To What Extent Are Programs Recruiting Their Own Graduates as Faculty? A CERA Study.

BACKGROUND AND OBJECTIVES: Most family medicine (FM) residency programs continuously recruit faculty, though little is known about their recruitment practices. In this study, we sought to define to what extent FM residency programs are relying on recruitment of program graduates, regional programs, or programs outside their region for filling faculty roles and to compare these data across program characteristics. METHODS: As part of a large 2022 omnibus survey of FM residency program directors, we asked specific questions regarding the percentage of FM faculty who were graduates of that program, a program in the region, or a distant program. We aimed to determine to what extent respondents attempted to recruit their own residents to faculty positions and to identify additional program offerings and characteristics. RESULTS: The response rate was 41.4% (298/719). Programs reported hiring more of their own graduates compared to regional or distant graduates, and 40% prioritized recruiting their own graduates for open positions. Those who prioritized recruiting their own graduates were significantly more likely to have a higher percentage of their graduates on faculty as were larger, older, more urban programs and those offering clinical fellowships. The existence of a faculty development fellowship was significantly associated with having more faculty from regional programs. CONCLUSIONS: Programs that aim to improve faculty recruitment from their own graduates should consider prioritizing internal recruitment. They also may consider the development of both clinical and faculty development fellowships for local and regional hires.

New Opportunities for Expanding Rural Graduate Medical Education to Improve Rural Health Outcomes: Implications of the Consolidated Appropriations Act of 2021.

Evidence shows that those living in rural communities experience consistently worse health outcomes than their urban and suburban counterparts. One proven strategy to address this disparity is to increase the physician supply in rural areas through graduate medical education (GME) training. However, rural hospitals have faced challenges developing training programs in these underserved areas, largely due to inadequate federal funding for rural GME. The Consolidated Appropriations Act of 2021 (CAA) contains multiple provisions that seek to address disparities in Medicare funding for rural GME, including funding for an increase in rural GME positions or "slots" (Section 126), expansion of rural training opportunities (Section 127), and relief for hospitals that have very low resident payments and/or caps (Section 131). In this Invited Commentary, the authors describe historical factors that have impeded the growth of training programs in rural areas, summarize the implications of each CAA provision for rural GME, and provide guidance for institutions seeking to avail themselves of the opportunities presented by the CAA. These policy changes create new opportunities for rural hospitals and partnering urban medical centers to bolster rural GME training, and consequently the physician workforce in underserved communities.

Rural Graduate Medical Education: Choosing the Road "Less Traveled By".

Despite active efforts to improve access to health care for people who live in rural communities, the need for developing a physician workforce that is committed to rural practice, and with the professional and personal skills that will best fit with the needs of the rural community, is only increasing over time. Supporting and solidifying the rural graduate medical education landscape must be a crucial piece of any plan to address gaps in rural health care. Embracing creative solutions that address the most important barriers to this development has high potential for meeting the health care needs of rural communities, with emphasis on the rural community stakeholders assuming the central role in planning efforts. In particular, essential innovations include developing a culture of learning in rural settings using concepts of a teaching health neighborhood and advancing interprofessional models of care; incorporating concepts of "place-based training" with focus on relational connectedness; enhancing a spectrum of potential partnerships, including rural and urban regional entities, the Health Resources and Services Administration, and other federal agencies (e.g., the Indian Health Service and Veterans Health Administration among others) to support the ability of rural health entities to embrace medical education; and advocating for federal and state funding initiatives to ensure the sustainability of training programs in rural communities. Although not sufficient to guarantee improved access to health care and better health outcomes among rural communities, robust collaborations to develop interprofessional training and enhancement of the entire pipeline of health professions training and practice holds significant promise for improving the health of rural populations.

Collaborating to Achieve the Optimal Family Medicine Workforce.

When the Family Medicine for America's Health (FMAHealth) Workforce Education and Development Tactic Team (WEDTT) began its work in December 2014, one of its charges from the FMAHealth Board was to increase family physician production to achieve the diverse primary care workforce the United States needs. The WEDTT created a multilevel interfunctional team to work on this priority initiative that included a focus on student, resident, and early-career physician involvement and leadership development. One major outcome was the adoption of a shared aim, known as 25 x 2030. Through a collaboration of the WEDTT and the eight leading family medicine sponsoring organizations, the 25 x 2030 aim is to increase the percentage of US allopathic and osteopathic medical students choosing family medicine from 12% to 25% by the year 2030. The WEDTT developed a package of change ideas based on its theory of what will drive the achievement of 25 x 2030, which led to specific projects completed by the WEDTT and key collaborators. The WEDTT offered recommendations for the future based on its 3-year effort, including policy efforts to improve the social accountability of US medical schools, strategy centered around younger generations' desires rather than past experiences, active involvement by students and residents, engagement of early-career physicians as role models, focus on simultaneously building and diversifying the family medicine workforce, and security of the scope future family physicians want to practice. The 25 x 2030 initiative, carried forward by the family medicine organizations, will use collective impact to adopt a truly collaborative approach toward achieving this much needed goal for family medicine.

