Expanding the opioid use disorder medication treatment workforce in rural communities through the RCORP initiative.

Purpose: The Rural Communities Opioid Response Program (RCORP) was funded to help rural communities improve prevention, treatment, and recovery services for Opioid Use Disorder (OUD), including increasing the supply of clinicians with a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine, which was required before 2023. This research investigates the impact of RCORP funding on the supply of DEA-waivered clinicians in rural communities.

Methods: We used 2017-2022 DEA lists of waivered clinicians to assign clinicians to US counties.

Impact of Primary Care Exception Expansion on Family Medicine Resident Billing During the COVID-19 Pandemic.

Background And Objectives: The Medicare Primary Care Exception (PCE) permits indirect supervision of residents performing lower-complexity visits in primary care settings. During the COVID-19 pandemic, Medicare expanded the PCE to all patient visits regardless of complexity. This study investigates how PCE expansion changed resident billing practices at a family medicine residency during calendar year 2020.

Routes to Rural Readiness: Enhancing Clinical Training Experiences for Physician Assistants.

Purpose: The purpose of this study was to describe practices and experiences of rurally oriented physician assistant (PA) training programs in providing rural clinical training to PA students.

Methods: A survey of PA program directors (PDs) included questions about program characteristics, student and clinical preceptor (CP) recruitment in rural areas, and barriers to, and facilitators of, rural clinical training. Programs that considered rural training "very important" to their goals were identified.

Understanding and Overcoming Barriers to Rural Obstetric Training for Family Physicians.

Background And Objectives: Family physicians are the most common health professional providing rural obstetric (OB) care, but the number of family physicians practicing OB is declining. To address rural/urban disparities in parental and child health, family medicine must provide robust OB training to prepare family physicians to care for parent-newborn dyads in rural communities. This mixed-methods study aimed to inform policy and practice solutions.

Growing a rural family physician workforce: The contributions of rural background and rural place of residency training.

Objective: To determine the distinct influences of rural background and rural residency training on rural practice choice among family physicians.

Data Sources And Study Setting: We used a subset of The RTT Collaborative rural residency list and longitudinal data on family physicians from the American Board of Family Medicine National Graduate Survey (NGS; three cohorts, 2016-2018) and American Medical College Application Service (AMCAS).

Study Design: We conducted a logistic regression, computing predictive marginals to assess associations of background and residency location with physician practice location 3 years post-residency.

A Match Made in Rural: Interpreting Match Rates and Exploring Best Practices.

Background And Objectives: Although rural family medicine residency programs are effective in placing trainees into rural practice, many struggle to recruit students. Lacking other public measures, students may use residency match rates as a proxy for program quality and value. This study documents match rate trends and explores the relationship between match rates and program characteristics, including quality measures and recruitment strategies.

Rural Versus Urban Family Medicine Residency Scope of Training and Practice.

Background And Objectives: Little is known about how rural and urban family medicine residencies compare in preparing physicians for practice. This study compared the perceptions of preparation for practice and actual postgraduation scope of practice (SOP) between rural and urban residency program graduates.

Methods: We analyzed data on 6,483 early-career, board-certified physicians surveyed 2016-2018, 3 years after residency graduation, and 44,325 later-career board-certified physicians surveyed 2014-2018, every 7 to 10 years after initial certification.

Academic Achievement and Competency in Rural and Urban Family Medicine Residents.

Background And Objectives: The quality of training in rural family medicine (FM) residencies has been questioned. Our objective was to assess differences in academic performance between rural and urban FM residencies.

Methods: We used American Board of Family Medicine (ABFM) data from 2016-2018 residency graduates.

Measuring the Impact of the COVID-19 Pandemic on Health Behaviors and Health Care Utilization in Rural and Urban Patients with Cancer and Cancer Survivors.

