1. The Future Supply of Rural Family Doctors The WWAMI Rural Health Research Center The WWAMI Center for Health Workforce Studies Spokane Rural Health Conference - 2004

2. How Many Physicians Are There?

3. Total Active Physicians

4. What do Physicians do? Primary care versus specialization

5. Definition of Primary Care Institute of Medicine Accessibility Comprehensiveness Coordination Continuity Accountability

6. Incentives for Specialization in the United States Health Care System Higher income Greater prestige Technological mastery Personal autonomy

7. Growth of Number of Recognized Medical Specialties

8. Percentage of Primary Care and Non-Primary Care Physicians primary care non-primary care

9. What is happening to Family Medicine?

10. Family Medicine Residency Positions: 1992 - 2004

11. What is happening to the supply of rural physicians?

12. Physicians per 100,000 Population by Location

13. Patient Care Physicians per 100,000 Population by Location and Specialty rural metro

14. UW students choosing family medicine (% of graduating class)

15. Results of 2004 Family Medicine Match in the WWAMI states – All Programs

16. Results of the 2004 Family Medicine Match in the WWAMI States – Urban Sites

17. Results of the 2004 Family Medicine Match in the WWAMI States – Rural Programs

18. Per cent of family medicine training that takes place in rural areas

19. Closures of Family Medicine Training Programs: 2000 - 2004

20. Career choices of graduating med students and the impact of total student debt

21. Which students choose to become family physicians?

22. First Tentative Conclusions: Declining interest in family medicine Increasing student debt - important at the margin Persistent salary disparities Increased emphasis on “life-style” control Cultural factors - very sensitive to broader societal trends

23. Second Tentative Conclusions:Greater challenges for rural recruitment Family medicine - and all of primary care - is becoming increasingly a female occupation Increasing diversity of medical school class makes rural practice less likely Falling family medicine match rates has led to closure of residency programs - disproportionately in rural areas

25. So what are we doing about it? UW Pipeline committee Targeted research on student debt, student career choice and the well-being of rural-based residency programs Engaging our rural constituency - that means all of us

26. Where will we find the doctors? They are already there - living and going to school in rural areas.

27. The future is waiting for us

28. We still have mountains to climb