The Cost of Family Medicine Residency Training: Impacts of Federal and State Funding.

BACKGROUND AND OBJECTIVES: Numerous organizations are calling for the expansion of graduate medical education (GME) positions nationally. Developing new residency programs and expanding existing programs can only happen if financial resources are available to pay for the expenses of training beyond what can be generated in direct clinical income by the residents and faculty in the program. The goal of this study was to evaluate trended data regarding the finances of family medicine residency programs to identify what financial resources are needed to sustain graduate medical education programs. METHODS: A group of family medicine residency programs have shared their financial data since 2002 through a biennial survey of program revenues, expenses, and staffing. Data sets over 12 years were collected and analyzed, and results compared to analyze trends. RESULTS: Overall expenses increased 70.4% during this period. Centers for Medicare and Medicaid Services (CMS) GME revenue per resident increased by 15.7% for those programs receiving these monies. Overall, total revenue per resident, including clinical revenues, state funding, and any other revenue stream, increased 44.5% from 2006 to 2016. The median cost per resident among these programs, excluding federal GME funds, is currently $179,353; this amount has increased over the 12 years by 93.7%. CONCLUSIONS: For this study group of family medicine programs, data suggests a cost per resident per year, excluding federal and state GME funding streams, of about $180,000. This excess expense compared to revenue must be met by other agencies, whether from CMS, the Health Resources and Services Administration (HRSA), state expenditures or other sources, through stable long-term commitments to these funding mechanisms to ensure program viability for these essential family medicine programs in the future.

Collaboration Between ACGME and AOA Programs to Enhance Success in the Single Accreditation System: A Process Paper.

Beginning in 2020, all residency programs will be accredited by the Accreditation Council for Graduate Medical Education (ACGME). Programs accredited by the American Osteopathic Association (AOA) that do not achieve ACGME pre-accreditation status by 2020 will be forced to close, resulting in loss of graduate medical education slots and affecting the physician workforce locally and nationally. Current ACGME programs are in a position to help consult, support, and learn from local AOA-only programs as they work toward meeting ACGME accreditation requirements, but to date there have been only limited collaborations. A regional network of ACGME- and dually accredited family medicine residency programs ("the Network") and family medicine programs solely accredited by the AOA recognized the imperative to support the AOA-only programs with their accreditation transitions to preserve their primary care residency positions. This article describes the inputs, activities, outputs, and outcomes of these collaborative efforts to establish communications and strategies using a logic model program "road map" format. Initial efforts included a collaborative conference and ongoing consultations and workshops. This model can be replicated for program collaborations in other locations.

A patient centered care plan in the EHR: improving collaboration and engagement.

Patients attempting to manage their chronic conditions require ongoing support in changing and adopting self-management behaviors. However, patient values, health goals, and action plans are not well represented in the electronic health record (EHR) impeding the ability of the team (MA and providers) to provide respectful, ongoing self-management support. We evaluated whether a team approach to using an EHR based patient centered care plan (PCCP) improved collaborative self-management planning. An experimental, prospective cohort study was conducted in a family medicine residency clinic. The experimental group included 7 physicians and a medical assistant who received 2 hr of PCCP training. The control group consisted of 7 physicians and a medical assistant. EHR charts were analyzed for evidence of 8 behavior change elements. Follow-up interviews with experimental group patients and physicians and the medical assistant assessed their experiences. We found that PCCP charts had more documented behavior change elements than control charts in all 8 domains (p < .001). Experimental group physicians valued the PCCP model and suggested ways to improve its use. Patient feedback demonstrated support for the model. A PCCP can help team members to engage patients with chronic illnesses in goal setting and action planning to support self-management. An EHR design that stores patient values, health goals, and action plans may strengthen continuity and quality of care between patients and primary care team members. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Ten-year trends in family medicine residency productivity and staffing: impact of electronic health records, resident duty hours, and the medical home.