Healthcare access and health behaviors differ between those living in urban and rural communities and contribute to inequitable cancer health outcomes. The COVID-19 pandemic led to significant disruptions in daily life and healthcare delivery. This cross-sectional survey aimed to measure the impact of the COVID-19 pandemic on the health behaviors of cancer patients and survivors, comparing outcomes for urban and rural respondents.

Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US.

Background: Diagnostic testing and treatment recommendations can vary when medical care is sought by individuals for low back pain (LBP), leading to variation in quality and costs of care. We examine how the first provider seen by an individual at initial diagnosis of LBP influences downstream utilization and costs.

Methods: Using national private health insurance claims data, individuals age 18 or older were retrospectively assigned to cohorts based on the first provider seen at the index date of LBP diagnosis.

Faculty and Resident Contraceptive Opt Outs and Training Site Restrictions: A CERA Study.

Background And Objectives: Contraception is a core component of family medicine residency curriculum. Institutional environments can influence residents' access to contraceptive training and thus their ability to meet the reproductive health needs of their patients.

Methods: Contraceptive training questions were included in the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors.

Brief online implicit bias education increases bias awareness among clinical teaching faculty.

Problem And Purpose: Healthcare provider implicit bias influences the learning environment and patient care. Bias awareness is one of the key elements to be included in implicit bias education. Research on education enhancing bias awareness is limited.

Gender Differences in Authorship of Family Medicine Publications, 2002-2017.

Background And Objectives: Representation of women in medicine is increasing, including in academic family medicine. Despite this, women continue to hold a minority of senior faculty and leadership roles. This study examines the trends of women first and senior authorship between 2002 and 2017 in five family medicine journals: Family Medicine, Journal of Family Practice, Journal of the American Board of Family Medicine, Annals of Family Medicine, and American Family Physician.

Tracking the geographic distribution and growth of clinicians with a DEA waiver to prescribe buprenorphine to treat opioid use disorder.

Purpose: Buprenorphine is an effective medication treatment for opioid use disorder (MOUD) but access is difficult for patients, especially in rural locations. To improve access, legislation, including the Comprehensive Addiction and Recovery Act (2016) and the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act (2018), extended the ability to get a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine to treat opioid use disorder (OUD) to numerous types of clinicians. This study updates the distribution of waivered clinicians as of July 2020 and notes regional and geographic differences.

Pipelines to Pathways: Medical School Commitment to Producing a Rural Workforce.

Purpose: Despite the efforts of numerous medical schools to produce rural physicians, many rural communities in the United States still experience physician shortages. This study describes the current landscape of rural efforts in US undergraduate medical education and catalogs medical school characteristics and activities that evidence has suggested, and that many experts in rural medical education believe, may result in more graduates choosing rural practice.

Methods: This is a descriptive study of publicly available and rurally relevant characteristics of all 182 allopathic and osteopathic medical schools operating in the 50 states and the District of Columbia in 2016, with rural program information for these schools updated in 2019.

Comparing the Health Workforce Provider Mix and the Distance Travelled for Mental Health Services by Rural and Urban Medicare Beneficiaries.

Purpose: To describe the mix of health professionals who care for rural and urban seniors suffering from mood and/or anxiety disorders, the quantity of services they receive, and to understand where beneficiaries receive care for mood and/or anxiety disorders and the distance and time they travel for care.

Methods: We used 2014 Medicare administrative claims data to examine access to health care for fee-for-service Medicare beneficiaries aged ≥ 65 years who received outpatient services for mood and anxiety disorders. We classified providers into 9 categories: (1) family physicians/general practice, (2) internists, (3) nurse practitioners (NPs) and physician assistants (PAs), (4) psychiatrists, (5) psychologists, (6) clinical social workers, (7) emergency medicine physicians, (8) other physicians, and (9) other providers.

Targeted Medical School Admissions: A Strategic Process for Meeting Our Social Mission.

Background And Objectives: Increased medical school class sizes and new medical schools have not addressed the workforce inadequacies in primary care or underserved settings. While there is substantial evidence that student attributes predict practice specialty and location, little is known about how schools use these factors in admissions processes. We sought to describe admissions strategies to recruit students likely to practice in primary care or underserved settings.

