access to primary care and offers potential solutions to the problem.
  • 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.
  • American Indians and Alaska Natives: How Do They Find Their Path to Medical School?
    WWAMI Rural Health Research Center
    Date: 01/2004
    This paper describes the findings of a study to understand the paths of American Indian and Alaska Native students who successfully entered medical school.
  • An Analysis of Medicare's Incentive Payment Program for Physicians in Health Professional Shortage Areas
    Journal Article
    WWAMI Rural Health Research Center
    Date: 03/2004
    The Medicare Incentive Payment program provides a 10 percent bonus payment to physicians who treat patients in Health Professional Shortage Areas (HPSAs). Results show that physicians eligible for the bonus payments often did not claim them, and physicians who likely did not work in approved HPSA sites, claimed the bonus payments and received them.
  • Assessing the Impact of Rural Provider Service Mix on the Primary Care Incentive Payment Program
    RUPRI Center for Rural Health Policy Analysis
    Date: 12/2013
    Under the Primary Care Incentive Payment Program (PCIP), if certain evaluation and management services represented 60% or more of Medicare allowable charges, the provider qualified for a 10% bonus calculated on the primary care portion of allowable charges. This brief assesses the impact of the rural provider service mix on the PCIP.
  • Attitudes of Family Physicians in Washington State Toward Physician-Assisted Suicide
    Journal Article
    WWAMI Rural Health Research Center
    Date: 02/2003
    Physician-assisted suicide is difficult and controversial. With recent laws allowing physicians to assist in a terminally ill patient's suicide under certain circumstances, the debate concerning the appropriate and ethical role for physicians has intensified. This paper utilizes data from a 1997 survey of family physicians in Washington.
  • 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.
  • Changes in the Supply and Rural-Urban Distribution of Psychiatrists in the U.S., 1995-2019
    Fact Sheet
    WWAMI Rural Health Research Center
    Date: 10/2022
    There are rural vs. urban disparities and unequal distribution of behavioral health providers across U.S. Census Divisions. This study examined the trends in the supply of psychiatrists by rural-urban status and Census Division.
  • Changes in the Supply of Physicians With a DEA DATA Waiver to Prescribe Buprenorphine for Opioid Use Disorder
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 05/2017
    This project mapped the location of physicians with a DEA DATA 2000 waiver to prescribe buprenorphine for opioid use disorder in July 2012 and April 2016. The number of counties without a waivered physician and the ratio of waivered physicians per 100,000 population is reported by the rural/urban status of the county.
  • 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 United States will decline further.
  • Colorectal Cancer Screening in Rural and Urban Primary Care Practices Amid Implementation of the Medicare Access and CHIP Reauthorization Act
    Journal Article
    Rural and Underserved Health Research Center
    Date: 06/2023
    This study examined whether colorectal cancer screening rates improved among rural and urban primary care practices amid implementation of the Medicare Access and CHIP Reauthorization Act. Researchers tested for rural/urban differences and changes in screening rates between 2016 and 2020.
  • 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
    Journal Article
    WWAMI Rural Health Research Center
    Date: 06/2014
    Evaluates a questionnaire that measures weekly outpatient visits and services provided in a rural setting.
  • County-Level Availability of Obstetric Care and Economic Implications of Hospital Closures on Obstetric Care
    Policy Brief
    Center for Economic Analysis of Rural Health
    Date: 07/2022
    This policy brief draws out demographic and economic differences between counties with obstetric care facilities and those without. It provides descriptive data on the economic changes underway in counties that lost obstetric care facilities between 2012 and 2019.
  • The Crisis in Rural Primary Care
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 04/2009
    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/retention of rural primary care providers.
  • Declining Endoscopic Care by Family Physicians in Both Rural and Urban Areas
    Journal Article
    Rural and Underserved Health Research Center
    Date: 07/2019
    This paper explores the decline in the percentage of family physicians providing endoscopic services overall and in urban and rural areas. This has implications on the availability of colonoscopies, endoscopies, and flexible sigmoidoscopies in areas that lack specialists who perform such services.
  • The Declining Scope of Practice of Family Physicians Is Limited to Urban Areas
    Journal Article
    Rural and Underserved Health Research Center
    Date: 11/2020
    The scope of practice for family medicine physicians has decreased in recent years. Using survey data, researchers compared family medicine physicians' scope of practice scores based on rural-urban status and other variables. Researchers found statistically significant decreases in scope of practice scores in urban settings.
