1. U.S. rural physician workforce and Medical education Frederick M. Chen, M.D., M.P.H. Meredith Fordyce, Ph.D. Gary Hart, Ph.D. WWAMI Rural Health Research Center University of Washington Seattle, Washington

2. Purpose of Project 2005 IOM report on rural health quality –Health IT systems –Appropriate financing –Rural health workforce Continuing need for physicians in rural areas

3. Project Aims Describe current rural physician workforce Identify which medical schools, residencies produce rural physicians Compare osteopathic and allopathic schools

4. Hypotheses 1.Majority of rural physicians are produced by a small subset of medical schools. 2.Physicians trained in osteopathic medical schools are more likely to locate in rural areas 3.Type and location of residency programs are an influence on production of rural physicians

5. 1992 Study 1991 AMA Masterfile Graduates from 1976-1985 MD physicians only No RUCA codes, used metro/non-metro areas at county level Examined medical schools, characteristics

6. Current Study National, cross-sectional 2005 AMA and AOA Masterfiles Graduates from 1988-1997 –Delay allows for residency training, established practice RUCA codes Medical schools and residency programs, rural locations

7. Methods Clinically active, patient care physicians Removed residents from analyses N=175,649 Geocoded practice ZIP codes to RUCAs Selected most recent residency for family physicians (only for >97%)

8. Results 164,385 (94%) MDs 11,264 (6%) DOs 11% practicing in rural areas –18% DO –11% MDs

9. Percent rural physicians

10. Rural Distribution by Physician Type

11. Percent rural physicians by specialty

12. More female rural physicians

14. Top 10 rural medical schools - 1992 South Dakota North Dakota Mississippi Arkansas East Carolina Southern Illinois New Mexico Kentucky Minnesota West Virginia

15. Top rural DO schools (n=16) West Virginia - 41% Oklahoma St - 30% AT Still - Kirksville - 27% Kansas City - 21% Ohio University - 21% Univ of New England - 20%

16. Percentage of Rural Family Physician residency graduates by Residency State

18. Rural residency training 36% of MD graduates from rural residencies are in rural practice 50% of DO graduates from rural residencies are in rural practice Rural residency graduates 3 times more likely to practice in rural area RR=3.4, p<.001

19. Conclusions Rural physician production appeared stable Family physicians, osteopaths more likely to practice in rural Stable group of medical schools produce most rural physicians Rural residency programs more likely to produce rural physicians

20. Conclusions Doesn’t reflect the most recent trends and changes How will it be affected by medical school expansion?