Challenges and Best Practices for Implementing Rurally Targeted Admissions in U.S. Medical Schools.

Student attributes can predict future rural practice, but little is known about how medical schools use these factors in admissions. This mixed-methods study examined admissions strategies to recruit and select students likely to practice rurally. Admissions personnel at U.

Prescribing Practices of Nurse Practitioners and Physician Assistants Waivered to Prescribe Buprenorphine and the Barriers They Experience Prescribing Buprenorphine.

Background: In 2016, the Comprehensive Addiction Recovery Act permitted nurse practitioners (NPs) and physician assistants (PAs) to obtain a waiver to prescribe buprenorphine to treat opioid use disorder (OUD), with the goal of increasing access to this treatment. This study's purpose was to describe the buprenorphine prescribing practices of NPs and PAs and compare the barriers rural and urban providers face delivering treatment.

Methods: From the October 2018 Drug Enforcement Administration list of providers with the waiver to prescribe buprenorphine, all rural NPs and PAs (1,057) and a random sample of 500 urban NPs and PAs were surveyed.

Preparing Physicians for Rural Practice: Availability of Rural Training in Rural-Centric Residency Programs.

Background: Exposing residents to rural training encourages future rural practice, but unified accreditation of allopathic and osteopathic graduate medical education under one system by 2020 has uncertain implications for rural residency programs.

Objective: We describe training locations and rural-specific content of rural-centric residency programs (requiring at least 8 weeks of rurally located training) before this transition.

Methods: In 2015, we surveyed residency programs that were rurally located or had rural tracks in 7 specialties and classified training locations as rural or urban using Rural-Urban Commuting Area (RUCA) codes.

Investigating the Impact of Geographic Location on Colorectal Cancer Stage at Diagnosis: A National Study of the SEER Cancer Registry.

Background: Early detection of colorectal cancer (CRC) is associated with decreased mortality and potential avoidance of chemotherapy. CRC screening rates are lower in rural communities and patient outcomes are poorer. This study examines the extent to which United States' rural residents present at a more advanced stage of CRC compared to nonrural residents.

Moral Distress and Attitudes About Timing Related to Comfort Care for Hospitalized Patients: A Survey of Inpatient Providers and Nurses.

Context: Providing nonbeneficial care at the end of life and delays in initiating comfort care have been associated with provider and nurse moral distress.

Objective: Evaluate provider and nurse moral distress when using a comfort care order set and attitudes about timing of initiating comfort care for hospitalized patients.

Methods: Cross-sectional survey of providers (physicians, nurse practitioners, and physician assistants) and nurses at 2 large academic hospitals in 2015.

Frontline Workers' Career Pathways: A Detailed Look at Washington State's Medical Assistant Workforce.

Medical assistants (MAs) are a rapidly growing and increasingly important workforce. High MA turnover, however, is common and employers report applicants frequently do not meet their needs. We collected survey responses from a representative sample of 3,355 of Washington's MAs with certified status (MA-Cs) to understand their demographic, education, and employment backgrounds; job satisfaction; and career plans.

A Method to Study the Effect of a Physician Assistant Student on Preceptor Productivity.

Purpose: Guided clinical experience is a critical component of a physician assistant (PA) student's education. However, clinical precepting is strongly perceived to have deleterious effects on productivity. In this study, we sought to test a method for evaluating the effect that PA students have on clinical productivity.

Overcoming Barriers to Prescribing Buprenorphine for the Treatment of Opioid Use Disorder: Recommendations from Rural Physicians.

Purpose: The United States is in the midst of a severe opioid use disorder epidemic. Buprenorphine is an effective office-based treatment that can be prescribed by physicians, nurse practitioners, and physician assistants with a Drug Enforcement Administration (DEA) waiver. However, many providers report barriers that keep them from either getting a DEA waiver or fully using it.