  • Differences in the Merit-Based Incentive Payment System (MIPS) Performance of Clinicians in Metropolitan and Nonmetropolitan Counties in 2018
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2023
    This brief describes rural clinician performance in the Merit-based Incentive Payment System in 2018, testing the supposition that they did not do as well as their urban counterparts.
  • Dimensions of Retention: A National Study of the Locational Histories of Physician Assistants
    Journal Article
    WWAMI Rural Health Research Center
    Date: 1999
    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.
  • The Distribution of Rural Female Generalist Physicians in the United States
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2000
    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.
  • The Distribution of the General Surgery Workforce in Rural and Urban America in 2019
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 03/2021
    Researchers examined the 2019 per capita supply of general surgeons in rural and urban areas of the U.S. and compared those results to a similar study of general surgeon supply conducted in 2001. Researchers also examined change in the regional distribution and age and gender characteristics of general surgeons since 2001.
  • Do Residencies That Aim to Produce Rural Family Physicians Offer Relevant Training?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 09/2016
    Examines the rural-centric family medicine residencies, their training locations, and rurally relevant skills training provided. Rural training can promote rural practice, but the number of family medicine residencies with a rural focus, geographic distribution of training, and training content are poorly understood.
  • Early-Career and Graduating Physicians More Likely to Prescribe Buprenorphine
    Journal Article
    Rural and Underserved Health Research Center
    Date: 01/2020
    Only a small percentage of people who need treatment for opioid use disorder receive it, including buprenorphine. This paper shows differences in rates of prescribing buprenorphine and intentions to prescribe buprenorphine between early- and mid-to-late career family physicians, based on a survey of physicians taking a certification examination.
  • Educating Generalist Physicians for Rural Practice: How Are We Doing?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2000
    About 20 percent of Americans live in rural areas, 9 percent of physicians practice there. Physicians consistently settle in metropolitan, suburban, and other nonrural areas. This report summarizes the successes/failures of medical education and government initiatives intended to prepare and place more generalist physicians in rural practice.
  • The Effect of Health Information Technology on Quality in U.S. Hospitals
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 04/2010
    This study examines changes in quality of care following adoption of electronic health records among a national sample of U.S. hospitals from 2004 to 2007. The use of computerized physician order entry and electronic health records resulted in significant improvements in two quality measures; larger effects in academic than nonacademic hospitals.
  • The Effect of Medicare Payment Policy Changes on Rural Primary Care Practice Revenue
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2014
    This policy brief describes the impact of recent Medicare payment updates to the Geographic Practice Cost Indices portion of the Medicare Physician Fee Schedule on rural primary care providers' practice revenue from Medicare.
  • The Effect of the Doctor-Patient Relationship on Emergency Department Use Among the Elderly
    Journal Article
    WWAMI Rural Health Research Center
    Date: 01/2000
    OBJECTIVES: This study sought to determine the rate of emergency department use among the elderly and examined whether that use is reduced if the patient has a principal-care physician.
    METHODS: The Health Care Financing Administration's National Claims History File was used to study emergency department use by Medicare patients older than 65 years in Washington State during 1994. RESULTS: A total of 18.1% of patients had 1 or more emergency department visits during the study year; the rate increased with age and illness severity. Patients with principal-care physicians were much less likely to use the emergency department for every category of disease severity. After case mix, Medicaid eligibility, and rural/urban residence were controlled for, the odds ratio for having any emergency department visit was 0.47 for patients with a generalist principal-care physician and 0.58 for patients with a specialist principal-care physician.
    CONCLUSIONS: The rate of emergency department use among the elderly is substantial, and most visits are for serious medical problems. The presence of a continuous relationship with a physician--regardless of specialty--may reduce emergency department use.
  • The Effects of the 1997 Balanced Budget Act on Family Practice Residency Training Programs
    Journal Article
    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 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
    This paper examines how much rural family practice training is taking place in the United States. 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.
  • Family Medicine Residency Training in Rural Locations (Final Report)
    WWAMI Rural Health Research Center
    Date: 07/2010
    This survey of family medicine residency programs found 33 rural programs accounted for more than 80% of family medicine training in rural sites. Expansion of rural family medicine training is limited by Medicare graduate medical education funding caps, financial hardships facing rural hospitals, and the challenges of creating programs.
  • 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.
