James G Boulger

Efforts to graduate more primary care physicians and physicians who will practice in rural areas: Examining outcomes from the university of Minnesota-Duluth and the rural physician associate program

Purpose To compare practice choices (primary care or specialty) and practice locations (rural or metropolitan) of medical students at the Duluth and Twin Cities (Minneapolis and St. Paul; TC) campuses of the University of Minnesota (UMN). In the early 1970s, Minnesota created two medical education programs at UMN to increase the number of rural and primary care physicians: the first two years of medical school at UMN–Duluth, where the program focuses on recruiting students who will be rural family physicians, and the Rural Physician Associate Program (RPAP) elective, a nine-month, longitudinal immersion experience with a preceptor in a rural community. Method In 2008, the authors analyzed outcomes for four student groups: (1) UMN–Duluth and (2) UMN–TC medical students who participated in RPAP and (3) UMN–Duluth and (4) UMN–TC students who did not participate in RPAP. UMN medical students complete their first two years on either campus; they can apply to RPAP for their third year. Non-RPAP students spend most of their third- and fourth-year rotations in the Twin Cities metropolitan area. Results The UMN–Duluth and RPAP students were most likely to select a rural location and primary care practice. UMN–TC, non-RPAP students followed national trends, choosing predominantly metropolitan and specialty practices. Conclusions RPAP and UMN–Duluth provide significant, complementary educational programs that lead more graduates to choose rural and primary care practices. Efforts across the nation to address the crisis in rural primary care should build on these successful efforts.

Medical school rural programs: A comparison with international medical graduates in addressing state-level rural family physician and primary care supply

Purpose Comprehensive medical school rural programs (RPs) have made demonstrable contributions to the rural physician workforce, but their relative impact is uncertain. This study compares rural primary care practice outcomes for RP graduates within relevant states with those of international medical graduates (IMGs), also seen as ameliorating rural physician shortages. Method Using data from the 2010 American Medical Association Physician Masterfile, the authors identified all 1,757 graduates from three RPs (Jefferson Medical Colleges Physician Shortage Area Program; University of Minnesota Medical School Duluth; University of Illinois College of Medicine at Rockfords Rural Medical Education Program) practicing in their respective states, and all 6,474 IMGs practicing in the same states and graduating the same years. The relative likelihoods of RP graduates versus IMGs practicing rural family medicine and rural primary care were compared. Results RP graduates were 10 times more likely to practice rural family medicine than IMGs (relative risk [RR] = 10.0, confidence interval [CI] 8.7–11.6, P < .001) and almost 4 times as likely to practice any rural primary care specialty (RR 3.8, CI 3.5–4.2, P < .001). Overall, RPs produced more rural family physicians than the IMG cohort (376 versus 254). Conclusions Despite their relatively small size, RPs had a significant impact on rural family physician and primary care supply compared with the much larger cohort of IMGs. Wider adoption of the RP model would substantially increase access to care in rural areas compared with increasing reliance on IMGs or unfocused expansion of traditional medical schools.

A look by medical students at medical practice in the future

Ninety-six first- and second-year students (97 percent) at the University of Minnesota, Duluth, School of Medicine responded to a questionnaire on their career choices and their perceptions of changes in the organization and financing of medical care. Their responses indicated a great deal of student concern regarding the future of medical practice. Overall, the students were the most concerned about a perceived loss of practice autonomy and inadequate financial rewards. In the face of these perceptions, the students reported changes in career preferences: from smaller to larger communities, from solo or partnership arrangements to group practice settings, and from generalist to specialist practices. A students anticipated debt level was the most important predictor of whether the student changed career goals.

The integration of a telemental health service into rural primary medical care.

Mental health care shortages in rural areas have resulted in the majority of services being offered through primary medical care settings. The authors argue that a paradigm shift must occur so that those in need of mental health care have reasonable, timely access to these services. Changes proposed include integrating mental health services into primary medical care settings, moving away from the traditional view of mental health care services (one therapist, one hour, and one client), and increasing the consultative role of psychologists and other mental health care providers in primary medical care. Characteristics of mental health providers that facilitate effective integration into primary medical care are presented. The results of a needs assessment survey and an example of a telemental health project are described. This project involved brief consultations with patients and their physicians from a shared care model using a broadband internet telecommunications link between a rural clinic and mental health service providers in an urban area.

The practicing physician as curriculum designer: Views of behavioral science

Abstract The results of a study of the attitudes toward teaching behavioral science of practicing physicians in obstetrics and gynecology are presented. The endorsement rates for including material in both medical school and residency programs were quite high. Comparisons with other specialty groups and implications for medical training programs are discussed. It is hoped that the results of studies such as this will help in revising training curricula.