Workforce

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.

2021

2020

2019

  • Community Health Worker Roles and Responsibilities in Rural and Urban America
    Policy Brief
    Southwest Rural Health Research Center
    Date: 11/2019
    The primary aim of this study was to understand the evolving profession of community health workers (CHWs) in the U.S. Through focus groups in rural and urban regions of four states, we explored CHW roles and responsibilities, the growing professionalization of the field, and evolving interactions between CHWs and other care providers.
  • The Development of Telehealth Laws in the U.S. from 2008 to 2015: A Legal Landscape
    Policy Brief
    Southwest Rural Health Research Center
    Date: 11/2019
    This study examines the scope and evolving nature of telehealth statutes and regulations in the U.S. Our research aims to understand changes in telehealth laws over time (2008-2015), variations in legal frameworks established across the U.S., and the extent that state laws regulate the primary care delivery through the use of telehealth.
  • Preparing Physicians for Rural Practice: Availability of Rural Training in Rural-Centric Residency Programs
    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 Nurse Practitioners and Physician Assistants Waivered to Prescribe Buprenorphine and the Barriers They Experience Prescribing Buprenorphine
    WWAMI Rural Health Research Center
    Date: 10/2019
    This study surveyed rural and urban nurse practitioners (NPs) and physician assistants (PAs) with Drug Enforcement Agency waivers to provide medication treatment for opioid use disorder by prescribing buprenorphine. Rural NPs and PAs reported facing many of the same barriers to providing buprenorphine as rural physicians have reported.
  • RN-to-BSN Programs: Challenges for Rural Nurse Education
    Policy Brief
    Rural and Minority Health Research Center
    Date: 10/2019
    To ascertain the status of rural-focused nursing education, we surveyed registered nurse to bachelor of science in nursing (RN-to-BSN) programs. Using an American Association of Colleges of Nursing mailing list, surveys were mailed to all schools with RN-to-BSN programs. This report summarizes responses from the 237 that completed surveys.
  • Rural Registered Nurses: Educational Preparation, Workplace, and Salary
    Policy Brief
    Rural and Minority Health Research Center
    Date: 10/2019
    Using national data from census data from the 2011-2015 American Community Survey Public Use Microdata Sample, this brief looks at the reported education levels and worksites of rural and urban registered nurses.
  • Perceived Facilitators and Barriers to Rural Nursing Practice
    Policy Brief
    Rural and Minority Health Research Center
    Date: 08/2019
    A web-based survey was disseminated to a geographically diverse sample of nurses throughout the U.S. to assess perceived barriers and facilitators to nursing practice; job satisfaction; and self-identified challenges in nursing work environments and patient care. Of particular interest were nurses in ambulatory care practices.

2018

2017

2016

  • Do Residencies that Aim to Produce Rural Family Physicians Offer Relevant Training?
    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.
  • 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.
  • State Variations in the Rural Obstetric Workforce
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2016
    Many types of staff are necessary to successfully run an obstetrics unit. Rural hospitals face unique staffing challenges. This policy brief describes the obstetric workforce in rural hospitals by state for nine states: Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin.
  • 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.
  • 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.
  • 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.

2015

2014

2013

2012

2011

2010

2009

  • Workforce Issues Among Sole Community Pharmacies
    North Carolina Rural Health Research and Policy Analysis Center, RUPRI Center for Rural Health Policy Analysis
    Date: 07/2009
    This brief explores the shared experiences of sole community pharmacist-owners regarding the challenges facing the pharmacy workforce in their communities and their concerns about their pharmacies' futures.
  • 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 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 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.
  • 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.
  • The Crisis in Rural Dentistry
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 04/2009
    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 the rural dentist supply, 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 decline in the number of rural general surgeons has caused a crisis. General surgeons are vital to the rural healthcare 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
    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.
  • 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 the coming years as the "baby boom" generation retires and as RNs commute to larger towns and urban areas for work.
  • The Key Role of Sole Community Pharmacists in Their Local Healthcare Delivery Systems
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 03/2009
    This brief presents findings from a survey of 401 community pharmacists who are the only retail providers in their communities. It documents their extended relationships with other healthcare providers and the additional healthcare services these pharmacists provide to their patients.
  • A Rural-Urban Comparison of Allied Health Average Hourly Wages
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 01/2009
    This report uses data from the Bureau of Labor Statistics to describe the extent to which rural-urban differentials exist in wages for 11 allied health professions, focusing on professions that are both likely to be found in rural communities and have adequate data to support hourly wage estimates.
  • Do International Medical Graduates (IMGs) "Fill the Gap" in Rural Primary Care in the United States? A National Study
    WWAMI Rural Health Research Center
    Date: 2009
    Compares the practice locations of international medical graduates (IMGs) and U.S. medical graduates (USMGs) in primary care specialties.