  • Family Medicine Training in Rural Areas
    Journal Article
    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.

  • Family Physician Vacancies in Federally Funded Health Centers
    WWAMI Rural Health Research Center
    Date: 11/2005
    This project summary presents results for family physicians from a study of staffing needs at Federally Qualified Health Centers (FQHCs). The summary provides information on family physician vacancy rates by rural and urban location and compares family physician vacancies to other physician vacancies at FQHCs.
  • The Flight of Physicians From West Africa: Views of African Physicians and Implications for Policy
    Journal Article
    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.
  • The Future of Family Medicine and Implications for Rural Primary Care Physician Supply (Final Report)
    WWAMI Rural Health Research Center
    Date: 08/2010
    This report 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 healthcare.
  • The Future of Family Medicine and Implications for Rural Primary Care Physicians
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 06/2009
    The shortage of providers in rural areas is being worsened by the decline in student interest in 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 healthcare delivery.
  • Gender-Related Factors in the Recruitment of Generalist Physicians to the Rural Northwest
    WWAMI Rural Health Research Center
    Date: 02/2001
    This paper 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.
  • Geographic Access to Health Care for Rural Beneficiaries in Five States: An Update
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 04/2021
    Using data from five states, this study describes the mix of providers caring for rural Medicare beneficiaries, the quantity of care received, and how far rural beneficiaries traveled for care for several selected conditions in 2014. Results are also compared with a similar study of the same states that used data from 1998.
  • Geographic Access to Health Care for Rural Medicare Beneficiaries: A National Study
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 09/2021
    Using national data from 2014, this policy brief describes geographic variation in the mix of providers caring for rural versus urban Medicare beneficiaries, the quantity of visits received by beneficiaries across Census Divisions and types of rural areas, and the distance traveled for care for several serious conditions.
  • Geographic and Specialty Distribution of U.S. Physicians Trained to Treat Opioid Use Disorder
    Journal Article
    WWAMI Rural Health Research Center
    Date: 01/2015
    Examines the distribution of physicians authorized to treat opioid use disorder in the United States, and proposes increasing access to office-based treatment as a promising strategy to address rising rates of opioid use disorder in rural areas.
  • Geographic Distribution of Providers With a DEA Waiver to Prescribe Buprenorphine for the Treatment of Opioid Use Disorder: A 5‐Year Update
    Journal Article
    WWAMI Rural Health Research Center
    Date: 06/2018
    This study compares the geographic distribution of physicians, physician assistants, and nurse practitioners waivered to prescribe buprenorphine in 2012 and 2017.
  • Geographic Variation in the Supply of Selected Behavioral Health Providers
    Journal Article
    WWAMI Rural Health Research Center
    Date: 06/2018
    This study examined the supply of select behavioral health providers by metropolitan, micropolitan, and non-core county and Census Division. Psychiatrists, psychologists, and psychiatric nurse practitioners are unequally distributed throughout the U.S., with disparities between Census Divisions and rural vs. urban areas.
  • 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.
  • 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.
  • 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.
  • How Many Physicians Can a Rural Community Support? A Practice Income Potential Model for Washington State
    WWAMI Rural Health Research Center
    Date: 04/2001
    This report addresses the ability of smaller and underserved rural communities to financially support needed physicians. It reports on an experimental simulation model that projects potential practice income for primary care physicians in rural communities of Washington state.
  • The Immediate and Future Role of the J-1 Visa Waiver Program for Physicians: The Consequences of Change for Rural Health Care Service Delivery
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2002
    This paper examines the consequences for the delivery of healthcare 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.
  • 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
    Journal Article
    WWAMI Rural Health Research Center
    Date: 09/2005
    Examined 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 debt is one of the factors that explains the recent decline in students' interest in family medicine and primary care.
  • Increases in Primary Care Physician Income Due to the Patient Protection and Affordable Care Act of 2010--Continued Tweaking of Physician Payment
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2010
    In this brief, the Affordable Care Act-authorized primary care payment adjustments are modeled in a prototypical rural primary care practice to assess both the potential impact on physician personal income and the likelihood that the changes will achieve the desired policy outcome.
  • Is Large Really Beautiful? Physician Practice in Small Versus Large Scale Communities
    University of Minnesota Rural Health Research Center
    Date: 09/2005
    This paper examines the effect of community size on how physicians view their practices as reported by respondents to two waves (1996-97 and 1998-99) of a national sample survey conducted as part of the Community Tracking Study. Results suggest that bigger is not necessarily better when it comes to physicians' perceptions of their practices.
