Colorado Family Physicians and Medical Marijuana: Has Recreational Marijuana Changed Physician Attitudes and Behaviors?

INTRODUCTION: Medical marijuana is permitted in 36 states; 15 states allow recreational marijuana use. Previous surveys showed that family physicians were concerned about the physical and mental health effects of medical marijuana use, but the impact of recreational marijuana legalization and liberalization of marijuana laws on physician attitudes is unknown. METHODS: A survey was distributed to 1582 members of the Colorado Academy of Family Physicians' listserv, with items on individual and practice characteristics and experience with and attitudes toward medical marijuana. The results of this survey were compared with that of a nearly identical survey conducted with the same group in 2011. RESULTS: The proportion of family physician respondents in Colorado recommending medical marijuana to patients was the same in 2020 as in 2011 at 31%; 53% of physicians said that legislation allowing recreational marijuana did not change their approach to medical marijuana with patients. Family physicians were more likely to be in favor of legalization of recreational marijuana in 2020 than in 2011. CONCLUSIONS: Marijuana decriminalization and a robust marijuana economy in Colorado have not led to more family physicians recommending marijuana to patients, but there is now greater support for the legalization of recreational marijuana among family physicians.

Competencies to Guide a Leadership Curriculum for Family Medicine Chief Residents.

BACKGROUND AND OBJECTIVES: Chief resident leadership competencies are neither clear nor standardized. The goal of this project was to identify specific leadership skills for chief residents and to develop a self-assessment tool. METHODS: Chief residents from 10 family medicine residencies participated in focus groups to identify leadership skills required to be an effective chief resident. The ideas generated by participants were grouped into 10 competencies and a self-assessment tool was developed. The tool has been used to help chief residents self-assess their leadership strengths and weaknesses, and to identify teaching priorities for biannual leadership workshops. RESULTS: The self-assessment instrument was completed by 83 chief residents over 5 years. Mean ratings range from 3.19 to 3.57 on a 5-point scale (low to high competency). The self-ratings of residents starting their chief year compared to residents at the end of their chief year showed an increase in 9 of the 10 competencies. CONCLUSIONS: The leadership competencies are a useful tool to identify training priorities and to help chief residents or other leaders within a residency program identify skills for further development.

Lack of Communication about Medical Marijuana Use between Doctors and Their Patients.

INTRODUCTION: Medical marijuana is now permitted in most states, but it is not clear whether primary care physicians (PCPs) are aware of or recommend its use in their patients. METHODS: We distributed paired surveys to PCPs and their patients to assess the frequency of patient marijuana use and communication with PCPs about use. RESULTS: Of 242 patients surveyed, 22% reported marijuana use in the past 6 months, and 61% of these identified as medical marijuana users. PCPs did not complete state forms to recommend medical marijuana for any of the surveyed medical marijuana users. PCPs were aware of marijuana use in their patients only 53% of the time. PCPs identified conditions they believed could be adversely affected by marijuana use in 31% of users. CONCLUSION: There is poor communication between patients and PCPs about medical marijuana use, which is being sanctioned by physicians other than patients' PCPs. We suggest more frequent assessment of and discussion about marijuana use in patients, particularly in states that have approved medical marijuana.

Assessment of Factors for Recruiting and Retaining Medical Students to Rural Communities Using the Community Apgar Questionnaire.

BACKGROUND: Rural communities throughout the United States are eager to recruit and retain family physicians. This study examined factors that may contribute to a medical student's decision to consider rural family medicine practice using the Community Apgar Questionnaire (CAQ). METHODS: Third- and fourth-year medical students from 10 medical schools responded to a survey of 62 identified factors deemed to be present when assessing the strengths and challenges of recruiting family physicians to rural communities. Participants could also respond to six demographic questions. Factors were ranked based on importance to respondents and were compared using demographic information. RESULTS: A total of 282 MS-3 and MS-4 students interested in family medicine from 10 US medical schools completed the survey (response rate 19.5%). Forty percent of participants anticipate practicing in a rural setting, followed by 31% for suburban and 29% for urban. The top three factors participants considered when anticipating a rural practice setting were spousal satisfaction, call frequency, and competition/collegiality. Additional differences were found across CAQ factors by future practice setting, gender, and location where the student was raised. CONCLUSIONS: Medical schools, rural preceptors, and rural communities may wish to consider highly rated factors found in the CAQ in the effort to increase the recruitment of family physicians interested in rural practice.

Poliovirus immunity in newly resettled adult refugees in Idaho, United States of America.

BACKGROUND: In the United States, vaccines have eliminated wild poliovirus (WPV) infection, though resettling refugees may lack immunity and importation of WPV remains a concern. METHODS: A cross-sectional survey was performed to determine the prevalence of poliovirus immunity in adult refugees resettling in Boise, Idaho, U.S.A.; immunity was evaluated using two definitions: serotypes 1, 2 and 3 positive, or serotypes 1 and 3 positive. RESULTS: This survey evaluated 795 adult refugees between August 2010 and November 2012. Poliovirus immunity in adults >18 years was 55.3% for serotypes 1, 2 and 3 combined, and 60% for serotypes 1 and 3 only. CONCLUSION: This study demonstrated a WPV immunity rate of <60% in a recently resettled adult refugee population in the United States, reinforcing the need to ensure poliovirus immunity in all newly arrived adult refugees, either by expanding pre-departure immunization or by screening for immunity at resettlement and vaccinating when indicated.

Association of "grit" and satisfaction in rural and nonrural doctors.

BACKGROUND: One potential psychological construct, grit, may help to explain the non-cognitive traits that account for both rural physician satisfaction and retention. We investigated (1) the psychological construct grit among rural and non-rural primary care/specialty care physicians, (2) satisfaction levels and (3), the relationship between the psychological construct grit and satisfaction across combinations of rural/non-rural and primary care/specialty care physicians. METHODS: We mailed a cross-sectional questionnaire to 2126 active members of the Idaho Medical Association and Idaho Academy of Family Physicians measuring their self-reported level of grit, satisfaction level and area of specialty. RESULTS: We received responses from 564 physicians (26.5%). Idaho physicians have relatively uniform levels of grit independent of specialty or practice location. Specialty care physicians reported significantly higher levels of ambition, regardless of practice location. Most physicians were satisfied with their practice (91.7%). Specialty care physicians reported a significantly higher difference in their levels of satisfaction with their practice compared to primary care physicians. CONCLUSIONS: Idaho primary care and specialty care physicians in both rural and non-rural settings reports themselves as individuals who work hard, persevere despite setbacks, and are ambitious. Furthermore, Idaho physicians are satisfied with their current practices.