BACKGROUND AND OBJECTIVES: Electronic health records (EHRs), resident duty hour restrictions, and Patient-centered Medical Home (PCMH) innovations have all impacted the clinical practices of residency programs over the past decade. The University of Washington Family Medicine Network (UWFMN) residencies have collaborated for 10 years in collecting and comparing data regarding the productivity and operations of their training programs to identify the program-level effects of such changes. Based on five survey results from 2000 to 2010, this study examines changes in faculty and resident productivity and staffing models of UWFMN residency training clinics using a standardized methodology, specifically describing the productivity impact of EHR changes and duty hour restrictions and the implementation of the PCMH by residencies. METHODS: Data were systematically collected via standardized questionnaire, evaluated for quality, clarified, and then analyzed. RESULTS: Resident productivity decreased over the 10-year interval, with resident total yearly patient visits down 17.2%. Core family medicine faculty productivity was highly variable among programs, and nonphysician provider visits increased. Faculty part-time status increased. Front office, medical assistant, and nursing staffing grew significantly, but other administrative staff decreased, resulting in minimal change in total non-provider staffing. A majority of programs engaged in PCMH initiatives in 2010 and had implemented an EHR. CONCLUSIONS: Physician productivity in UWFMN residency programs decreased for all resident physicians from 2000 to 2010, likely due to a combination of decreased resident duty hours and other clinical practice changes. Productivity trends have implications for the structure and training requirements for family medicine residency programs.

Ten-year trends in the financing of family medicine training programs: considerations for planning and policy.

BACKGROUND AND OBJECTIVES: The recent Affordable Care Act (ACA) includes physician training provisions to address the US primary care workforce shortage and maldistribution. Policymakers require current graduate medical education (GME) residency finance data to design and implement programs that increase primary care physicians. The University of Washington Family Medicine Network residencies have collaborated for 10 years in collecting and comparing data regarding the revenues and expenses of their training programs. Based on biennial survey results from 2000 to 2010, this study examines changes in the finances of residency training over a decade using a standardized methodology. METHODS: Data were systematically collected by standardized questionnaire, evaluated for quality and verified, and then analyzed. RESULTS: The per-resident expense of residency education for these programs increased an average of 63%, and overall residency revenues increased 75%. GME funding per resident increased 47% but decreased as proportionate contribution to overall program revenue. CONCLUSIONS: The mean cost per resident remained relatively stable over the 10-year period, with a 3.1% overall increase to $27,260 per resident per year. Programs that successfully obtained federally qualified health center (FQHC) status, increased their residency graduate medical education (GME) slots or received other new significant funding, such as state grants, were the most financially stable. Policy solutions would stabilize both federal GME and state Medicaid GME funding and increase reimbursement of primary care practice to maintain the viability of primary care training programs. Conclusions: The mean cost per resident remained relatively stable over the 10-year period, with a 3.1% overall increase to $27,260 per resident per year. Programs that successfully obtained federally qualified health center (FQHC) status, increased their residency graduate medical education (GME) slots or received other new significant funding, such as state grants, were the most financially stable. Policy solutions would stabilize both federal GME and state Medicaid GME funding and increase reimbursement of primary care practice to maintain the viability of primary care training programs.

Three-year trends in the costs of residency training in family medicine.

BACKGROUND AND OBJECTIVES: A 3-year follow-up survey was performed to update and examine trends in the financial and operational benchmarking data for family medicine residency programs within the University of Washington Network. METHODS: Using the standardized approach that had been used in 2000, data were systematically collected by standardized questionnaire, evaluated for quality and verified, and then analyzed. Updated data regarding revenues, expenses, faculty structures, productivity, and family medicine center staffing models are reported, as well as data on trends in each of these areas for the 3-year period. RESULTS: Although revenues increased during this time, expenses increased relatively more, leading to an overall increase in the "cost per resident" among the Network programs. Particular factors leading to increased costs were salary expenses and the cost of malpractice insurance in these states. CONCLUSIONS: The results of this study contribute to the establishment of normative data for budgeting and operational evaluation of family medicine programs and projections of cost variations over time.

Benchmarking the costs of residency training in family practice.

Financial and operational benchmarking data for family practice residency programs within the University of Washington Network were established for the year 2000. Data were systematically collected by standardized questionnaire, evaluated for quality and verified, and then analyzed. Revenues, expenses, faculty structures, productivity, and family practice center staffing models are reported, using program averages and ranges or standard deviations for individual data elements. Variations and data problems included data line definitions, difficulties obtaining data from sponsoring institutions, indirect program costs, and widely differing program structures. Limited conclusions can be made regarding "best practices," but the results contribute to the establishment of normative data for budgeting and operational evaluation of family practice programs.