  • Key Environmental Health Competencies for Rural Primary Care Providers
    Policy Brief
    West Virginia Rural Health Research Center
    Date: 05/2010
    Providing healthcare that considers environmental determinants of health, environmental impact on health, and outcomes attributed to environmental issues is complex because of the need for providers to be competent not only in social and health sciences, but also in environmental health concepts.
  • Key Environmental Health Competencies for Rural Primary Care Providers (Final Report)
    West Virginia Rural Health Research Center
    Date: 03/2010
    The purpose of this study was to develop a set of basic environmental health competencies that are needed by all rural primary care providers to direct healthcare and education policy.
  • Meaningful Use of Health Information Technology by Rural Hospitals
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 01/2011
    This study examines the current status of meaningful use of health information technology in Critical Access Hospitals (CAHs) and other rural and urban U.S. hospitals, and it discusses the potential role of Medicare payment incentives and disincentives in encouraging CAHs and other rural hospitals to achieve meaningful use.
  • Medicare Beneficiary Access to Primary Care Physicians -- Better in Rural, but Still Worrisome
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2011
    In this policy brief, results from a large national physician survey are used to assess U.S. primary care physician and general surgeon willingness to accept Medicare patients and physician-reported reasons for not accepting Medicare patients.
  • Medicare Physician Payment
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2003
    This rural policy brief examines how the Resource-Based Relative Value Scale has replaced the 25-year-old Medicare CPR charge system.
  • Medicare Physician Payment: Impacts of Changes on Rural Physicians
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2006
    This policy brief provides an overview of the effects of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 on physician payment rates in rural areas. The brief discusses the effects of the Medicare incentive payment for providing services in shortage areas and of the bonus for practicing in a physician scarcity area.
  • Medicare Physician Payment: Practice Expense
    RUPRI Center for Rural Health Policy Analysis
    Date: 10/2003
    This rural policy brief examines the physician practice expense component of Medicare payment, which proportionately results in greater geographic physician payment variation than does the physician work payment. The practice expense adjustment warrants careful validation to demonstrate that the index measures actual geographic cost differences.
  • The Migration of Physicians From Sub-Saharan Africa to the United States of America: Measures of the African Brain Drain
    Journal Article
    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.
  • More May Be Better: Evidence of a Negative Relationship Between Physician Supply and Hospitalization for Ambulatory Care Sensitive Conditions
    Journal Article
    Rural and Minority Health Research Center
    Date: 2005
    The authors conducted an empirical test of the relationship between physician supply and hospitalization for ambulatory care sensitive conditions.
  • The National Health Service Corps: Rural Physician Service and Retention
    Journal Article
    WWAMI Rural Health Research Center
    Date: 07/1997
    The National Health Service Corps (NHSC) scholarship program is the most ambitious program in the US designed to supply physicians to underserved areas, in addition the NHSC promotes long-term retention of physicians in the areas to which they were initially assigned. This study explores some of the issues involved in retention in rural areas.
  • 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.
  • Pathways to Rural Practice: A Chartbook of Family Medicine Residency Training Locations and Characteristics
    WWAMI Rural Health Research Center
    Date: 08/2005
    This chartbook discusses the characteristics and geography of family medicine residency programs' rural locations, types of rural family medicine training by location, and rural mission of family medicine residencies.
  • Patient-Centered Medical Home Services in 29 Rural Primary Care Practices: A Work in Progress
    RUPRI Center for Rural Health Policy Analysis
    Date: 09/2011
    This brief discusses responses from 29 rural physician practices. When asked about the use of specific policies/procedures included as criteria to certify patient-centered medical homes, fewer of them would qualify in each of five domains, including access to care, population-based, quality, care management, and clinical information management.
  • Practice Predictors of Buprenorphine Prescribing by Family Physicians
    Journal Article
    Rural and Underserved Health Research Center
    Date: 01/2020
    Physicians may prescribe buprenorphine if they obtain a waiver, but relatively few family physicians do so. This paper examines the association between practice characteristics and the likelihood that a family physician will prescribe buprenorphine, based on a survey of physicians seeking board certification in family medicine.
