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Santavicca S, Willis MH, Friedberg EB, Hughes DR, Duszak R. Osteopathic Versus Allopathic Radiologist Workforce Characteristics: A Medicare Administrative and Claims Data Analysis. J Am Coll Radiol 2022; 19:997-1005. [PMID: 35931137 DOI: 10.1016/j.jacr.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Radiologist medical school pathways have received little attention in recent workforce investigations. With osteopathic enrollment increasing, we assessed the osteopathic versus allopathic composition of the radiologist workforce. METHODS Linking separate Medicare Doctors and Clinicians Initiative databases and Physician and Other Supplier Files from 2014 through 2019, we assessed (descriptively and using multivariate panel logistic regression modeling) individual and practice characteristics of radiologists who self-reported medical degrees. RESULTS Between 2014 and 2019, as the number of osteopathic radiologists increased 46.0% (4.7% to 6.0% of total radiologist workforce), the number of allopathic radiologists increased 12.1% (representing a relative workforce decrease from 95.3% to 94.0%). For each year since completing training, practicing radiologists were 3.7% less likely to have osteopathic (versus allopathic) degrees (odds ratio [OR] = 0.96 per year, P < .01). Osteopathic radiologists were less likely to work in urban (versus rural) areas (OR = 0.95), and compared with the Midwest, less likely to work in the Northeast (OR = 0.96), South (OR = 0.95), and West (OR = 0.94) (all P < .01). Except for cardiothoracic imaging (OR = 0.78, P = .24), osteopathic radiologists were more likely than allopathic radiologists to practice as general (rather than subspecialty) radiologists (range OR = 0.37 for nuclear medicine to OR = 0.65 for neuroradiology, all P < .01). CONCLUSIONS Osteopathic physicians represent a fast-growing earlier-career component of the radiologist workforce. Compared with allopathic radiologists, they more frequently practice as generalist radiologists, in rural areas, and in the Midwest. Given recent calls for greater general and rural radiology coverage, increasing osteopathic representation in the national radiologist workforce could improve patient access.
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Affiliation(s)
- Stefan Santavicca
- Senior Data Analyst, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | - Marc H Willis
- Clinical Professor and Associate Chair of Quality Improvement, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Eric B Friedberg
- Associate Professor, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Danny R Hughes
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Professor, School of Economics, Director, Health Economics and Analytics Lab (HEAL), Georgia Institute of Technology, Atlanta, Georgia
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Professor, Vice Chair for Health Policy and Practice, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and Chair, Commission on Leadership and Practice Development, American College of Radiology
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Waslowski J, Paton M, Freymond M, Patel S, Brownrigg T, Olesovsky S, Nyhof-Young J. Evaluation of a pilot rural mentorship programme for and by pre-clerkship medical students. CANADIAN JOURNAL OF RURAL MEDICINE : THE OFFICIAL JOURNAL OF THE SOCIETY OF RURAL PHYSICIANS OF CANADA = JOURNAL CANADIEN DE LA MEDECINE RURALE : LE JOURNAL OFFICIEL DE LA SOCIETE DE MEDECINE RURALE DU CANADA 2021; 26:176-185. [PMID: 34643557 DOI: 10.4103/cjrm.cjrm_82_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction While medical school interventions can help address rural physician shortages, many urban Canadian medical students lack exposure to rural medicine. The Rural Mentorship Programme (RMP) is a 4-month pilot initiative designed by medical students to bridge this gap by pairing preclerkship medical students at an urban medical school with rural physician mentors to provide exposure to rural careers. Methods A realist-influenced methodology evaluated perceived benefits and challenges of RMP, assessed how RMP influenced mentee perceptions and intentions towards rural careers, and investigated factors leading to success. Quantitative and qualitative data were collected through evaluative pre-, post-, and 4-month post intervention surveys, mentor interviews and a mentee focus group. Likert scales assessed satisfaction, attainment of objectives and mentee changes in perceptions and intentions. Results 18/23 mentees and 11/15 mentors completed at least 1 survey; 5 mentees joined the focus group and 3 mentors were interviewed. Most mentees were of non-rural backgrounds and initially neutral about pursuing rural practice. RMP helped mentees better understand rural careers. They especially valued the mandatory community clinical visit and forming relationships with mentors. Mentors enjoyed teaching, reflecting on their careers and demonstrating the merits of rural practice. Transportation and scheduling were major programme challenges. Conclusions This pilot suggests that structured mentorship programmes can improve understanding of, and provide exposure to, careers in rural medicine for urban medical students. Results will inform future programme development.