2008

2007

2006

2005

  • Dentist Vacancies in Federally Funded Health Centers
    WWAMI Rural Health Research Center
    Date: 12/2005
    This project summary presents results for dentists from a study of staffing needs at Federally Qualified Health Centers (FQHCs). It provides information on dentist vacancy rates by rural and urban location and compares dentist vacancies to other healthcare provider vacancies at FQHCs.
  • The State of Rural Hospital Nursing and Allied Health Professional Shortages
    Southwest Rural Health Research Center
    Date: 12/2005
    This study estimated shortages of nurses and allied health personnel among rural hospitals to gauge the difficulty experienced by rural hospitals in recruiting such personnel. The study also examined strategies these hospitals use in recruitment and retention of nurses and addressed strategies that might effectively address such shortages.
  • 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.
  • Washington State Hospitals: Results of the 2005 Workforce Survey
    WWAMI Rural Health Research Center
    Date: 10/2005
    A survey of nonfederal acute care hospitals found growth in Washington's hospital sector is keeping demand for healthcare occupations high, even when vacancy rates for some jobs appear to be lower than in the past. This growth, and the shift away from contracting employees, should be considered in future workforce supply and demand projections.
  • 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: 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.
  • 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.
  • Community Health Worker (CHW) Certification and Training: A National Survey of Regionally and State-Based Programs
    Southwest Rural Health Research Center
    Date: 05/2005
    This report details the results of a qualitative study of states providing a national overview of state policy and state involvement in the standardized training and certification of community health workers.
  • 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.
  • Rural Health Research in Progress in the Rural Health Research Centers Program, 9th Edition
    Maine Rural Health Research Center
    Date: 02/2005
    This book provides policymakers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current that affects rural health services and populations.
  • Recruitment and Retention of EMTs: A Qualitative Study
    Rural and Minority Health Research Center
    Date: 2005
    Emergency medical technicians (EMTs) are critical to out-of-hospital care, but maintaining staff can be difficult. The study objective was to identify factors that contribute to recruitment and retention of EMTs and paramedics.

2004

2003

2002

  • Accounting for Graduate Medical Education Funding in Family Practice Training
    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.
  • 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.

  • Rural Populations and Health Care Providers: A Map Book
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 09/2002
    This book uses 2000 Census data to reassess and provide a picture of where rural people live, how the racial and ethnic nature of rural populations are changing, and whether the distribution of healthcare providers matches the population distribution.
  • Rural-Urban Differences in the Public Health Workforce: Findings From Local Health Departments in three Rural Western States
    WWAMI Rural Health Research Center
    Date: 07/2002

    Most local health departments or districts are small and rural; two thirds of the nation's 2832 local health departments serve populations smaller than 50,000 people. Rural local health departments have small staffs and slender budgets, yet they are expected to provide a wide array of services during a period when the healthcare system of which they are a part is undergoing change.

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

  • 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.
  • State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
    Maine Rural Health Research Center
    Date: 05/2002
    This paper investigates whether and the extent to which licensure laws that determine the permissible scope of practice for each of these professions may affect the availability of mental health services, particularly in rural communities.
  • 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.
  • Essential Research Issues in Rural Health: The State Rural Health Directors' Perspective
    NORC Walsh Center for Rural Health Analysis
    Date: 03/2002
    This policy brief describes the key issues confronting state rural health directors. Issues repeatedly raised by directors from a wide variety of states included workforce, telemedicine, emergency medical services, mental health, and lack of local data.
  • 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.

2001

2000

  • Rural Hospital Area Wages and the PPS Wage Index: 1900-1997
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2000
    This paper examines the hospital wage index used by the Health Care Financing Administration and its effects on rural hospitals.
  • U.S. Medical Schools and the Rural Family Physician Gender Gap
    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 Distribution of Rural Female Generalist Physicians in the United States
    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.
  • Educating Generalist Physicians for Rural Practice: How Are We Doing?
    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.

1999

  • 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.
  • Dimensions of Retention: A National Study of the Locational Histories of Physician Assistants
    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.

1998

  • 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.

1997

  • The National Health Service Corps: Rural Physician Service and Retention
    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.