  • Preparing Physicians for Rural Practice: Availability of Rural Training in Rural-Centric Residency Programs
    Journal Article
    WWAMI Rural Health Research Center
    Date: 10/2019
    This study surveyed physician residency programs in anesthesiology, emergency medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, and psychiatry to describe training locations and rural-specific content of rural-centric residency programs (those requiring at least eight weeks of rurally located training).
  • Prescribing Practices of Rural Physicians Waivered to Prescribe Buprenorphine
    Journal Article
    WWAMI Rural Health Research Center
    Date: 06/2018
    This study finds more than 60% of rural counties don't have a physician waivered to prescribe buprenorphine, which is used to treat opioid use disorder.
  • Primary Care Clinician Participation in the CMS Quality Payment
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2019
    Approximately 10% of primary care clinicians participate in Advanced Alternative Payment Models (A-APMs) and less than 30% of primary care clinicians participate in the Merit-Based Incentive Payment System. Metropolitan primary care clinicians are more likely to participate in A-APMs than nonmetropolitan primary care clinicians.
  • The Production of Rural Female Generalists by U.S. Medical Schools
    WWAMI Rural Health Research Center
    Date: 05/1999
    This paper compares the production of rural female generalists among medical schools. Data from the AMA Physician Masterfile for the 1988-1996 graduate cohort were used 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.
  • The Productivity of Washington State's Obstetrician-Gynecologist Workforce: Does Gender Make a Difference?
    Journal Article
    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.
  • Professional Liability Issues and Practice Patterns of Obstetrical Providers in Washington State
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2006
    Objective: To describe recent changes in obstetric practice patterns and liability insurance premium costs and their consequences to Washington State obstetric providers (obstetrician-gynecologists, family physicians, certified nurse midwives, licensed midwives).
    Methods: All obstetrician-gynecologists, rural family physicians, certified nurse midwives, licensed midwives, and a simple random sample of urban family physicians were surveyed about demographic and practice characteristics, liability insurance characteristics, practice changes and limitations due to liability insurance issues, obstetric practices, and obstetric practice environment changes.
    Results: Fewer family physicians provide obstetric services than obstetrician-gynecologists, certified nurse midwives, and licensed midwives. Mean liability insurance premiums for obstetric providers increased by 61% for obstetrician-gynecologists, 75% for family physicians, 84% for certified nurse midwives, and 34% for licensed midwives from 2002 to 2004. Providers' most common monetary responses to liability insurance issues were to reduce compensation and to raise cash through loans and liquidating assets. In the 2 years of markedly increased premiums, obstetrician-gynecologists reported increasing their cesarean rates, their obstetric consultation rates, and the number of deliveries. They reported decreasing high-risk obstetric procedures during that same period.
    Conclusion: Liability insurance premiums rose dramatically from 2002 to 2004 for Washington's obstetric providers, leading many to make difficult financial decisions. Many obstetric providers reported a variety of practice changes during that interval. Although this study's results do not document an impending exodus of providers from obstetric practice, rural areas are most vulnerable because family physicians provide the majority of rural obstetric care and are less likely to practice obstetrics.
  • The Proximity of Rural African American and Hispanic/Latino Communities to Physicians and Hospital Services
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 06/2001
    This paper assesses how local physician concentrations and distances to hospitals differ for rural communities of varying African-American and Hispanic/Latino compositions.
  • Proximity of Rural African-American and Hispanic/Latino Communities to Physicians and Hospital Services
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 05/2001
    This brief reports the findings of a study of how the African-American and Hispanic/ Latino composition of rural communities relates to local physician concentrations and relates to distances to hospitals offering various levels of services.
  • The Racial and Ethnic Diversity of the Family Physician Workforce in Non-Metropolitan and Metropolitan Counties
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 06/2022
    Racial/ethnic concordance of clinicians and patients may improve health outcomes by increasing access to care for underserved populations. Our objective was to determine the distribution of family physicians (FPs) in rural areas by race/ethnicity and also whether rural minority FPs were more likely to be in underserved rural areas.
  • 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 and Urban Differences in Primary Care Pain Treatment by Clinician Type
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 04/2020
    In this brief, we compare 2017 opioid prescribing rates among physicians and nurse practitioners within primary care practices and how these differ for rural versus urban areas.
  • Rural and Urban Physicians: Does the Content of Their Medicare Practices Differ?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 1999
    Rural and urban areas have significant differences in the availability of medical technology, medical practice structures and patient populations. This study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physicians practicing in rural and urban areas.