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Affiliation(s)
- Jasmine Waslowski
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Morag Paton
- Department of Leadership, Higher and Adult Education, OISE, University of Toronto, Toronto, ON, Canada
| | - Mary Freymond
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Department of Emergency Medicine, Alberta Health Services and the Cumming School of Medicine, Calgary, AB, Canada
| | - Sagar Patel
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Tristan Brownrigg
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Department of Family Medicine, Queen's University School of Medicine, Kingston, ON, Canada
| | - Shelby Olesovsky
- MD Program, Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joyce Nyhof-Young
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto; Office of Education Scholarship, Department of Family & Community Medicine, Temerty Faculty of medicine, University of Toronto, Toronto, ON, Canada
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MacQueen IT, Maggard-Gibbons M, Capra G, Raaen L, Ulloa JG, Shekelle PG, Miake-Lye I, Beroes JM, Hempel S. Recruiting Rural Healthcare Providers Today: a Systematic Review of Training Program Success and Determinants of Geographic Choices. J Gen Intern Med 2018; 33:191-199. [PMID: 29181791 PMCID: PMC5789104 DOI: 10.1007/s11606-017-4210-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/22/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rural areas have historically struggled with shortages of healthcare providers; however, advanced communication technologies have transformed rural healthcare, and practice in underserved areas has been recognized as a policy priority. This systematic review aims to assess reasons for current providers' geographic choices and the success of training programs aimed at increasing rural provider recruitment. METHODS This systematic review (PROSPERO: CRD42015025403) searched seven databases for published and gray literature on the current cohort of US rural healthcare practitioners (2005 to March 2017). Two reviewers independently screened citations for inclusion; one reviewer extracted data and assessed risk of bias, with a senior systematic reviewer checking the data; quality of evidence was assessed using the GRADE approach. RESULTS Of 7276 screened citations, we identified 31 studies exploring reasons for geographic choices and 24 studies documenting the impact of training programs. Growing up in a rural community is a key determinant and is consistently associated with choosing rural practice. Most existing studies assess physicians, and only a few are based on multivariate analyses that take competing and potentially correlated predictors into account. The success rate of placing providers-in-training in rural practice after graduation, on average, is 44% (range 20-84%; N = 31 programs). We did not identify program characteristics that are consistently associated with program success. Data are primarily based on rural tracks for medical residents. DISCUSSION The review provides insight into the relative importance of demographic characteristics and motivational factors in determining which providers should be targeted to maximize return on recruitment efforts. Existing programs exposing students to rural practice during their training are promising but require further refining. Public policy must include a specific focus on the trajectory of the healthcare workforce and must consider alternative models of healthcare delivery that promote a more diverse, interdisciplinary combination of providers.
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Affiliation(s)
- Ian T MacQueen
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Veterans Affairs/Robert Wood Johnson Clinical Scholars Program, UCLA, Los Angeles, CA, USA
| | - Gina Capra
- National Association of Community Health Centers, Bethesda, MD, USA
| | - Laura Raaen
- Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, 90407, USA
| | - Jesus G Ulloa
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Veterans Affairs/Robert Wood Johnson Clinical Scholars Program, UCLA, Los Angeles, CA, USA
- Department of Surgery, UCSF Medical School, San Francisco, CA, USA
| | - Paul G Shekelle
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, 90407, USA
| | - Isomi Miake-Lye
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jessica M Beroes
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Susanne Hempel
- Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, 90407, USA.
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
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