  • Rural Dimensions of Medicare Reimbursement for Inpatient and Outpatient Institutional and Physician Services
    NORC Walsh Center for Rural Health Analysis
    Date: 12/2002
    This report examines major Medicare payment policies from the rural perspective and summarizes major payment policies with explicit rural dimensions that directly affect physicians and hospitals. It looks at whether direct rural impacts are consistent with legislative and regulatory intentions.
  • Rural Family Physicians Have a Broader Scope of Practice Than Urban Family Physicians
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2018
    While the scope of practice of family physicians has been shrinking, they still practice broadly, often due to fewer health care resources in rural areas. Using data from family physicians seeking continued board certification in 2014 and 2015, we found that a high percentage of rural family physicians provide nearly every clinical service queried.
  • Rural Family Physicians in Patient Centered Medical Homes Have a Broader Scope of Practice
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2018
    The Patient Centered Medical Home (PCMH) is supposed to provide accessible and comprehensive care. Using data from family physicians seeking to continue their American Board of Family Medicine certification in 2014 and 2015, we found that rural family physicians in PCMH practices generally provide more services than those in non-PCMH practices.
  • Rural Hospital and Physician Participation in Private Sector Quality Initiatives
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 10/2015
    This project examined private sector quality reporting and quality improvement initiatives being implemented by dominant insurers in states with significant rural populations. The policy brief profiles 12 initiatives, half focused on physician quality improvement and half focused on hospital quality improvement.
  • Rural Hospital Employment of Physicians and Use of Cesareans and Nonindicated Labor Induction
    Journal Article
    University of Minnesota Rural Health Research Center
    Date: 03/2017
    Findings are shared from a study that discovered the types of doctors employed at rural hospitals may make a difference in the rates of cesarean births.
  • Rural Implications of the Primary Care Incentive Payment Program
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2013
    This policy brief reports on eligibility among rural primary care providers for the Primary Care Incentive Payments established in the Patient Protection and Affordable Care Act.
  • Rural Physicians' Acceptance of New Medicare Patients
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2004
    Findings are presented regarding rural physicians' acceptance of new Medicare patients from an analyses of national survey data of urban and rural respondents, published studies, and results of a survey of state organizations representing physicians.
  • Rural Primary Care Physician Payment 2006-2009: What a Difference Three Years Doesn't Make
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2009
    The analysis in this brief shows the impact of Medicare's Evaluation and Management (E&M) service valuation adjustment (implemented January 1, 2007) on two prototypical primary care practices—one providing only E&M services and the other providing a mix of procedures and E&M services.
  • Rural Research Focus: Rural Physician Shortages
    WWAMI Rural Health Research Center
    Date: 05/2002
    This paper discusses a model for understanding how many physicians a rural community can support, based on research at the WWAMI Rural Health Research Center.
  • 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.
  • Satisfaction With Practice and Decision to Relocate: An Examination of Rural Physicians
    NORC Walsh Center for Rural Health Analysis
    Date: 05/2009
    The goal of this project was to improve our understanding of the dynamics of physician practice location decision making.
  • Shortages of Medical Personnel At Community Health Centers: Implications for Planned Expansion
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2006
    Examines the status of workforce shortages that may limit Community Health Center (CHC) expansion by surveying all 846 federally-funded US CHCs that directly provide clinical services and are within the 50 states and the District of Columbia.
  • Supply and Distribution of the Primary Care Workforce in Rural America: 2019
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 06/2020
    Maintaining an adequate supply of primary care providers in the U.S. is one of the key challenges in rural healthcare. This study examines the 2019 supply and geographic distribution of primary care physicians, nurse practitioners, and physician assistants across rural areas of the U.S.
  • Supply and Distribution of the Primary Care Workforce in Rural America: A State-Level Analysis
    Report
    WWAMI Rural Health Research Center
    Date: 06/2020
    Maintaining an adequate supply of primary care providers in the U.S. is one of the key challenges in rural health care. This study examines the 2019 supply and geographic distribution of primary care physicians, nurse practitioners, and physician assistants across rural areas of the U.S., providing state-level data briefs.
  • The Supply and Rural-Urban Distribution of the Obstetrical Care Workforce in the U.S.
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 06/2020
    Monitoring the supply of the obstetrical (OB) care workforce is important for identifying areas that may lack OB care access. This brief describes the supply and geographic distribution of obstetricians, advanced practice midwives, midwives (not advanced practice), and family physicians in rural versus urban counties.
  • The Supply and Rural-Urban Distribution of the Obstetrical Care Workforce in the U.S. - A State-Level Analysis
    Report
    WWAMI Rural Health Research Center
    Date: 06/2020
    Monitoring the supply of the obstetrical (OB) care workforce is important for identifying areas that may lack OB care access. This set of data briefs describes the supply and geographic distribution of obstetricians, advanced practice midwives, midwives (not advanced practice), and family physicians in rural versus urban counties for every state.
  • 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
    Journal Article
    WWAMI Rural Health Research Center
    Date: 05/2000
    Women comprise increasing proportions of med school graduates. They tend to choose primary care but are less likely than men to choose rural practice. This study identified the U.S. medical schools most successful at producing rural family physicians and general practitioners of both genders.
  • The U.S. Rural Physician Workforce: Analysis of Medical School Graduates From 1988-1997
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 10/2008
    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.
  • The U.S. Rural Physician Workforce: Analysis of Medical School Graduates From 1988-1997 (Final Report)
    WWAMI Rural Health Research Center
    Date: 10/2008
    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.
  • Understanding and Overcoming Barriers to Rural Obstetric Training for Family Physicians
    Journal Article
    WWAMI Rural Health Research Center
    Date: 03/2023
    Family physicians are the most common health professional providing rural obstetric (OB) care, but the number of family physicians practicing OB is declining. This mixed-methods study aimed to inform policy and practice solutions to address the training landscape and inform sustainable initiatives for rural family medicine obstetrical training.
  • Understanding and Overcoming Barriers to Rural Training in Family Medicine Obstetrics Fellowships
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 06/2023
    This policy brief describes the results of a survey on the characteristics and challenges faced by rurally oriented family medicine obstetrics fellowship programs. All survey respondents reported their programs had a mission to train family physicians for rural practice, yet less than one-third of programs reported they required rural training.
  • Urban-Rural Flows of Physicians
    Journal Article
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 2007
    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.
  • Use of Electronic Health Records to Manage Tobacco Screening and Treatment in Rural Primary Care
    Journal Article
    Maine Rural Health Research Center
    Date: 09/2021
    This study compares the performance of rural and urban primary care providers in adhering to evidence-based smoking-related standards of care and assesses the degree to which electronic health record use was related to improved adherence to these standards in the practice of rural versus urban providers.
  • Use of Health Information Technology in Support of Patient-Centered Medical Homes Is Low Among Non-Metropolitan Family Medicine Practices
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2011
    Are physician practices, especially non-metropolitan primary care practices, ready to become patient-centered medical homes? We use a nationwide survey of physician practices to partially answer this question, focusing on the use of health information technology.
  • Variation in Primary Care Service Patterns by Rural-Urban Location
    Journal Article
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2016
    Examines primary care physician service patterns by rural-urban location and discusses effect on recruitment strategies for primary care providers in rural communities.
  • Who Is Caring for the Underserved? A Comparison of Primary Care Physicians and Nonphysician Clinicians in California and Washington
    Journal Article
    WWAMI Rural Health Research Center
    Date: 07/2003
    This article compares the geographic distribution and patient populations of physician and nonphysician primary care clinicians. It includes the proportion of clinicians within each discipline practicing in rural areas, health professional shortage areas, and areas with vulnerable populations.
  • Why Do Rural Primary-Care Physicians Sell Their Practices?
    University of Minnesota Rural Health Research Center
    Date: 06/2000
    This study evaluates why rural primary care physicians sell their practices. It examines the factors that led independent physicians to sell their practices to either non-local buyers, local hospitals, or local physicians.
  • Will Rural Family Medicine Residency Training Survive?
    Journal Article
    WWAMI Rural Health Research Center
    Date: 2006
    This report shares the results of a study examining the recent performance of rural residencies in the National Resident Matching Program as an indicator of their viability.
  • WWAMI Physician Workforce 2005
    WWAMI Rural Health Research Center
    Date: 05/2005
    This report responds to a request by the University of Washington School of Medicine Primary Care Steering Committee to examine the current supply and distribution of physicians in the WWAMI region.
  • Wyoming Physicians Are Significant Providers of Safety Net Care
    Journal Article
    WWAMI Rural Health Research Center
    Date: 11/2006
    Describes the contributions of family and general practice physicians from Wyoming to the health care safety net.